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.
Download ReportTranscript 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.
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 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) 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) Statistics cont. Transmission via drug use ____ Transmission through heterosexual intercourse ____ Percentage of AIDS in women ____ _____ in AIDS that involved men having sex with men _____ among adolescents Routes of Transmission Blood Semen Vaginal & cervical secretions Amniotic fluid Breast milk Variables r/t whether infection occurs??? High Risk Behaviors 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 19781985 Mother to infant modes of transmission Antenatal • Transplacental passage Intranatal • Exposure to _________________ & ___________ during labor & delivery Postnatal • Breastfeeding Pathophysiology Infects T4 cellshave 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<____ 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 Virology Two major strains • HIV 1- found worldwide, most prevalent in Americas & Europe • HIV 2- prevalent in West Africa but uncommon elsewhere 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 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 HIV Testing Enzyme immunoassay (EIA) to detect serum _________ A _________ test (Western blot) CD4+ T cell count Viral load CBC HIV Viral Load 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 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 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 Course of the disease Acute Retroviral Syndrome Early Chronic Infection/Asymptomatic Disease Intermediate Chronic Infection/Early Symptomatic Disease Late Chronic Infection (AIDS) 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 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 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 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 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 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 Oral Candidiasis (Thrush) Kaposi’s Sarcoma 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) 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 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 Treatment & Nursing Care: Antiretroviral Therapy (ART) HAART – highly active antiretroviral treatment 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 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) 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) Exs. of HAART Regimen Sustiva + combivir Sustiva + truvada Atripla Kaletra + combivir Kaletra + truvada HAART – highly active antiretroviral treatment Side Effects & Toxicities of ART Liver problems Diabetes High cholesterol Lactic acidosis Lipodystrophy syndrome Skin rash GI problems Decreased bone density Pancreatitis Nerve problems Bleeding in Hemophilic patients First, Second, Third line ART “First” combination “Second” combination “Third” combination HIV-AIDS vaccine Continued efforts are being undertaken by various government health agencies in partnership with pharmaceutical companies to develop a vaccine. 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 HIV Manifestations in Women Vaginal candidiasis Pelvic Inflammatory Disease Genital ulcers Genital warts Invasive cervical carcinoma Herpes simplex CDC Guidelines Health Care Workers exposure to HIV http://www.cdc.gov/mmwr/preview/m mwrhtml/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 CDC Guideline on HCW exposure to HIV http://www.cdc.gov/mmwr/preview/mmwrhtml/r r5409a1.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 You are the new charge nurse on a busy medical-surgical floor at a community hospital. On a particularly busy day, one of the “new hires” tells you that she had a needle stick injury, at the start of shift, today. She was giving her 78-year-old diabetic client insulin and accidentally stuck herself, trying to put the needle into an overflowing sharps container. In talking with other nurses, she doubts that this is a highrisk needle stick since it was with an insulin syringe, and the client is an older woman, who is obviously at low risk for HIV. She washed off the blood thoroughly from her finger, applied Betadine, and covered it with a Band-Aid. Because it is almost change of shift the nurse wants to fill out an incident report and go home. How will you counsel this nurse about the needle stick injury? What rights and obligations does she have? For what other blood-borne diseases has this incidence placed her at risk? Should PEP be started? Why or Why not? Should this nurse inform her sexual partner of this incident? Why or why not? A male client who is HIV- positive wants to know why oral Megace has been prescribed. What information can you provide related to this medication? A client is concerned about the number of medications that have been prescribed for the treatment of AIDS and states that “there is no way to comply” with this regimen. What information could you provide to the client to support the importance of compliance with treatment regimen? A HIV + client now presents with a CD4 count of <200 and invasive cervical cancer. How would the nurse evaluate these findings in terms of current CDC definitions? A. The client has seroconverted B. The client is HIV + C. The client is in the latent period of the disease process D. The client has acquired immunodeficiency syndrome Legal & Ethical Perspective: Reporting STDs in Texas http://www.dshs.state.tx.us/ hivstd/policy/comment_perio d10.shtm And the research continues The end.