1. What is the most common mode of HIV transmission? 2. How else is HIV transmitted? 3. What is the most common mode of work related transmission? p. 241

a) Vaginal secretions b) Kissing c) Semen d) Urine and feces e) Breast milk f) Coughing, sneezing g) Using the same comb as person with HIV

 What is the main receptor to which the HIV virus must bind in order to gain entry into the host’s body?

 Viruses cannot reproduce /replicate without a host, what is the host, target cell for HIV?  What is the function of T-cells?  The normal CD4 cell count in an adult is ______?

 What is the difference between HIV and AIDS?  How long does it take for HIV to become AIDS?

 Flu-like symptoms  Fatigue  Sore throat  Enlarged lymph nodes  Headache  Muscle and joint pain  Goes through stages

Which stage does this occur?

1. Swollen lymph glands 2. Thrush 3. Muscle and joint pain 4. Low-grade fever 5. Oral hairy leukoplakia 6. Sore Throat 7. CD4 + T cells drop to 200 to 500 cells/ μ l 8. Localized infections a. Acute Stage b. Early Chronic c. Intermediate Chronic d. Late Chronic/ AIDS

What is major problem rt diagnosis?

 Diagnostic CDC criteria  CD4+ T cell count below 200 cells/ μ l  Specific opportunistic infection or cancer  Wasting syndrome  AIDS dementia complex (ADC)  Must meet CDC criteria outlined in Table in textbook

 Enzyme immunoassay (EIA) to detect serum antibodies  If test is negative – what do they do?  If test is positive – what do they do?  If re-test is positive – what do they do?  A confirming test (Western blot)  If this test is positive – reported as +

 Progression monitored by:  CD4+ T cell counts  viral load  Abnormal blood tests common  Neutropenia, thrombocytopenia, and anemia

 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

 When should Therapy be Started?

 Adherence to drug regimens is critical to prevent  Disease progression  Opportunistic disease  Viral drug resistance

 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 viral replication

 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)

 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 1 or more drug classes ex.- efavirenz, tenofovir (atripla)

 Common physical problems  Depression  Diarrhea  Peripheral neuropathy  Pain  Nausea/vomiting  Fatigue

 Common metabolic disorders  Lipodystrophy  Hyperlipidemia  Insulin resistance  Bone disease  Lactic acidosis  Cardiovascular disease

 If the side effects occur – what would the nurse expect to happen next?

 What is the major problem encountered in treating with ART primarily when one drug alone is being used?  What to do about it?

 How would the nurse know that ART is effective ?

 Major goal: Prevention  Four CDC strategies  Use testing as routine health care  Use rapid testing  Work to modify risky behaviors  Offer tests universally to pregnant women

 What is important to teach to decrease the risk of spread via:  Sexual intercourse?  Drug use?  Perinatal transmission?

 Ways to promote a healthy immune system (slow disease progression)  Nutritional support  Moderation or elimination of alcohol, tobacco, and drug use  Mental health counseling  Vaccines  Rest, exercise, and stress reduction  Avoid exposure to infectious agents

 Needlesticks (open bore needle) or cuts  Skin contact (intact)  Splashes in mucous membrane  (eye, nose or mouth) Source of Exposure HIV %   <0.1  0.1

 The End