1 / 57

HIV/AIDS

HIV/AIDS. ACC RNSG 1247. HIV/AIDS- A Brief History. June 1981-CDC publishes study of otherwise healthy young homosexual males who developed PCP & Kaposi’s sarcoma 1981-name “AIDS” is used for the first time. History cont. 1988- called HIV 1989- WHO reports AIDS in 160 countries.

sven
Download Presentation

HIV/AIDS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HIV/AIDS ACC RNSG 1247

  2. HIV/AIDS- A Brief History • June 1981-CDC publishes study of otherwise healthy young homosexual males who developed PCP & Kaposi’s sarcoma • 1981-name “AIDS” is used for the first time

  3. History cont. • 1988- called HIV • 1989- WHO reports AIDS in 160 countries

  4. Global estimates for adults & children, 2008 • People living with HIV…… 33.4 million • Newly infected…………………2.7 million • AIDS deaths ……………………2.0 million (Reference: www.unaids.org)

  5. Statistics • In first 20 years of epidemic about 13 million people have died from complications of HIV infection. • By the year 2020 another 68 million will die (from AIDS Conference 2002)

  6. Transmission via drug use ____ Transmission through heterosexual intercourse ____ Percentage of AIDS in women ____ _____ in AIDS that involved men having sex with men _____ among adolescents Statistics cont.

  7. Routes of Transmission • Blood • Semen • Vaginal & cervical secretions • Amniotic fluid • Breast milk • Variables r/t whether infection occurs???

  8. Unprotected sexual intercourse (vaginal, anal or oral) with male or female partners Multiple sex partners Sexual intercourse with partner of unknown HIV status Intravenous drug use, especially shared needles Recreational drug or alcohol use History of STD History of blood transfusions between 1978-1985 High Risk Behaviors

  9. Mother to infant modes of transmission • Antenatal • Transplacental passage • Intranatal • Exposure to _________________ & ___________ during labor & delivery • Postnatal • Breastfeeding

  10. Infects T4 cells-have more receptor sites T4 cells comprise 70%-80% of circulating cells Norm- _____ -______ /microliter of blood Virus destroys 1 billion T4 cells/day, eventually HIV destroys T4 cells faster than body can replace Problems when count ________ Severe problems<____ Pathophysiology

  11. Virology of HIV • Retrovirus- stores genetic information in RNA instead of DNA. Infects, replicates, & destroys T4 cells • Uses enzymes transcriptase, integrase & protease to read, copy, insert and assemble viral proteins into infected cell

  12. Virology • Two major strains • HIV 1- found worldwide, most prevalent in Americas & Europe • HIV 2- prevalent in West Africa but uncommon elsewhere

  13. Gene Mutation • Viral copies almost always contain errors, slight differences in genetic code that result in slightly different versions of HIV= mutations • When HIV multiplies, it mutates • Problem-antiretroviral meds cannot make sense of changes & can’t work against virus • __________ to medications occurs

  14. Testing • Antibody testing tells condition of immune system. • Antibodies present about _ weeks to _ months after infection. • _________ tells us how active virus is. • More virus first 3 mos. & during late stages of disease, viremia

  15. HIV Testing • Enzyme immunoassay (EIA) to detect serum _________ • A _________ test (Western blot) • CD4+ T cell count • Viral load • CBC

  16. Measures amount of HIV specific RNA, Viral load correlates strongly with stage of disease HIV RNA levels during course of infection or at the time of seroconversion= 5 million copies 5 yrs= 25, 000 copies 8 yrs= 300,000 copies HIV Viral Load

  17. HIV Viral Load cont. • 10 yrs/clinical AIDS=2 million copies • Client’s with lowest viral level <5,000 HIV RNA copies/ml of plasma have lowest risk of progression to clinical AIDS & death

  18. Antiretroviral Drug Resistance Assay Test • Used by HIV specialist to determine whether the virus is likely to respond to specific antiretroviral drugs • Genotype assay – detects drug resistant mutations • Phenotype assay – measures growth of virus in various concentrations of drug

  19. Course of the disease • Acute Retroviral Syndrome • Early Chronic Infection/Asymptomatic Disease • Intermediate Chronic Infection/Early Symptomatic Disease • Late Chronic Infection (AIDS)

  20. Course of HIV Disease • Acute Retroviral Syndrome • occurs 1-3 wks after infection • T4 cell count drops temporarily & quickly returns to normal • develops HIV specific antibodies or seroconversion • symptoms- fever, lymphadenopathy, pharyngitis, HA, diarrhea, flu like symptoms

  21. Course of HIV Disease • Early Chronic Infection/Asymptomatic Disease • 8 yrs. • T4 cells remain >500 (normal or slightly decreased) • Symptoms - fatigue, HA, low grade fever, night sweats

  22. Course of Disease • Intermediate Chronic Infection/Early Symptomatic Disease • 8-10 yrs. • T4 cts. below 500-600 • Symptoms - persistent fever, night sweats, chronic diarrhea, fatigue, neurological manifestations (HA), candidiasis (thrush), etc

