Deck 24: Hiv and Aids

Question 1

Describe the pathophysiology of HIV infection.

Answer 1

Pathophysiology is defined as the medical symptoms, observations and treatments regarding a diseased state as well as the physiological processes and mechanisms of the host body.
Human immunodeficiency virus (HIV) is a retrovirus of about 0.1 micron diameter. This is a fatal virus which under uncontrollable conditions leads to AIDS (Acquired Immunodeficiency Syndrome). HIV has surface glycoproteins, which bind specifically to certain receptor proteins. It has a unique outer coat which keeps on changing.
The virus contains only 9 genes, of which 6 are essential to penetrate and infect the T-helper cells and produce copies of the virus. Other 3 genes are used to provide the necessary information to produce new viral particles in the host cell.
HIV is transmitted through the blood via sexual contact, blood transfusion, intravenous needle sharing or prenatally (from mother to child) through the mother's milk or through blood.
After reaching the body, the HIV identifies and targets CD4 cell and fuses to the surface. The HIV injects its ribonucleic acid (RNA), enzymes and other substances into the host that assist in viral integration and replication.
The HIV RNA is transcribed to DNA (deoxyribonucleic acid) particles by the action of reverse transcriptase enzymes. This newly formed DNA is then carried to the nucleus and integrated into the DNA of the host by integrase enzymes.
The host DNA has been infected with the viral DNA which, once activated, can command the cell to produce viral components. Protease enzymes cleave the viral proteins for assembly into viral cores. Once fully assembled, the newly formed virus is capable of budding out of the infected host cell and finds another host cell to destroy.
This is a vicious cycle, where the T-helper cell or CD4 cell manufactures, assembles and releases viruses after being infected by HIV. Thus, the immune system of our body is rendered dysfunctional and the disease gets graver in due course of time.

Question 2

What kind of virus is the human immunodeficiency virus (HIV)? Which types of cells does it target?

Answer 2

Human immunodeficiency virus (HIV) is a retrovirus of about 0.1 micron diameter. A retrovirus is an RNA (ribonucleic acid) virus, which contains RNA and reverse-transcripts a DNA (deoxyribonucleic acid) with the help of reverse-transcriptase enzyme. It integrates a part of its genome into the DNA of the host cell.
This is a fatal virus which under uncontrollable conditions leads to AIDS (Acquired Immunodeficiency Syndrome). HIV has surface glycoproteins, which bind specifically to certain receptor proteins. It has a unique outer coat which keeps on changing.
The virus contains only 9 genes, of which 6 are essential to penetrate and infect the T-helper cells and produce copies of the virus. Other 3 genes are used to provide the necessary information to produce new viral particles in the host cell.
HIV enters its host and multiplies in blood cells, weakening the immune system drastically. The HIV targets the T-helper cells or CD4 (Cluster of differentiation) lymphocytes which are responsible for adaptive immunity of the human body. Immune systems can be innate or adaptive.

Question 3

How is HIV infection treated?

Answer 3

Human Immuno-deficiency virus (HIV) infection damages and destroys our immune system. The Treatment of chronic HIV infection includes antiretroviral medications, prevention of and treatment for opportunistic events, modulation of the altered hormonal conditions, maintenance and restoration of the nutritional status.
Anti-Retroviral Therapy (ART) is recommended for adults, pregnant woman, infants and children diagnosed with HIV infection. ART is recommended for all HIV-infected individuals because this therapy reduces the risk of the disease progression. There are five classes of ART:
(1) Entry inhibitors prevent the HIV from binding to the host cell.
(2) Fusion inhibitors prevent the HIV from fusing onto the host wall.
(3) Nucleotide reverse transcriptase inhibitors alter the ability of reverse transcriptase enzyme from converting HIV RNA to HIV DNA.
(4) Integrase strand transfer inhibitors block the HIV enzyme integrase.
(5) Protease inhibitors block the HIV enzyme protease.
Opportunistic events or infections may occur as a result of immune dysfunction. Early treatment of these opportunistic infections can help to prevent nutritional decline and the disease progression.
Wasting syndrome is a syndrome, which occurs during the HIV infection. It causes rapid weight loss and Lean body mass loss (wasting). Several medications are there for the body weight loss as well as the depletion of hormones or nutrition. Androgens, appetite stimulants, hormone supplements or hypoglycemic agents may be given to the patient to cope up with the ailments. Proper exercise also helps.
Supplements and herbal medications should be taken only after getting the food habits checked by a specialized doctor. For example, large quantities of garlic or St. John's wort (Hypericum perforatum) should not be taken with any protease inhibitor.

Question 4

How do AVT medications affect the replication of HIV?

Question 5

Describe the lipodystrophy syndrome associated with HIV infection.

Question 6

List two factors that are predictive of disease progression. List one nutrition-related factor that is predictive of survival.

Question 7

What may be the etiology of insulin resistance in an individual being treated for HIV?

Question 8

Describe potential side effects of two medications used to treat HIV infection that could alter nutritional status.

Question 9

What is RE's body mass index? What do his anthropometric data indicate about his body composition?

Question 10

Describe two types of dietary interventions that may be required in treated HIV infection.

Question 11

Which assessment data support the diagnosis of lipodystrophy?

Question 12

Describe a non-nutrient intervention that is used to improve nutritional status.

Question 13

Which medications may contribute to lipodystrophy and/or insulin resistance?

Question 14

Describe how HIV infection and its treatment may contribute to insulin resistance and diabetes.

Question 15

Identify at least two nutrition problems suggested by the nutrition assessment and medical history. Determine the diagnostic term for each nutrition problem. Next, identify the etiology of each nutrition diagnosis. Finally, identify the signs and symptoms that support the evidence for the diagnoses.

Question 16

List the chronic diseases that HIV patients tend to develop with aging.

Question 17

Based on your PES statements, what would be your nutrition prescription and goals for intervention?

Question 18

What non-nutrient recommendations would you suggest that this patient, his physician, and his health care team explore in order to improve lipodystrophy-related discomfort and heartburn?

Question 19

Based on your intervention, what criteria would you monitor in this patient for improvement?