1. HIV Case 36
Andrea Sigrist

2. Patient Client Reason for Admittance Terry Long Sex: Male
Ethnicity: African American
DOB: 5/12
Age: 32
Height: 6’1”
Weight: 151 lbs
HIV positive (diagnosed 4 years ago)
Exhausted all the time
Sore mouth
Sore throat
Significant weight loss
Possible pneumonia per referring physician

3. Patient History Physical Exam
Stereopositive for HIV-1, confirmed by ELISA and Western Blot 4 years ago
Unknown contraction
Not currently undergoing treatment
Tonsillectomy at age 6
Appendectomy at age 18
Current medications; multivitamin, vitamin E, vitamin C, ginseng, milk thistle, echinacea
Quit smoking 5 years ago
Family history: father with angina, heart problems, high blood pressure (CAD, HTN)
General Appearance: Thin African American in no acute distress
Vitals: Temp 98.6F, BP 120/84, HR 92bpm, RR 18bpm
Heart: regular rate and rhythm
Nose: Mucosa pink without drainage
Throat: erythematous with white, patchy exudate
Extremities: good pulses, no edema
Skin: warm, with flaky patches
Chest/lungs: Rhonchi in lower left lung
Abdomen: nondistended, nontender, hyperactive bowel sounds

4. Lab Values Measure Normal Value Terry’s Value Reason for Concern
Albumin
3.6 – 5
3.6
Low levels are a sign of malnutrition
Prealbumin
19 – 43
6.0
Transferrin
200 – 400 17
Viral Load
29000
Elevated levels are a sign of an immune disorder
CD4
325 – 997
157
< 200 defines AIDS
BUN
8 – 26 11

5. Patient diagnosis and treatment
HIV for four years
AIDS
Clinical Cate
Oral thrush
No clinical evidence of pneumonia
Antiretroviral regimen
AZT (zidovudine) 200 mg every 8hr
Crixivan (indinavir) 800mg every 8hr
3TC Epivir (lamivudine) 150 mg every 12hr

6. What is Hiv?
Infection caused by the human immunodeficiency virus which destroys the immune system and makes it hard for the body to fight off infections
Transmitted through sexual contact, blood, and mother to child
People infected may not show symptoms for up to ten years, but can still infect others
Progresses to AIDS
There is no cure, but it can be treated
People infected with HIV will develop AIDS if not treated
A small amount of people develop AIDS slowly or not at all
Is a preventable infection

7. HIV tests
Western Blot
ELISA
Uses gel electrophoresis to separate specific HIV proteins being detected
After separation, the proteins are transferred to a membrane to be identified using antibodies that target a specific protein
HIV antigens are added to a sample of blood and antibodies react with the HIV virus
An enzyme linked to an antibody is added and reacts with the HIV antigen/antibody
A catalyst is added to change the color of the enzyme-linked complex

8. Risk factors for contracting hiv
Common Risk Factors
Terry’s Risk Factors
Sexual contact with an infected person
Unprotected sex
Coming in contact with blood of an infected person
Sharing needles
Blood transfusions
Mother to child by blood during delivery or breast milk
Worked as a nurse in a dialysis clinic
Numerous sexual partners
Use of recreational drugs

9. Prognosis HIV is a chronic condition
It will eventually completely destroy a person’s immune system
Progression depends on each individual
There are treatment options, but no cure
Can prevent complications and delay the progression of AIDS
Almost all people infected will develop AIDS
Lack of treatment is fatal
HAART (highly reactive antiretroviral therapy) dramatically increases how long an infected person lives, but is not a cure
The weakened immune system makes individuals more susceptible to infections and cancers

10. Treatment for hiv
Treatment
When to Start
Medications used in combination is the only way to control the virus
It is best to use three different medications from two different classes of drugs to avoid creating strains of HIV that are immune to single drugs
Symptoms become severe
CD4 count is below 500
Become pregnant
Have HIV-related kidney disease
Being treated for Hep-C

11. Medications 200 mg of zidovudine (AZT) every 8 hours
Types of Medications
Terry’s Medications
NNRTIs (Non-nucleoside reverse transcriptase inhibitors): disables proteins HIV needs to copy itself
NRTIs (Nucleoside reverse transcriptase inhibitors): faulty versions of building blocks HIV needs to copy itself
PIs (Protease Inhibitors): disable protease , which HIV uses to copy itself
Entry or fusion inhibitors: block HIV’s entry into CD4 cells
Integrase inhibitors: disables integrase which HIV uses to insert genetic material into CD4 cells
200 mg of zidovudine (AZT) every 8 hours
800 mg of indinavir (Crixivan) every 8 hours
150 mg of lamivudine (3TC Epivir) every 12 hours

