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HIV/AIDs, REFERENCES - Coggle Diagram

- - - - -Unprotected receptive anal sex poses is especially dangerous
        -This is because the rectal mucosa lacks the protective humoral immune barrier that is present in vaginal secretions
        -Additionally, the anal mucosa is more susceptible to abrasions
  - - - -In the presence of an STD-causing infectious agents, Langerhans cells may become activated
        -When activated, Langerhans cells are responsible for transmitting the HIV virus to T cells
        -Therefore, the presence and Hx of other STDs increases the risk of being infected with HIV
  - - - A needle stick injury involves penetration of the skin by a needle or other sharp object that has been in contact with with blood or other body fluids
  - - - -Advances in HIV research and treatment have made it possible for many women to give birth to babies without perinatal transmission
        -If positive, the mother will be started on HIV medication therapy
        -the mother must, take the medication exactly as prescribed throughout the pregnancy
- - - - HIV can be transmitted by blood or blood contaminated body fluids via broken skin, mucous membranes, or wounds
    - - HIV can also be transmitted from mother to baby during birth, pregnancy, or breastfeeding
    - - HIV can be transmitted by many bodily fluids during intercourse such as...
        -semen
        -vaginal fluid,
        -blood
        -and anal mucous
        
        Anal Sex
        
        -The riskiest type of intercourse for receiving or transmitting HIV
        -The receptive partner has a greater risk of obtaining HIV due to the rectum's thin lining
        -However, the insertive partner is also at risk for infection
        -HIV may enter the body via the urethra or via any cutes or scratches on the penis
        
        Vaginal sex
        
        -Vaginal intercourse poses less risk for infection
        WOMEN
        -Most women who obtain HIV get it from vaginal intercourse
        -HIV can enter the woman's body through the mucous membranes lining the cervix and vagina
        MEN
        -Men can also contract HIV during vaginal intercourse from blood or vaginal fluid
        -the infection can enter the body via the urethra or small cuts on the penis
  - - - -during this stage, the infected person will be asymptomatic
        -The HIV virus is still active, but is being replicated at very low levels
        -This period may last a decade or longer without medication, but may also progress faster
        -infected people are still able to transmit the virus during this phase
        
        -At the end of Phase 2, the viral load will rise and the CD4 cell count will plummet
        -this may produce symptoms and cause the patient to enter phase 3
        
        This phase is identified by CD4 T-cell counts between 200-400/µL
    - - -This is the most severe phase of infection
        -at this point, the person's immune system has been extremely damaged
        -this makes them succeptible to a number of severe illnesses
        -People will receive an AIDS diagnosis if their CD4 count drops below 200 cells/mm, or if they develop certain infections
        
        Later effects of HIV/AIDs include....
        -AIDs associated dementia/encephalopathy
        -HIV wasting syndrome (chronic weight loss and diarrhea with no cause)
        
        Without treatment, people with an AIDS diagnosis typically die after 3 years
    - - -during this stage, the person will have a large amount of HIV in their blood supply
        -At this point, the infected person is very contagious
        
        -the person may experience flu-like symptoms due to acute seroconversion
        -generalized lymphadenopathy may be an initial symptom as your body attempts to mount an immune response
        
        This phase is identified by a CD4 T-cell count over 500/µL
  - - - -HIV specifically attacks CD4 cells, which are a type of WBC
        -HIV enters the CD4 cell and replicates
        -HIV then kills the CD4 cell, and enters another cell, repeating the cycle
- - - - Antibody Tests
        
        -These tests can detect antibodies in either blood or saliva
        -It can take 3-12 weeks after exposure for these tests to come back positive
        -These comprise most "rapid" HIV tests, including self-tests that can be done at home
      - Nucleic acid tests
        
        -These tests detect the actual HIV virus in your blood
        -These tests will be the first to become positive after exposure
        -Therefore, if you may have been exposed in the past few weeks, your health care provider will often recommend this test first
      - Antigen/Antibody Tests
        
        -involves drawing blood from a vein
        -Antigens are located on the HIV virus itself
        -Antigens are detectable in the blood within a few weeks of exposure
        -Antibodies will be produced by the immune system in response to HIV
        -Antibodies can take weeks to months to become detectable
        
