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66 Cards in this Set
- Front
- Back
HIV requires which enzyme once inside the DNA |
Reverse Transcriptase |
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HIV/AIDS invades genetic code of CD4 cells which are |
receptor sites of T helper lymphocytes |
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HIV Test: ELISA |
tests for the HIV antibodies |
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HIV Test: Western Blot |
confirms ELISA |
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HIV Test: Viral Load |
Amount of virus found in blood |
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HIV Test: Oral and Urine |
Require confirmation test |
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HIV Test: Rapid Test |
Fingerstick, quick results, approved 2002 |
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All tests requires counseling including |
1. Risk assessment 2. Risk reduction 3. Emphasize importance of decreaseing transmission |
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CDC Defines HIV as |
+ HIV test CD4 count > 200 lack of opportunistic infection |
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CDC Defines AIDS as |
+ HIV test CD4 count < 200 presence of opportunistic infections |
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CD4/T lymphocytes Stage 1 |
> 500 cell/ul |
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CD4/T lymphocytes Stage 2 |
200-499 cell/ul |
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CD4/T lymphocytes Stage 3 |
< 200 cell/ul |
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Clinical Categories Stage 1 |
asymptomatic HIV infection, generalized |
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Clinical Categories Stage 2 |
symptomatic but no AIDS-defining condition |
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Clinical Categories Stage 3 |
Presence of AIDS-defining condition |
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Lab Tests related to Dx Viral Load |
# of viral particles measured in the blood |
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Lab Tests related to Dx CD4 count |
Amount of T helper lymphocytes remaining |
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Malignancies Kaposi Sarcoma |
affects mouth, oral cavity, intestinal tract |
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Malignancies Lymphoma |
leads to malabsorption, diarrhea, intestinal obstruction |
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HIV Related Complication Neurological |
HIV encephalopathy or AIDs dementia Precipitated by Vitamin deficiency |
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HV Related Complication Liver |
Infections Co infected with Hep C Hepatotoxic Meds AIDS cholangiopathy |
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HIV Related Complication Pulmonary |
TB PCP (Pneumocystis Pneumonia) |
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HIV Related Complication Kidney |
HIV nephropathy Proteinuria |
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Effects on GI tract Candidiasis |
Sore Mouth Dysgeusia (distortion of the sense of taste) |
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Effects on GI tract KS or Herpes |
Sore Mouth Inhibits Swallowing |
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Thrush |
yeast infection in the mouth caused by candida albicans fungus |
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Effects on GI tract Gastric |
Hypochlorhydria (low stomach acid) CMV, Cryptosporidium, and other parasites |
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Effects on GI tract Small Bowel |
Small Bowel Morphology Villi shortened and flattened, absorptive areas substantially reduced lowered Ig A production: affects gut immunology reduced enzyme leves CMV, MAC, microsporidia prevalent |
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Effects on GI tract Large Bowel |
CMV colitis |
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Effects on GI tract HIV Enteropathy |
Diarrhea of the second degree small and large bowel inflammation and malabsorption Intestinal Mucosal Change Increase Gut Permeability Glutamine Supplements |
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Lipodystrophy Syndrome |
Fat redistribution, abnormal lipid elves, and insulin resistance Accumulate abdominal fat and lose fat from face, arms, and legs Fat deposits accumulate between shoulders Buffalo Hump and Lipomas Hypercholesterolemia |
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Treatments for Lipodystrophy Syndrome |
Dietary Adjustments Meds for elevated TG and LDL cholesterol levels and insulin resistance Aerobic activity Resistance Training Cosmetic Surgery |
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AIDS wasting |
Involuntary weight loss of 10% body weight, plus more than 30 days of either diarrhea, or weakness and fever associated with higher morbidity and mortality |
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Etiology of AIDS wasting |
Anorexia and reduced food intake emotional stress and pain oral & respiratory infections fatigue, lethargy, and dementia Meds (taste alterations & food aversions, n/v, diarrhea & malabsorption Cachexia= changes in macronutrient metabolism and pro inflammatory cytokines |
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PEM (protein energy metabolism)
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effects immune function which effects risk of infection |
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Treatment for AIDS Wasting |
Aggressive Nutrition Intervention Appetite Stimulants: magace & marinol Anabolic Agents: Oxandrin Oral Nutritional Supplements Nutritional Support: EN or PN |
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Diarrhea/Malabsorption Small Bowel |
Fat Mono/disaccharides B12 Folate Minerals |