12. Proposed use in HIV/AIDS
Supplements
Supplement
Proposed use in HIV/AIDS
Potential Risk
Vitamin C
Improve antioxidant capacity, increases iron absorption from non-heme sources
Increases urinary losses of oxalate and calcium
Vitamin E
Vitamin E may protect against toxicity and side effects from AZT (antiretroviral medications)
Can interfere with blood clotting. Cause nausea, diarrhea, muscle weakness, fatigue
Ginseng
Has anti-stress and anti-fatigue effects; May contain a protein with anti-HIV activity
morning diarrhea, insomnia, nervousness, depression, confusion, skin rashes and high blood pressure
Milk thistle
May prevent liver damage caused by HIV medications
Upset stomach, diarrhea, bloating, gas
Echinacea
Anticancer, immunostimulatory; stimulate immune system and promote CD4 cell activation
May inhibit metabolism of drugs using the cytochrome P 450 enzyme pathway
Multivitamin
Slows disease progression, increases CD4 count, lowers viral load values
None

13. Nutrition with hiv Terry’s Diet before Mouth Sores
Suggested HIV Nutrition
Breakfast/Lunch: 1-2 cups of cold cereal with ½ cup of whole milk
Dinner: Meat, potatoes or rice, tea or soda
Snacks: Pizza, candy bar, or cookies with tea or soda
1-2 beers or glasses of wine several times a week
Consume a healthy and balanced diet like healthy individuals
Calories should be 10% higher if untreated
Calories should be 30% higher during recovery
Take a daily multivitamin
If suffering from loss of appetite:
Eat several small meals
Exercise to stimulate appetite
Consume nutrition supplement beverage
Terry’s 24-hour Diet Recall
Sips of apple juice, 1 cup of yogurt, 1 cup of rice and gravy, sips of iced tea with sugar throughout the day

14. Alcohol and hiv
Studies show regular alcohol consumption is associated with an increase in the progression of HIV
The immunosuppressive effects of alcohol may cause CD4 count to fall below 200 cells
Still being researched, not a fact

15. Main concerns for terry
Problems
Suggestions
Not eating enough
Consumes a lot of sugar and soda
Alcohol consumption
Not taking medications
Place on pureed or soft food diet
Add nutritional supplement beverage
Vegetable juices
Soy or almond milks
Educate about programs that help pay for medications

16. GOALS
COURSE OF ACTION
Main goal is to get Terry his medications and get him taking them every day as directed
Educate about healthy diet and consequences of malnutrition and not taking medications
Get back on a normal diet
Start exercise routine
Have him meet with a Medication Assistance program
Create diet plan
Begin with soft/liquid diet
Progress to normal diet
Have Terry keep a food journal
Join a gym or fitness group
Join a support group

17. Questions?

18. References
AIDS (2012). AIDS Information, Education, Action, Awareness | CD4 (T-CELL) TESTS. AIDS Information, Education, Action, Awareness | HIV, AIDS Facts. Retrieved from
AIDS.org (2012). AIDS Information, Education, Action, Awareness | How is HIV Transmitted? AIDS Information, Education, Action, Awareness | HIV, AIDS Facts. Retrieved from
Boskey, Ph. D., E. (2011, September 6). HIV Testing - How Does a Western Blot HIV Test Work? Sexually Transmitted Diseases - STDs. Retrieved from
Carter, M., & AIDS Map (2010, May 17). HIV & AIDS Information :: Frequent alcohol use hastens HIV disease progression. HIV & AIDS Information :: Home. Retrieved from
Cooper, C. L., & Cameron, D. W. (2005). Effect of Alcohol Use and Highly Active Antiretroviral Therapy on Plasma Levels of Hepatitis C Virus (HCV) in Patients Coinfected with HIV and HCV. Oxford Journals | Medicine | Clinical Infectious Diseases. Retrieved from
FitDay. (2012). FitDay - Free Weight Loss and Diet Journal. Retrieved from ogSummaryTabs-Focus=Nutri
Mayo Clinic (2011, August 11). HIV/AIDS: Treatments and drugs - MayoClinic.com. Mayo Clinic. Retrieved from
Medline Plus (2012, May 30). HIV infection: MedlinePlus Medical Encyclopedia. National Library of Medicine - National Institutes of Health. Retrieved from
The Body (2005, January). Herbs, Supplements and HIV - TheBody.com. The Complete HIV/AIDS Resource - TheBody.com. Retrieved from
WebMD (2007). HIV & AIDS Symptoms: Weight Loss, Lack of Energy, Fever, and More. WebMD - Better information. Better health. Retrieved from
Web MD (2012). Drug Search from WebMD. WebMD - Better information. Better health. Retrieved from