Final Prep - HIV/AIDS Flashcards

HIV - 2 categories, different strains

HIV 1: mostly US & Europe HIV 2: mostly W.
Africa some strains progress to AIDS much faster (as fast as
3yr, instead of typical 10yr)

HIV Transmission

blood sex perinatal (pregnancy, delivery,
breastfeeding) Men transmit easier, women receive more easily
(# infectious particles in body fluid, fluid volume exchanged,
surface area in contact)

HIV Description

is a retrovirus that infects T4 helper cells (CD4), macs, &
B cells reactivates diseases dec. in white men
only, inc. in all other races

HIV & Gay Men

with safe sex practice = no higher risk than others
sexual practice, not preference = risk most Americans
w/ HIV are MSM HIV in MSM has dec. considerably

T4 / CD4 Cell Range

normal = 500-1600 <200 = AIDS infection likely


best indicators = CD4 & viral load
CD4: damage already done
viral load / HIV RNA: risk of progression to AIDS,
best predictor long term course
ELISA - (many false positives) if 2/3 are + do
Western Blot (reliable but time consuming)
others not often used: p24 antigen
& virus cultures might take
up to 3yr for detection

Opportunistic Infections w/ Low CD4

leukopenia herpes zoster/shingles HSV/herpes
simplex (type 1 - above waist, type 2 - below waist)
eczema esophagitis PCP/pneumonia
MAC hepatitis (HBV, HCV) candida/thrush
cryptococcus toxoplasmosis cytomegalovirus

HIV Management

maintain health antiretroviral meds prevent

HIV Management - Monitor:

CBC, chem panel, UA TB test CSR STD
screen Hep antibody annually serologic
CD4 viral load

HIV Meds - Antiretrovirals

NRTIs NNRTIs PIs entry or fusion
inhibitors integrase inhibitors

Signs When HIV Becomes AIDS

CD4/T4 <200 or development of AIDS-defining illness
opportunistic disease cancers HIV wasting
HIV dementia

Hepatitis w/ AIDS

hepatic failure (secondary to Hep B/C) - leading cause of death
w/ AIDS dramatic inc. co-infection of HIV & Hep C
treatable with combo drug, adds to Tx complexity when taking

Neoplasms w/ AIDS

Kaposi's Sarcoma Non-Hodgkin's Lymphomas
invasive Cervical Cancer

Kaposi's Sarcoma

unrelated to CD4 mostly with MSM cancer of
lining of blood vessels most common cancer r/t
Sx: patchy, flat, pink area, develops into bruise,
becomes dark violet/black lesions
Tx: radiation, chemo, cryo therapy

Non-Hodgkin's Lymphomas

usually aggressive primary lymphoma of the brain
also common: bone marrow, liver, GI tract early Sx:
H/A, changes in mental status

Invasive Cervical Cancer

r/t CD4 count lowering 40% women w/ HIV have cervical
dysplasia, usually die from the cancer, not HIV women w/
HIV screen - pap smear q 6mo
Sx: vag bleed/discharge, pain, anemia, enlarged
lymph nodes
Tx: aggressive w/ colposcopic exam & cone

AIDS Dementia

early, widespread HIV to brain 5 stages: 1 = minimal
S/S, 5 = nearly vegetative
Dx: HIV + in CSF underdiagnosed or
misdiagnosed as depression (antidepressants can exaggerate

AIDS Dementia Sx

cognitive dysfunction: diff. concentration &
memory, impaired judgment, slow thinking
motor deficits: leg weakness, ataxia, clumsiness,
slow, less precise hand movement
behavioral changes: apathy, dec. spontaneity,
social withdrawal, irritability, anxiety, delirium

AIDS Dementia Tx

antiretroviral combo therapy psychotropics
goals: safety, fall protection, independence as
long as possible

HIV Wasting Syndrome

occurs in >90% AIDS pts r/t: dec. food intake,
nutrient malabsorption, altered nutrient metabolism, low
testosterone levels
Dx from Sx: weight loss >10% baseline wt. w/
chronic diarrhea or chronic weakness & fever
Assess: diet Hx, protein/calorie intake adequacy,
substitute vitamins for intake

HIV Wasting Syndrome Tx

nutrition supp. dronabinal (inc. appetite, dec.
vomiting) megace (inc. fat synthesis)
testosterone anabolic steroids TPN (last
goals: prevent further wt. loss, stimulate
appetite, weight gain, inc. lean muscle mass

Management of AIDS

prevention/Tx of opportunistic infections treat
neoplasms (cancers) Tx other AIDS illnesses (wasting,
dementia, etc)

Starting Antiretroviral Therapy for AIDS

earlier Tx = earlier drug resistance, high med compliance necessary
starts w/ any of these:
AIDS defining illness CD4 <350 pregnant
women w/ HIV HIV-assoc. nephropathy co-infected
with HBV

Infection Prevention - CD4 <200

Prophylactic Meds

ABx antifungals antivirals

Pregnant Women w/ AIDS Tx

only 1 drug (instead of typical 2-3 w/ AIDS Tx)
Zidovudine (AZT) during pregnancy, delivery, breastfeeding
AZT = dramatic decrease in perinatal transmission

Opportunistic Infection Tx Types

antiprotozoal: PCP & cryptosporidiosis
antibacterial: TB, MAC, salmonella, recurrent
bacterial pneumonia
antifungal: candida albicans, cryptococcus,

AIDS Required Meds

ABx (trimethoprim/sulfamethazole) antifungal
(fluconazole) antiviral (acyclovir) antiretroviral

Pt/Family Teaching

disease progression, transmission, Tx safer sex
practices inform med personnel of HIV status no
organ, tissue, blood donation optimum health, infection
control med admin & side effects viral load
& CD4 opportunistic disease Sx & Tx


Impaired Skin Integrity Altered Nutrition: Less Than
Body Requirements Altered Sexuality Patterns
Self-Care Deficit Risk for Injury Ineffective
Individual Coping Altered Thought Processes

HIV/AIDS - Healthcare Workers

0.3% get HIV after needlestick injury strict
blood/body fluid precautions one-handed needle recap mandatory needles
w/ visible blood more likely infective
if needlestick exposure: follow institution policy,
prophylaxis via combo post-exposure protocol (PEP) w/in 2hrs