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36 terms

Care of Patients with HIV Disease and Other Immune Deficiencies

Chp. 21 Ignatavicious
STUDY
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HIV Define
Acquired immune deficiency syndrome is the most common secondary immune deficiency disease in the world
Clinical catergory A for CDC
HIV positive, persistent generalized lymphadenopathy, or acute primary infection with HIV
Clinical category B for CDC
Bacterial endocarditis, meningitis, sepsis, pneumonia, vulvovaginal candidiasis that is persistent more than 1 month, severe cervical dysplasia or carcinoma, diarrhea or fevere lasting longer than 1 month, oral hairy leukoplakia, herpes zoster (shingle) ITP, listeriosis, TB, nocardiosis, PID and peripheral neuropathy.
Long term non progressors
These people have been infected with HIV for at least 10 years and have remained asymptomatic, with CD4+ %-cell counts within normal range. Genetic component found with this
Faster growing group with HIV infection and AIDS?
Women
First signs of HIV infection in woman
Gynecologic problems, especially persistent or recurrent vaginal candidiasis
Absolute safe methods of preventing infection with sexual contact
Abtinence or monogamous sex with noninfected partners
Most risky sexual contact for HIV transmission
Anal intercourse
Drugs to decrease neuropathic pain from peripheral neuropathy
May respond best to TCA such as amitriptyline (elavil) or to anticonvulsant drugs such as phenytoin (dilantin) or carbamezepine (tegretol). Drugs may take several weeks to work, during this time an opiod may be given for pain.
Drug therapy for arthralgia and Myalgia
NSAIDS. Motrin (ibuprofen), Toradol, Lodine, Indocin, Relafen, Daypro, Feldene, Celebrex, Naproxen (aleve), Ketoprofen, Voltaren
Which medication would you expect to be to a patient with Candidiasis?
Fluconazole (Diflucan)
Monotherapy
promotes drug resistance and does not improve the duration or quality of life for the patient with HIV/AIDS.
HAART
Highly active antiretroviral therapy and is showing good results as measured by reduced viral load and improved CD4+ T cell counts
Lab work with Zidovudine (retrovir)
Monitor CBC, hepatic, and renal function
NARTI's action
Suppress viral replication in infected cells by inhibiting the activity of revere transcriptase.
NNRTI's
Suppress viral replication in infected cells by inhibiting the activity of revere transcriptase.
Protease inhibitors
Prevent viral replication and relase of viral particles by inhibiting viral protease
CDC recommendations for HIV testing
People with STDs, injection drug users, women of childbearing age, recieved transfusion between 1978-1985, planning to get married, people admited to hospitals, people in correctional institutions, prostitutes and customers. HIV epidemic began in 1970.
Entry Inhibitors action
Prevents HIV infection by blocking the CCR5 receptor on CD4 + T lymphocytes. Prevents binding of gp41 to CCR5 receptor
NARTI's and NNRTI's action
Inhibit HIV revere transcriptase. Prevents HIV concerting of DNA
Integrase inhibitors action
Prevents this enzyme from allowing the viral ds-DNA to be inserted into the host ds DNA, which completes the infection of the CD4-T cell
Protease Inhibitors action
Prevents viral replication and release of viral particles by inhibiting viral protease.
A healthy adult has at least this many of CD4-Tcells
800 - 1000 cells/mm3
First manifestations of HIV
Fevere, night sweats, chills, headache, and muscles aches. Common to influenza
Classifaction of A1
CD4 t cell counts at least 500
Classification A2
CD4 t cells counts 200-499
Classifaction of A3
CD4 t cells counts at least 200 u/l
HIV has been cound in most body fluids including
Semen, blood, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, cerebrospinal fluid, lymph nodes, cervical cells, corneal tissue, and brain tissue.
Syrince cleanign
First fill with clear water, next fill with bleach and shake for 30 - 60 seconds
Perinatal transmission risk
25% who are not using drug therapy, and 8% who are on drug therapy
Seroconversion
the phase of an infection when antibodies against the infecting agent are first detectable in the blood.
Drug therapy for P. jiroveci pneumonia (PCP)
Trimethropim/sulamethoxazole (Apo-sulfatrim, bactrim, cotrim, septra). Many patients have adverse reactions to this drug including nausea, vomiting, hyponatremia, rashes, fever, leukopenia, thrombocytopenia, and hepatitis.
Immune enhancements
Including bone marrow trasnplantation, lympocyte transufsion, and infusion of lympokines.
Drug therapy for an imbalanced nutrition
Ketoconazole (nizorol) or fluconazole (fiflucan) orally, or IV amphotericin B (fungizone). Treatment for esophagitis.
Drug therapy for diarrhea
Diphenoxylate hydrochloride (diaresd, lomotil) or loperamide (imodium.
Drug therapy for promoting healing
Modified burrows solution (domebro)