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1,000,000 people in North America are living with HIV/AIDS - many are????

Unaware of their status

10% of those living with aids in the US are ages?

50 and over

40,000 people are diagnosed with......?

HIV/ AIDS every year in the US

What countries are effected at much higher rates?


Remains a disease of?

Marginalized individuals (those who are disenfranchised by virtue of gender, race, sexual orientation, poverty, drug use, or lack of access to health care)

AIDS has killed....... people throughout the world and ..........are infected

>20 million/>60 million

Who are being infected at increasing rates?

Women and Children

Someone in the US is being infected with HIV every?

9 1/2 minutes

It's projected that the number of deaths caused by AIDS in the next 10 years will?

Be greater that the combines fatalities in all wars of the 20th century

HIV is a fragile virus that can only be transmitted under specific conditions that allow contact with infected body fluids, including???

Blood, Semen, Vaginal fluids, Brest Milk

Infection occur after an exposure depends on ?

1. Duration and frequency of contact, 2. Volume of fluid in exposure, 3. Virulence (The ability of any agent of infection to produce diseas) and the concentration of the organism, 4. Host immune defense capability.

Once the person is infected, they have a LIFELONG ability to?

Transmit HIV to others (Few days post infection to death: HIV infected individuals can transmit HIV to others)

When is it most infections?

When large amounts of HIV virus are in the blood

When are the large amounts in the blood?

2-6 days (most initial infection), and During late stages of the disease...........VIRAL LOAD IS HIGH DURING THESE TIMES


Look at Viral Load in the blood and CD4+. There is a diagram thing.

HIV cannot be spread through?

Tears, Saliva, Urine, emesis, sputum, feces, sweat, hugging, DRY KISSING, shaking hands, sharing eating utensils, attending school, working with HIV infected people, insects or formites(non-living material - necktie, stethoscope)


Dont Share!

What is Viral load?

The number of HIV particles in the blood

HIV is a ?

Human immunodeficiency virus

What is Aids?

Acquired immunodeficiency syndrome - END STAGE OF CHRONIC HIV infection.

HIV sexual transmission?

Must be positive for HIV to infect another

Why is unprotected anal sex the most risky?

Its more traumatic to the tissues and likelihood of bleeding (ouch!)

Risk is greater for the?

Receptive partner (prolonged contact with infected material - anal, vaginal, or oral sex)

Presence of blood increases the risk? When?

during menstruation, trauma to the tissues, genital lesions present from STD's


Men who have sex with men

Sharing in?

Injection equipment (street drugs and prescribed meds)

Get HIV from blood transfusions?


Puncture wounds?

Greatest risk for occupational transmission of HIV



Risk of HIV infection after a?

Needle Stick. (exposure is higher with high viral load, puncture wound is deep, needle is hallow bore with visible blood, venous or arterial access with the device, or if the PT dies within 60 days.

Perinatal Transmission possible when?

During preggo, during delivery, or during breast feeding

25% of infants born to untreated HIV- infected women will be born with


U.S children with AIDS under 13:

90% were infected at birth (others through blood products and abuse)

What has significantly reduced transmission?

Zidovudine Therapy

What are potential influences on HIV transmission in infants?

Limit time membranes rupture before birth, mode of birth, duration of labor, exposure to cervical and vaginal secretions

Medication use?

ART prohylaxis AZT(zidovudine) to pregnant woman ...?....weeks of pregnancy until labor

New born will receive?

Oral AZT for 6 weeks after birth

Occupational Exposure?

What is recommended practice after an exposure? Mercy Policy, Iowa City for Questions, Contact Employee Health to determine risk and where to go from there. Concerns exist also about Hepatitis B and Hepatitis C exposure as well

Factors that increase risk for HIV transmission (lecture)

Prev hx of a child with HIV infection, AIDS, Preterm Birth, Low maternal CD4 count, 1st born twin, elevated maternal viral load, intrapartum blood exposure, Chorioamnionitis, failure to tx mom and fetus with AZT during prenatal period

HIV is a retrovirus discovered in 1983 (obligate parasite) it......???

must be in a living cell to replicate

HIV replicates in a backward manner - from.....?


HIV carries its genetic formation in?

