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 is the most important global infection associated with HIV infection

 

What is co infection

 

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

 

 

 

 

 

 

 

 

 

 

 

Immunodeficiency Disease

 

 

Other factors in immunodeficiency

 

 

HIV

 

 

Biology

 

 

Epidemiology

 

 

Risk groups

 

 

Other risks

 

 

Contagion

 

 

Evolution

 

 

Group I             Seroconversion illness

 

Group II            Asymptomatic phase

 

Group III            Persistent Generalised Lymphadenopathy

 

Group IV           Symptomatic infection

 

 

Clinical features

 

 

Diagnosis

 

 

Treatment

 

 

Prevention

 

 

Nursing Management

 

 

Health education and promotion

 

 

Prevention of nosocomial spread

 

 

Promote compliance

 

 

Other nursing measures

 

 

Psychosocial aspects