Immunodeficiency
Disease
* The inability to produce an
immune response to antigenic exposure.
* Immunodeficiency may be as
a result of an infection, drug therapy or inheritance.
* Includes defects in production
of antibodies, (hypogammaglobulinaemia), and complement activity. Also reduced
lymphocyte and phagocyte function.
* These features are produced
by many obscure syndromes not commonly known about.
Other factors in immunodeficiency
Steroids pregnancy post
graft treatment leukaemia cytotoxics
reduced bone marrow activity malnutrition immune-overload
thymectomy
HIV
Aetiology is a HIV retrovirus
which causes acquired immunodeficiency syndrome, (AIDS)
The sub types of the virus
are HIV - 1 and HIV - 2, (Type 1 is most common in the UK)
Fully recognised in 1981
The CD4 receptor on the T
helper lymphocyte
An RNA retrovirus using
reverse transcriptase
This results in imbalance
between T helper and T supressors
The virus replicates by
making a DNA copy of itself, (a provirus)
This is inserted in to the
host DNA
The DNA can them make new
viral proteins and RNA
Biology
HIV absorbs onto CD4 receptor site on the T helper cells
(Lymphocytes)
T Helper T
Suppresser B
Cell
Antibodies to fight infection
RNA Ribonucleic Acid - Goes
into DNA
No cure - management only
Epidemiology
Transmission - sex and blood
and to a lesser extent other body fluids.
West - homosexual men and drug abuse Africa - heterosexual, prostitutes and
perinatal
Liverpool in 1959 Incubation
of 1 - x years
Less in infants often just a
few months, 30% by 18 months
India/Nepal In
the West
Risk groups
Homosexual and bisexual men Women
with bisexual partners
Recipients of infected blood
or blood products
Parenteral drug abuses Babies
with risk group parents
Anyone who has more than one partner or who's partner has more than one
partner.
Also
HCPs avoid blood contact Gloves Care
with used sharps
Street shavers Tooth
brush or razor sharers Tattoos
Blood ceremonies Exchanges
of body fluid
Contagion
Blood to blood in dirty
needles etc Blood
to open wounds
Cuts with infected
instruments
Needle sticks - about 1% of
those infected develop infection
Blood transfusion and blood
products Drug
addicts
Sex Homosexual Heterosexual
Genital sex Oral
sex Seminal
fluid and vaginal secretions
Mother to Child - !5% risk in
UK 30% risk in third world
Placenta Birth
Breast feeding - further 14%
risk Give
zidovudine during pregnancy
Not social contact Not
insects
Don't share razors or tooth
brushes.
Evolution
1-14 years. Depends somewhat
on lifestyle factors.
Much of time patient looks
fine.
CDC 1992 Classification of
HIV disease uses groups I - IV
Group I Seroconversion
illness
Influenza type illness just
after infection
2 - 12 weeks after infection
About 90% of those infected
get seroconversion illness
Lasts for 1 day - 2 weeks Fever
Swollen lymph glands Diarrhoea,
headaches, sore throat
CD4 may drop during
seroconversion illness Infected
but immunocompetent
Group II Asymptomatic
phase
This may last for 10 years or
more
Asymptomatic but immune
damaged - CD4 around 300
Group III Persistent
Generalised Lymphadenopathy
Group IV Symptomatic
infection
HIV wasting syndrome -
progressive weight loss Aids related
complex
Full blown Aids
Clinical features
Progressive HIV
encephalopathy and neurological disease
Many opportunistic infections
- bacteria, viruses, fungi, parasites
Bacterial lobar pneumonia Reactivation
of latent herpes
Immune thrombocytopenia Tuberculosis
Diarrhoea Intermittent
fever
Night sweats Chronic
diarrhoea
Pneumocystis carinii
pneumonia Candida
Cryptococcal meningitis,
(fungal infection)
Various skin disorders, eg.
tinea, dermatitis
Widespread Kaposi`s (skin
cancer) Non
- Hodgkin`s lymphoma
Death usually occurs from
infection
Diagnosis
High risk groups Unexplained
immunodeficiency
Antibody test
May remain HIV antibody
negative for 9 - 12 weeks after infection
CD4 counts - normal 600 - 800
Treatment
Azidothymidine (AZT) seems to
slow down the progression of early symptomatic disease, (toxicity effects
include, bone marrow suppression, myopathy and encephalopathy).
Combination retroviral
therapy Symptomatic
support Avoid
pregnancy
Advise on breast feeding Check
for Hep B as well
Keep as healthy as possible Protect
from infections Antibiotics
Prevention
Only by Health Education Screening
Change in sexual behaviours,
(modes of viral transfer)
Change in drug taking behaviour,
preferably stop
Screening of blood products Vaccination
would be a good idea
Lock up unreliable infected
individuals
Nursing Management
Health education and promotion
Prevention of nosocomial spread
Barrier nursing Prevent
spread to others
Great care with body fluids Care
of sharps
Promote compliance
Other nursing measures
Reverse barrier nursing Avoid
infections
Early recognition and
treatment of infections - temperature
Close observation of
opportunistic infections
Daily shower Good
nutrition Rest
and exercise
Prevent pressure sores Mouth
care Encourage
chest clearance
ADLs Antibiotics
Prophylaxis of pneumocystis
with low CD4 counts
Fluid replacement for
diarrhoea Treat
TB
Look for skin cancers Keep
skin integrity
Terminal care
Psychology
Prejudices Acceptance
- Befriending - Compassion
Advise on help groups Arrange
for specialised counselling
Appropriate answers to
questions
Questions on HIV/AIDS
What is a retrovirus
What is a provirus
Name the receptor the HI virus adsorbed onto
What is the normal role of the T helper cells
Why can HIV be sexually transmitted
Why are male homosexuals a high risk group
What is vertical transmission
How may nurses be infected by HIV, what are the
risks to avoid
What is the incubation period for AIDS in the UK
among adults
What happens during the group II phase of HIV
infection
Why are HIV patients prone to diarrhoea
What form of fungal meningitis are HIV patients
prone to
Name a pneumonia caused by a protozoa HIV patients
may suffer from
What protozoa may cause encephalopathy in HIV
patients
Name a type of malignant tumour infected
individuals are at risk from
What does the term viral load mean
Does treating STD in the general population reduce
the spread of HIV
What is triple therapy
Why is triple therapy more effective then single
or double therapy
What is the prognosis without treatment
How many new cases of HIV are occurring every day