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Diarrhea/Malabsorption Large Bowel |
Fluids Electrolytes |
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Tx for Diarrhea/Malabsorption |
Recommend multi vit/min with B complex High dose tx should be avoided MCT oil Probiotics |
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Tx Goals |
decrease viral load restore/ preserve immune function improve quality of life decrease HIV morbidity/mortality |
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Drug Treatment Highly Active Anti Retrovirus Therapy |
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors Non Nucleoside Reverse Transcriptase Inhibitors Protease Inhibitors Entry Inhibitors Integrase Inhibitors |
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Reverse Transcriptase Inhibitors Nucleoside RTI |
ziagen viread epivir (3TC0 Zerit |
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Reverse Transcriptase Inhibitors Non nucleoside RTI |
Viramune Rescriptor Sustiva Intelence (Enravirine) approved as a combo drug 2008 by the FDA |
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Reverse Transcriptase Inhibitors act by |
preventing HIV from becoming part of the cell therefore it does not replicate |
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Protease Inhibitors |
Invirase Agenerase Norvir Kaletra Crixivan Viracept Prezista |
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Protease Inhibitors act by |
preventing the protease enzyme fro cutting the long protein chain. New copies of HIV cannot be made. |
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Entry Inhibitors |
Fuzeon T-20 Virus still exists in the system but meds prevent HIV from entering CD4 cells by stopping ti from zipping together the two ends of the glycoprotein and fusing with the host cell Given as injection |
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CCR5 Entry Inhibitors |
Selzentry blocks CCR5, a protein on the CD4 cells that HIV need to enter the cells |
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Intergrase Inhibitors |
Isentress Works by binding to one of several specific enzymes that HIV uses when copying itself. Once bound to the drug, the enzyme is unavailable to HIV, hindering HIV's ability to make copies of itself |
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Immune Based Therapy |
Helps bolster the body's own immune system to help fight the HIV infection Reproduces cytokines New therapy and there is no clinical data, regarding its efficacy |
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Combo Meds |
Sustive + Epivir + Retrovir or Viread or Zerit Kaletra + Epivir + Retrovir or Zerit Combo meds are always recommended b/c the decrease of viral load is only temporary with less than 3 meds |
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First Prophylaxis Tx |
FDA approved July 2012 Truvada for use in highly susceptible individuals |
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Nutritional Concerns of HIV/AIDS |
wasting, cachexia GI sx and side effects of meds Lipodystrophy Hyperlipidemia Hyperglycemia |
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Nutritional Assessment of HIV/AIDS |
Assess weight hx % usual, % lost, Anthropometrics MAC, TSF, CHI Diet hx Nutrient Intake, Intolerances Not traditional therapies Nutrition Related complications of Sx &Tx Biochemical Assessment: Alb, Pre alb, Chol, SMA 7, and TLC |
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Nutritional Assessment Macronutrients |
Fat consider MCT if malabportion is present omega 3 FA are being studied for immune modifying effect low chol, sat and trans fat secondary lipodystophy Diet Comp: 45-65 % CHO, 10-35% PRO, and 20-30% Fat |
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Low Immune Function to deficiency of |
Vit A Vit E Thiamine Riboflavin B6 & B12 Folate Zn Fe |
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Vitamins associated with higher survival |
B vitamins and Vit C |
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B12 |
low levels are prevalent in HIV pts etiology may be malabsorption and low intake dietary supplements may not be enough especially with PI use |
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Vitamin A |
low levels associated with MTCT but supplementation has been found to crease risk of MTCT by 38% U shaped relation between intake and risk of progression to AIDS/death with in range of 9000 and 20000 expected lower risk |
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Vitamin A in children |
reduce diarrheal morbidity by 50% and significantly reduce overall morbidity and mortality improve growth lesson the increase in viral load associated with influenza vaccination increase circulation CD4 and natural killer cells No significant lower viral load in adults/kids |
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Beta Carotene |
results are contradictory one study showed a positive effect on CD4 counts but another study found no effect on CD4 or viral load |
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Vit B, C, and E |
Large doses of a combo of vit c and e were found to reduce oxidative stress and produce a trend towards a reduction in viral load Three studies showed the RDS for bit b, c, and e helping pregnancy and increase in CD4+ and CD8+ cell counts |
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ZInc |
In adults with TB co-infected with HIV, zinc in combo with other micronutrients increased weight gain and survival during treatment |
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Special Issues |
CAM Food Handling Nutrition counseling and supplementation are beneficial Research on blu, arg, omega 3, HMB |
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Nutriton Intervention |
meet kcal and pro needs increase LBM irritated throat/difficulty swallowing dry mouth/ sore mouth altered taste diarrhea poor appetite |