  23. Course of Disease • AIDS Or Late Chronic Infection • develops at least one of these conditions (established by CDC): • wasting syndrome, pneumocystis carinii pneumonia, rare cancers/malignancies, AIDS dementia or other neurological problems, other opportunistic infections, CD4 count<200, CMV, candidiasis of bronchi, trachea

  24. Opportunistic Infections (OI’s) • PCP (pneumocystic carini pneumonia)-caused by fungus • symptoms- persistent dry cough, SOB, fever, chills, sweats • prevention- everyone with less than 200 T-cells should take prophylaxis, Bactrim or Septra • side effects- sun sensitivity

  25. OI’s • Candidiasis- thrush(oral) or vaginal candidiasis • Hepatitis C Virus- infects the liver, transmitted by blood to blood contact, may cause no symptoms until liver damage occurs • Tuberculosis • Kaposi’s sarcoma- rare cancer, vascular lesions on skin, mucous membrane, and viscera

  26. Oral Candidiasis (Thrush)

  27. Kaposi’s Sarcoma

  28. OI’s • Cryptosporidosis- parasitic infection, transmitted by contaminated water, failure to wash hands after gardening etc., causes sever persistent diarrhea, no standard treatment. • Cytomegalovirus- sexually transmitted, primarily damages eyesight, treated with gancyclovir (Cytovene)

  29. OI’s • Shingles • MAC- affects GI system, bacterial infection, organisms common in food, water,causes recurring fevers, fatigue, watery diarrhea, medications available. • Occurs late in disease when CD4 <50mm3 • Major cause of wasting syndrome in AIDS • Lymphoma • Human Papilloma Virus

  30. Treatment & Nursing Care Goals of Care: • Decrease _______ levels • Maintain or raise __ count to > ___ • _____ development of HIV related symptoms __________ of a healthy immune system is the main goal of care

  31. Treatment & Nursing Care: Antiretroviral Therapy (ART) • HAART – highly active antiretroviral treatment

  32. Treatment and Nursing Care: ART cont. • Non-nucleoside reverse transcriptase inhibitor (NNRTIs) ex: efavirenz (sustiva) • Nucleoside/nucleotide reverse transcriptase inhibitor (NRTIs/NtRT) ex: zidovudine (retrovir, AZT, SDV), tenovir DF (viread, TDF) Work by inhibiting the activity of Reverse Transcriptase

  33. Treatment and Nursing: ART cont. • Protease inhibitors – disable protease, a protein that HIV needs to make more copies of itself ex: darunavir (prezista) • Entry/Fusion inhibitors – blocks HIV entry into cells ex: enfuvirtide (FuzeonT-20)

  34. Treatment & Nursing Care: ART cont. • Integrase inhibitors – disable integrase, a protein that HIV uses to insert its viral genetic material into that of the infected cell ex: raltegravir (isentress) • Fixed dose combination – contain 2 or more meds from I or more drug classes efavirenz, tenofovir (atripla)

  35. Exs. of HAART Regimen • Sustiva + combivir • Sustiva + truvada • Atripla • Kaletra + combivir • Kaletra + truvada HAART – highly active antiretroviral treatment

  36. Liver problems Diabetes High cholesterol Lactic acidosis Lipodystrophy syndrome Skin rash GI problems Decreased bone density Pancreatitis Nerve problems Bleeding in Hemophilic patients Side Effects & Toxicities of ART

  37. First, Second, Third line ART • “First” combination • “Second” combination • “Third” combination

  38. HIV-AIDS vaccine Continued efforts are being undertaken by various government health agencies in partnership with pharmaceutical companies to develop a vaccine.

  39. Treatment & Nursing Care: Nutrition • Marinol (dronabinol) synthetic extract of marijuana is indicated for _______ associated with weight loss • Megace (megesterol acetate) used for anorexia, cachexia, or unexplained significant weight loss • Thalidomide used for mouth ulcers/wasting

  40. HIV Manifestations in Women • Vaginal candidiasis • Pelvic Inflammatory Disease • Genital ulcers • Genital warts • Invasive cervical carcinoma • Herpes simplex

  41. CDC Guidelines Health Care Workers exposure to HIV http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm(Sept 2005 update) • Mucous membranes – flush with ___ • HIV testing __________ , _ weeks, __ weeks, _ months • ___ regimen if high risk • Basic or expanded regimen for at least 4 weeks

  42. CDC Guideline on HCW exposure to HIV • http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm • BASIC REGIMEN example • Zidovudine (Retrovir™; ZDV; AZT) + lamivudine (Epivir®; 3TC); available as Combivir™ • --- ZDV: 300 mg twice daily or 200 mg three times daily, with food; total: 600 mg daily --- 3TC: 300 mg once daily or 150 mg twice daily --- Combivir: one tablet twice daily

More Related