RNA (ribonucleic acid; found in nucleus and cytoplasm of cells. Transmit genetic instructions from nucleus to cytoplasm)

HIV infects cells which have?

CD4+ (primarily lymphocytes, monocytes/macrophages)

These CD4+ cells include.................primarily

T Cells

So how does the HIV virus invade cells?

This is important to understand because of pharmacologic interventions!!!

HIV enters the cells after?

Binding to cell surface, then genetic material enters the cell, then Viral RNA is transcribed into Viral DNA through the assistance of TRANSCRIPTASE which is made why HIV?


Assist transcription of Viral RNA to Viral DNA

HIV more specifically enters the cell when?

The gp 120 "knobs" on the virus binds of fit to specific CD4+ and chemokine receptor sites on the surface of the CD4+ T Cells (FUSION)-or knobs on

This is usually a lymphocyte

(a leukocyte or white blood cell that develops in the bone marrow - 2 forms are T-cell and B-cell)

Once bound, the......?

HIV genetic material enters the CD4+ cell (oh no!)

HIV Cell

Look for a picture; find GP120, p24, Viral Dna, and Reverse trascriptase enzyme

HIV then sheds its protein coat and converts?

RNA to DNA with the assistance of REVERSE TRANSCRIPTASE (an enzyme that is made by HIV)

The Viral DNA can now enter the poor CD4+ cell's nucleus and?

With the use of INTEGRASE it becomes a permanent part of the CD4+ cell's genetic structure

What are the consequences of this action?

There are two!

First consequences

Since all genetic material is replicated during cellular division, all daughter cells from the infected cells will also be infected

Second consequences

Because the genome (gene in the chromosome of each cell) now has a viral DNA, the cell's genetic codes CAN DIRECT CELL TO MAKE NEW HIV - small virus --> can mutate!

Production of HIV within the cell is a complicated and involved process that......?

Results in long strands of HIV RNA that must be CUT INTO appropriate lenghts

What enzyme helps cleaving or splitting these genetic strands?

Protease (one of the 1st drugs came out, worked on this enzyme)

All steps are required to?

Produce new virions (virus particle)

Initial infection results in?

VIREMIA (large amounts of virus in the blood) or high viral load, very infectious time)

This is followed by a prolonged period during which?

HIV levels in the blood remains low even without treatment (happens after a few weeks and may last for 10-12 years) and few clinical symptoms are present. HIV REPLICATION IS STILL CONTINUING THOUGH! Still continuing w/o symptoms

Look for Timeline for the spectrum of untreated HIV infection

LEWIS Page 250

But even without symptoms, HIV replication continues at a?

Rapid Constant rate in blood and lymph tissues early in the infection

Thus, there is a steady state of?

VIRAL LOAD (the number of copies of HIV detectable in a blood sample) that is achieved and maintained in the body of those infected for years!

In order for the body to maintain this...the body makes?

1,000,000,000 to 10,000,000,000 new viruses A DAY! Wow!

Rapid replication can cause problems....

During the copying process

This can lead to?

Mutations - contributing to DIFFICULTIES in tx and vaccine development

What is HIV1?

Immune suppression and AIDS milder

What is HIV2?

West, West Africa (?)



Acute illness develops?

Shortly after the virus is contracted - as the rapid rise in viral levels are present

Antibodies are formed and remain present?

Through course if infection

Late in the disease?

Viral activation and an increase in the virus circulating.

CD4+ (T cells) decrease as they?

Destroyed with viral replication

Antibody levels?

Decrease as immune function is impaired.

Although HIV may remain inactive in infected cells for years, antibodies are?

Produced to its proteins - a process knows as SEROCONVERSION (detectable in blood or cells)

When are Seroconversion detectable?

6 weeks to 6 months after the initial infection

There antibodies have?

Little effect on the virus.


Look at Viral Load in the blood and CD4+ diagram again.

What are the 2 major classes of lymphocytes?

B & T Cells

In the normal immune response, foreign antigens interact with B cells, which start the process of?

Antibody Development

Antigens also interact with T cells which initiate?

A cellular immune response

So, in initial stages of HIV infection....?

B and T cells function NORMALLY.