        The combination of antigen/antibody tests may take 2-6 weeks to become detectable
  - - - Viral Load
        
        -This test functions by measuring the amount of the HIV virus in your blood (viral load)
        -After beginning treatment, the goal is to have an undetectable viral load
        -Having an undetectable viral load greatly reduces the chance for an opportunistic infection and other complications
      - Drug resistance
        
        -particular strains of the HIV virus are resistant to medication
        -testing for drug resistance helps your health care provider to determine if your specific strain of HIV is resistant
        -this will guide treatment decisions
      - CD4 T cell count
        
        -your CD4 T called are specifically targeted and destroyed by the HIV virus
        -Even with no symptoms, AIDS is diagnosed when your CD4 cell count drops below 200 cells/mm
  - - - -Tuberculosis
        -Hepatitis B or C
        -STIs
        -Liver or kidney damage
        -urinary tract infection
        -cervical and anal cancer
        -cytomegalovirus
        -toxoplasmosis
- - - - -ART is a combination of 3+ medications from several different classes
        -This approach is the best way to lower HIV levels in the blood
        -There are many options that combine all 3 medications in a pill that can be taken once per day
        
        -Each class of drugs helps block the virus in different ways
        -treatment involves combinations of drugs to:
        
        account for individual drug resistance
        
        avoid making new drug-resistant strains
        
        maximize viral suppression in the blood
        
        Classes of anti-HIV medications include:
        
        Protease Inhibitors
        
        -function by blocking the activity of HIV protease
        -protease is an enzyme that HIV needs in order to multiply
        -Therefore, by blocking HIV's ability to replicate inside of the CD4 cells
        
        EXAMPLES:
        -atazanavir (Reyataz)
        -darunavir (Prezista)
        -lopinavir/ritonavir (Kaletra)
        
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        Integrase Inhibitors
        
        -Integrase inhibitors rely on the fact that HIV requires integrase to replicate
        -without integrase, HIV is unable to overt take the CD4 cells and copy itself
        
        EXAMPLES:
        -bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy)
        -raltegravir (Istentress)
        -dolutegravir (Tivicay)
        
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        Nucleoside or Nucleotide reverse transcriptase inhibitors (NRTIs)
        
        -The first class of antiretroviral medications approved by the FDA
        -these drugs function by inhibiting reverse transcription
        -they do this by causing chain termination after being incorporated into viral DNA
        NOTE
        -These medications are taken as prodrugs
        -This means that they must be taken into the host cell and phosphorylated before they wull become active
        -Once they enter the host cell, cellular kinases will activate them
        
        EXAMPLES:
        -abacavir (Ziagen)
        -tenofovir (Viread)
        -emtricitabine (Emtriva)
        -lamivudine (Epivir)
        -Zidovudine (Retrovir)
        COMBINATION DRUGS
        -emtricitabine/tenofovir (truvada)
        -emtricitabine/tenovir alafenamide
        
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        Entry (fusion inhibitors)
        
        -Entry inhibitors function by preventing HIV to enter healthy CD4 cells
        -In order for HIV to enter CD4 cells. the proteins on the HIV virus must bind to proteins on the surface of CD4 cells
        -Entry (fusion) inhibitors prevent this binding
        
        EXAMPLES:
        -enfuvirtide (Fuzeon)
        -maraviroc (selzentry)
        
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        Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
        
        -NNRTIs bind directly to the active site of HIV reverse transcriptase
        -this alters its conformation and prevents DNA binding
        -this results in inhibition of viral replication
        
        EXAMPLES INCLUDE:
        -efavirenz (Sustiva)
        -Nevirapine (Viramune)
        -Etravirine (Intelence)
        -rilpivirine (Edurant)
        -doravirine (Pifeltro)
        
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        Maintaining Treatment
        
        -Remaining on ART with an undetectable viral load is the most effective way for a patient to remain healthy
        -In order for treatment to be effective, medications must be taken as prescribed
        -The patient should not be missing or skipping any doses
        
