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NURS 2280 (11)


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Dalhousie University
NURS 2280
Shauna Houk

HIV/AIDS Objectives o Understand HIV transmission and risk factors. o Know the clinical manifestations and complications ofAIDS. o Know the assessment and diagnostic findings ofAIDS o Knowledge of treatments for HIV infection. o Be aware of nursing care and support measures nurses provide. o Understand the emotional concerns of patients withAIDS. History of HIV & Epidemiology  31 million people are infected (UNAIDS, 2010)  1981:First Documented Case ofAIDS  1982:Acquired Immune Deficiency Syndrome (AIDS)  CDC names AIDS  Scientist believeAIDS is spread by contaminated blood because disease is seen in hemophiliacs  In sub-Saharan Africa, AIDS was known as "slim disease." 1983: Viral discovery patient.r Institute researchers isolate a virus from the swollen lymph gland of anAIDS  They called it lymphadenopathy-associated virus (LAV.)  1986 renamed HIV: human immunodeficiency virus 1987  The U.S. forbids immigration by people with HIV, a policy reversed in 2010 by President Obama.  The first WorldAIDS day is held on Dec. 1 1991-1992  The red ribbon is introduced as a symbol ofAIDS solidarity.  Magic Johnson announces he is HIV +  Queen lead singer Freddy Mercury dies ofAIDS.  AIDS becomes the leading cause of death in U.S. men aged 25-44. 1996-1997: Treatment Breakthrough  load to undetectable levelsly active anti-retroviral therapy (HAART )- can cut HIV viral  AIDS researcher David Ho, suggests treatment could eliminate HIV from the body. He's wrong -- it's later found that HIV hides in dormant cells 2006-2007  HIV treatment is shown to extend life by 24 years-cost $618,900.  AIDS vaccine fails in clinical trials - latest in a long line of vaccine failures  Of the 33 million people living with HIV only 3 million are getting treatment. That’s less than 1/3 that need it 2009-2010 o Polls show mostAmericans no longer considerAIDS a major problem. o New infections continue to rise in Canada:  Nov 1985-Dec 2008: 67,422 HIV + tests reported to Centre for Infectious Disease Prevention and Control Transmission of HIV o Transmitted by body fluids containing HIV or infected CD4 lymphocytes  Blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk  Most prenatal infections occur during delivery o Casual contact does not cause transmission o Breaks in skin and mucosa increase risk Prevention o Standard precautions (Chart 52-3) o Practice safer sex (Chart 52-2)  Abstain from sharing sexual fluids  Reduce the number of sexual partners to one  Condoms o Do not share drug injection equipment  Needle exchanges o Blood screening and treatment of blood products Question When was blood screening for HIV instituted in Canada? o 1980 o 1985 o 1990 o 1995 Answer: 1985 Rationale: Blood screening in Canada was instituted in 1985. HIV Testing Three types: o Nominal-/name based o Non-nominal- test is ordered using a code or the initials of the person being tested o Anonymous-code only known to the person being tested Laboratory Testing-2 Step Procedure o Enzyme immunoassay (EIA) o Western blot test-used to confirm EIA o Viral load: measures HIV RNAin plasma o CD4/CD8-lymphocytes Structure of HIV-1 Life Cycle 1 . HIV virus attaches to CD4+ receptor 2. Internalization and uncoating of the virus with viral RNAand reverse transcriptase 3. Reverse transcriptase copies the viral RNAinto double stranded DNA 4. Double stranded DNAis spliced into cellular DNAby integrase 5. Using the integrated DNAas a blueprint, the cell makes new viral RNAand viral proteins 6. HIV protease cleaves the new proteins 7. The new proteins join the viral RNAinto new viral particles 8. Assembly and release of the new virus from the host cell. Types of HIV o HIV-1: Most common form o HIV-2  Appears to be limited toAfrica  Less easily transmitted  Co-infection possible o Current HIV tests screens for both types Primary Infection (Acute HIV infection orAcute HIV syndrome) o Part of CDC category A o Symptoms: none to flulike syndrome o Window period: lack of HIV antibodies o Period of rapid viral replication and dissemination through the body o Viral set point: balance between amount of HIV and the immune response HIVAsymptomatic o CDC categoryA + 3 o More than 500 CD4 T lymphocytes/mm o On reaching the viral set point, chronic asymptomatic state begins o Body has sufficient immune response to defend against pathogens HIV Symptomatic o CDC category B o 200-499 CD4 lymphocytes/mm o The patient exhibits symptoms or conditions such as:  Candidiasis  Cerv
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