B cells

Make HIV specific antibodies that are effective in reducing blood viral loads

T cells

respond to the site when viruses are trapped in the lymph vessels

REMEMBER which cells the HIV(virus) infects and destroys?

T cells


Lymph nodes swollen


primarily destroys CD4+ T cells (these are also known as T helper Cells or CD4+ lymphocytes)

Why the destroy that?

Because T cells have more CD4+ RECEPTOR on their surface than other CD4+ cells, SO HIV PREFERS THESE!

Adults have?

800-1200 CD4+ T cells per microliter (uL) of blood

Normal life span of CD4+ cell is?

100 days

But in HIV CD4+ cells die after?

2 days

Viral activity destroys?

1 billion CD4+ cells everyday!

Fortunately, bone marrow and thymus produce enough CD4+ cells to last for?


But eventually?

The ability if HIV to destroy T cells (CD4+ cells) exceed the body's ability to replace cells

Decease in the T cell count equals

Decrease in the immune capability of the body

Immune system remains healthy?

500 T cells/uL

Immune problems start?

200-499 T cells/uL

Severe problems develop?

<200 T cells/uL

Severe immune suppression leads to?

Development of infections and cancers that cause mortality and morbidity

HIV destroys CD4+ cell in?

3 ways


Viral replication with the process of BUDDING


Infected cells fuse with other cells and can combine into a mass (syncytium) that destroys all cell involved


Initiation of destruction through the infected persons immune system and the antibodies that decrease immunity BIND AND DESTROY INFECTED CELL

Budding Process

LEWIS Page 252

2. HIV spreads throughout the body

Lymphoid tissue becomes an early reservoir for HIV/ HIV causes significant degenerative change in the lymph system/ Allows the viral particles to spill over into the blood --> leads to DECREASED IN IMMUNITY

3. HIV Spreads throughout the body

infects the monocytes/ infected monocytes move into tissues and become macrophages (phagocytic cells)/ These cells become "HIV factories" and can rupture, spreading newly formed HIV into the surrounding tissue: SKIN, CNS, LYMPH NODES, BONE MARROW, and LUNG.



Stages of HIV Infection Acute Infection

Symptoms usually occur 1-3 weeks after an initial infection and last 1-2 weeks but can persist for months./ CD4+ T cell counts temporarily fall (that dip the chart) but quickly RETURN TO BASELINE/ Most symptoms are mild - may may mistaken for a COLD or FLU/ In a few people, neurologic complications may develop(meningitis, peripheral neuropathy, facial palsy, Guillain-Barre syndrome

Stages of HIV infection Acute Infection

Seroconverting (development of HIV specific antibodies) - fever, rash, sore throat, HA, joint pain, malaise, muscle pain, Nausea, Diarrhea, and Swollen Lymph nodes.

Early Chronic Infection?

HIV infection to the diagnosis of AIDS

Medial interval of the process is?

11 years

CD4+ T lymphocyte count remain above?

500 cell/uL (normal or drop slightly)

Viral load is?

Low (during early chronic infection)

Referred to as asymptomatic but......?

May feel......fatigue, HA, low-grade fevers, night sweats, persistant generalized lymphdenopathy (PGL) and other vague symptoms. they dont understand that they are infected

No lifestyle changes if.....?

Not aware of diagnosis/ No medical help may be sought/ Can create public health concern as they are still able to transmit HIV to others even when unaware of Dx or..........(i missed this).....

Intermediate Chronic Infection

AKA Early symptomatic disease

Lymphocyte T cell count drops to?

200-499 cells/uL / Viral load increase/ HIV advance to a more ACTIVE STAGE

Symptoms seen earlier get worse....

Persistent fever, frequent drenching night sweats, chronic diarrhea, recurrent HA's, fatigue severe enough to interrupt normal routines.

Localized infections

in Intermediate chronic infection.

Most common is?

Oropharyngeal candidiasis

More localized infections

Shingles(varicella roster), Persistant vaginal....?....., Outbreaks of oral or genital herpes, and Bacterial infections


Lypmphadenopathy & Kaposi sarcoma (KS) [ cancerous tumor of the connective tissue, and is often associated with AIDS], Neurological manifestations, and Oral hairy leukoplakia.