        Remaining on ART with an undetectable viral load helps to:
        
        help your immune system stay strong
        
        reduce your chance of infection
        
        reduce the chance of transmitting HIV
        
        Reduce the chance of developing treatment-resistant HIV
        
        -remaining on ART therapy can poses many challenges for the person
        -Talk to your health care provider about side effects, issues taking medications, or anything else that makes it difficult to maintain ART
        -Regular follow-up appointments are extremely important for monitoring the person's health and response to medications
        -inform your health care provider immediately if you are experiencing issues with treatement
        
        Treatment Side Effects Include:
        
        -heart disease
        -nausea, vomiting, or diarrhea
        -kidney and liver damage
        -weakened bones or bone loss
        -abnormal cholesterol levels
        -higher blood sugar
        -cognitive and emotional problems
        -sleep problems
        
        Age-relates Issues
        
        -Some issues that occur naturally due to aging may be more difficult to manage if you have HIV
        -Some drugs used for age-related bone, heart, or metabolic conditions may not interact well with ART medications
        -it is important to talk with your health care provider about other conditions and medications
        
        Treatment Response
        
        -Your health care provider will routinely monitor your CD4 cell count in order to determine your response to treatment
        -Initially your CD4 count will be checked at 2 and 4 weeks, and then every 3-6 months as needed
        -If effective, treatment will lower your viral load so that it is undetectable in the blood
        NOTE:
        -this does not mean that HIV is gone
        -However, it greatly decreases the risk of transmitting the disease to other people and the risk for obtaining other infections
  - - - Avoid food-borne illnesses
        
        -avoid raw meat, eggs, etc
        -Food-borne illnesses are especially dangerous in people with HIV
      - Receive the right vaccinations
        
        -Vaccines help prevent typical infections (ex. pneumonia)
        -Your health care provider may recommend additional vaccines (ex. HPV, Hep A and B)
        NOTE
        -inactivated vaccines are usually safe
        -However, vaccines with live viruses are not safe for patients with HIV
        -This is because they have a weakened immune system
      - Having a healthy diet
        
        -make sure that you are well nourished
        -receiving necessary nutrients provide energy and support the immune system
        -A healthy diet should consist of fruits, vegetables, whole grains, and lean protein
      - Choose Pets Carefully
        
        -some animals carry parasites that can cause additional infection in patients with HIV
        -wash hands thoroughly after handling pets or emptying a litter box
  - - - -There is no scientific evidence that suggest any nutritional supplement improves immunity
        -many supplements may interfere with other medications
        -it is important to check with your health care provider before taking any supplements
    - - Whey protein and specific amino acids
        
        WHEY PROTEIN
        -Research indicates that whey protein can help some patients with HIV to gain weight
        -Whey protein can also help reduce diarrhea and increase CD4 cell counts
        AMINO ACIDS
        -L-glutamine, L-arginine, and hydroxymethylbutyrate have also been shown to help with weight gain
      - Probiotics
        
        -Early research has shown that Saccharomyces boulardii may help with HIV-related diarrhea
        -This probiotic is only to he used as directed by your health care provider
      - Acetyl-L-carnitine
        
        -Researchers have used this to treat nerve pain, numbness, and weakness in patients with diabetes
        -This may also help with neuropathy experienced by HIV patients
      - Vitamins and Mineral Supplements
        
        -Taking supplements may be helpful for patients with low vitamin and mineral levels
        VITAMINS
        -A, D, E, C, and B
        MINERALS
        -zinc, iron, and selenium
    - - -Numerous practices such as meditation, yoga, and tai chi have been shown to reduce stress
        -These practices have also been shown to improve blood pressure and quality of life
- - - - YOUTH
        
        -In 2018, youth ages 13-24 made up 21% of the new 37,832 new cases
        -youth with HIV are the least likely group to be receiving HIV care and often do not have suppressed viral loads
        -Most new HIV diagnoses were among gay and bisexual men (6,284 cases)
        -A majority of the overall cases were contributed to men with 6,8219 cases
        -Young women accounted for 978 of these cases, and 936 were transmitted via heterosexual contact
      - PEOPLE AGED 50+
        
        -17% of the new 37,968 new HIV diagnoses in the US were among people 50 years and older
        -Most new HIV diagnoses were among men, accounting for 4,548 of the cases
        -Women accounted for 1,815 of the cases
    - - BLACK/AFRICAN AMERICANS
        