Oropharyngeal candidiasis or Trush

Will occur in most (90%) of HIV-infected people at some time/ Whitish yellow patches IN MOUTH, ESOPHAGUS, OR GI TRACT/ Diagnosed with microscopic exam of scraping from lesion and culture

Oropharyngeal candidiasis is treated with?

Fluconazole (or other antifungal)


Know it! (in lewis text)

Oral Hairy Leukoplakia (look like trush, painless)

Epstein- Barr virus infection/ Painless, white, raised lesions on lateral aspects of tongue/ May be THE EARLIEST signs of HIV INFECTION/ Also an INDICATION OF DISEASE PROGRESSION

Late Chronic Infection - AIDS

Diagnosed of acquired immunodeficiency syndrome (AIDS) cannot be made until the HIV infected person meets the CDC guidelines for the case definition criteria.

Must have AT LEAST one of the criteria by CDC:

1. CD4+ T cell count drops below 200 cells/ml
2. Development of one of the opportunistic infections (Fungal, Viral....) 3. Development of one of the opportunistic cancers (KS, Burkitt's..), 4. Wasting syndrome, 5. DIMENTIA DEVELOPS


Look at Table 15-10 LEWIS


These criteria are more likely to occur when the immune system becomes severely compromised/ These opportunistic conditions generally do not occur in people with FUNCTIONING IMMUNE SYSTEM/ These infections can be severe, debilitating, and life-threatening


Immune system is SEVERELY COMPRIMISED/ Increased amount of HIV in the blood/ Decrease in the lymphocyte/ Advance in tx have led to significant decreases in the rates of opportunistic diseases- successful tx of HIV helps to maintain the immune system and prevent infections and cancers.

What is Koposi's Sarcoma? (opportunistic diseases)

Often the presenting SYMPTOM of AIDS/ Most common CANCER FROM AIDS/ Manifest as firm, flat, raised or nodular hyperpigmented, multicentric lesions/ Diagnosed with BIOPSY OF LESIONS/ Treated with cancer chemotherapy, radiation of lesions, alpha-interferon or local radiation or cryotherapy (risk for bleeding) for skin lesions.

Koposi Sarcoma (KS) is a?

A common neoplasm caused by herpes virus 8/ Common neoplasm in HIV-infected patients/ Associated with SEXUALLY TRANSMITTED HERPES VIRUS/ Can effect many organ systems

KS can frequently be seen on?

Skin and mouth, but can cause bleeding and respiratory distress with lesions in those areas

Nursing focus?

Provide information about treatment options, provide CARING SUPPORT AS DISEASE PROGRESSES

What is Pneumocystis Carinii Pneumonia?

Caused by a FUNGUS/ Most common opportunistic infection - many clients will develop PCP at some point/ Recurrent problem - PROPHYLAXIS NEEDED

Clinical manifestations are?

nonproductive cough that may progress to productive, SOB, fever, night sweats, and fatigue

PCP diagnosed with?

CXR, and sputum for culture

Treated when?

CD4+ T cells <200 u/L with TMP/SMX (recommended) (trimethoprim-sulfamethoxazole (Bactrim), dapsone as PROPHYLAXIS AND ALSO IF DISEASE PRESENT

Nursing Implementation?

Acute exacerbations/ Pneumocystic carinii pneumonia (PCP): cause by a common fungus/ Most people exposed by age 3/ Does not cause disease unless immunocompromised - major SOURCE OF MORTALITITY

Nursing resp

Monitor resp status, fever, give meds and O2, position to FACILITATE BREATHING, FLUID REPLACEMENT (NIGHT SWEAT-FLUID MONITORING LOSS)

Tuberculosis (TB) or Mycobacterium tuberculosis

Can affect the respiratory system or any site

TB clinical manifestations.


TB diagnosed by?

CXR, sputum culture, and AFB stain

TB treatment?

isonaizid (INH), ethambutol (Myambutol), rifampin (Rifadin)

Cytomegalovirus (CMV) clinical manifestation?

stomatitis, esophagitis, gastritis, colitis, diarrhea (can be bloody), pain, weight loss, and RETINITIS

CMV diagnosed with?

stool exam, small bowel BIOPSY or COLON BIOPSY

CMV treatment?

Ganciclovir (Cytovene), foscarnet (Foscavir) ---> both are antivirals

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