        -Black/African American people made up 42% or 16,002 of the new HIV diagnoses in the United States in 2018
        -Among Black/African American people most new diagnoses were men with 11,905 new cases
        -Women accounted for 3,758 cases
      - AMERICAN INDIANS/ALASKA NATIVES
        
        -of the 37,832 new HIV cases in the United States, less than 1% were among American Indians/Alaska natives
        -American Indians/Alaska natives represent approximately 1.3% of the US population, and about 0.5% of the HIV diagnoses in 2018
        -Men accounted for 151 of the new cases among this population and women accounted for 32 cases
      - ASIANS
        
        -Of the 37,968 new HIV diagnoses in the United States, 2% were among asians
        -Most new HIV diagnoses were among asian men, accounting for 771 cases
        -Women accounted for 104 cases
      - HISPANICS/LATINOS
        
        -Of the new 37,968 new HIV diagnoses in the United States, 27% were among Hispanics/Latinos
        -Most new diagnoses were among men, accounting for 8,977 cases
        -Women accounted for 1,269 of the cases
      - NATIVE HAWAIIANS AND OTHER PACIFIC ISLANDERS
        
        -Less than 1% of the 37,968 new HIV diagnoses in the United States were among this group
        -Men accounted for 63 of the cases
        -women accounted for 5 of the cases and were all due to heterosexual contact
    - - WOMEN
        
        -HIV diagnoses among women have been on a steady decline in recent years
        -However, in the United States, more than 7,000 women received HIV diagnoses in 2018
      - MEN
        
        -In 2018, men accounted for 81% (30,691) of new HIV diagnoses in the United States
        -86% of diagnoses among men were due to gay or bisexual intercourse
    - - Sexual intercourse
        
        -in 2018, the largest percent of HIV infections were from male-to-male sexual contact
        -These cases accounted for 67% of overall cases and 86% of cases among males
      - Perinatal Transmission
        
        -The annual number of HIV infections via perinatal transmission has declined over 95% since the early 1990s due to advances in medical technology and treatment
        -Of the 37,968 new HIV diagnoses in the United States in 2018, less than 1% were transmitted perinatally
        
        -Studies performed in 2018 showed perinatal transmission occurred most often in Black/African American Children, accounting for 65% of cases
        -White/caucasian children accounted for 14% of cases
        -Hispanic/Latino children accounted for 9% of cases
        -Children of multiple races accounted for 8% of cases
        -Asian children accounted for 5% of cases
      - Injection Drugs
        
        -a 2018 study showed that 32% of people who inject drugs share syringes
        -Among people who inject drugs, most new diagnoses were among men, accounting for 2,806 cases
        -Women who inject drugs accounted for 1,058 cases
- - - - -During this phase, HIV is till present in the body however at lower levels
        -For this reason, many people do not experience any symptoms at this time
        
        -This stage may last for many years, even over a decade if the person is not receiving ART
        -However, some people may develop a more severe form of the disease much sooner
    - - Mild infections or chronic signs and symtpoms may present as HIV continues to multiply and destroy CD4 cells
        
        SIGNS AND SYMPTOMS
        -Fever
        -Fatigue
        -Swollen lymph nodes
        -diarrhea
        -weight loss
        -oral yeast infection (thrush)
        -shingles
        -pneumonia
    - - -Many people develop a flu-like illness within 2-4 weeks of exposure
        -This illness, known as acute HIV, may last for a few weeks
        
        SIGNS AND SYMPTOMS
        -fever
        -headache
        -muscle aches
        -joint pain
        -rash
        -sore throat and painful mouth sores
        -swollen lymph nodes and glands
        -diarrhea
        -weight loss
        -cough and night sweats
        
        -These symptoms can be extremely mild, and may not even be noticeable
        -However, the amount of HIV in your blood is very high during this phase
        -the infection can spread very easily during this phase
    - - -When AIDS develops, your immune system has been extremely damaged
        -The risk for developing opportunistic infections/cancers greatly increases
        
        SIGNS AND SYMPTOMS
        -sweats
        -chills
        -recurring fever
        -chronic diarrhea
        -swollen lymph glands
        -persistent white spots or unusual lesions in the mouth and on the tongue
        -weakness
        -weight loss
        -skin rashes or bumps