immuno-disorders: immunodeficiency disorder

1. AQUIRED IMMUNO
DEFICIENCY SYNDROME

2. INTRODUCTION
• One of the world’s greatest public heath issue
• 4th among the leading cause of death world wide

3. AIDS
• AIDS results in destruction of the bod’s host defenses and
immune system
• HIV continues to be a major global public health issue,
having claimed 36.3 million [27.2–47.8 million] lives so
far.

4. Epidemiology
• There were an estimated 37.7 million [30.2–45.1 million]
people living with HIV at the end of 2020, over two thirds
of whom (25.4 million) are in the WHO African Region.
• In 2020, 680 000 [480 000–1.0 million] people died from
HIV-related causes and 1.5 million [1.0–2.0 million]
people acquired HIV.

5. Etiology and risk factors
• The etiological agent associated with AIDS is Human
Immunodeficiency Virus (HIV) (family-Retroviridae).
• Two viruses
• HIV 1
• HIV 1 Group M : 10 subtypes
• HIV 1 Group O
• HIV 2

6. Risk factors
• Sexual practices
• Heterosexual activity
• Homosexual men
• Unsafe sexual practices
• Exposure to blood and body fluids
• Transfusion of infected blood
• Transplantation of infected tissue or organs
• Use of injected drugs

7. Risk factors
• HIV transmission to health care
workers
• Needle stick/sharps injury
• Occupational exposure to blood and
body fluids
• Perinatal (vertical transmission)
• Pregnancy
• Vaginal delivery
• Breast feeding

8. Pathophysiology
A retrovirus possesses RNA – dependent DNA
polymerase .
HIV infects T helper cells, macrophages, and B cells
Once inside the host , HIV attaches to the target
cell membrane by way of its receptor molecule, CD4
The virus is uncoated , &the RNA enters the cell
The enzyme known as reverse transcriptase is
released, and viral RNA is transcribed into DNA

9. Pathophysiology
The newly created DNA moves into the nucleus
and the DNA of the cell
A provirus is created when the viral DNA
integrates itself into the cellular DNA or
genome of the cell
Once the provirus is in place, its genetic
material is no longer pure host DNA but is part
viral DNA
The cell may function abnormally . The host
cell dies , and viral budding occurs. The new
virus infects other cell

10. Attachment
Uncoating
DNA synthesis
Integration
Transcription
Translation
Cleavage
Budding
Pathophysiology

11. • The main target of HIV is T4 helper cells (CD4 T cells)
• The CD4 T cells are regulating cells in the immune
system (‘conductor’ of immune system)
• Loss of CD4 T helper cells results in significant decrease
in the coordinated immune activity.
• HIV infected person become highly susceptible for
infection

12. Co-factors for immune deficiency
Malnutrition Continued
substance
abuse
Allergic
conditions
Genetics Age
Pregnancy Gender Presence of
other
infections
Low
socioeconomic
status
Lack of
access to
adequate
care

13. Stages of HIV disease
1. Primary Infection (Acute/Recent HIV Infection,
Acute HIV Syndrome)
2. HIV Asymptomatic (CDC Category A: More Than 500
CD4 T Lymphocytes/mm3 )
3. HIV Symptomatic (CDC Category B: 200 to 499 CD4
T Lymphocytes/mm3)
4. AIDS (CDC Category C: Fewer Than 200 CD4 T
Lymphocytes/mm3 )

16. Opportunistic infections
Respiratory
system
• Pneumocystis
pneumonia
• Mycobacteriu
m avium
complex
• Tuberculosis
GI
manifestation
• Oral
candidiasis
• Wasting
syndrome
Oncologic
manifestations
• Kaposi’s
Sarcoma
• B-cell
lymphomas

17. Pneumocystis pneumonia

18. Oral candidiasis

19. Wasting syndrome

20. Kaposi’s Sarcoma

21. Opportunistic infections
Neurologic
manifestations
• Peripheral neuropathy
• HIV encephalopathy
• Cryptococcus
neoformans
• Progressive multifocal
leukoencephalopathy
• Central peripheral
neuropathies
Depressive
manifestations
• Irrational guilt and
shame
• Loss of self esteem
• Helplessness
• Worthlessness
• Suicidal ideation

22. HIV encephalopathy

23. Opportunistic infections
Integumentary
manifestations
• KS
• Herpes zoster
• Herpes simplex
• Molluscum
contagiosum
• Seborrheic
dermatitis
• Generalized
folliculitis
• Atopic Dermatitis
Endocrine
manifestations
• Infiltration and
destruction
Gynaecologic
manifestations
• Recurrent vaginal
candidiasis
• STD
• Ulcers and warts
• PID

24. Assessment and diagnostic findings
of infection
• Antibodies are detected, resulting in positive results and
marking the end of the window period
EIA (enzyme immunoassay)
• Also detects antibodies to HIV; used to confirm EIA
Western blot
• Measures HIV RNA in the plasma
Viral load
• These are markers found onlymphocytes. HIV kills CD4 cells,
which results in a significantly impaired immune system.
CD4/CD8

25. Results of HIV testing
Positive
Negative
Indiscriminate

26. Management of HIV
infection

27. Prevention of HIV infection

28. • Preventive
education
• Safe sexual practices
• Related reproductive
educations

29. Safe
sexual
practices
Abstain from sharing sexual fluids
Reduce the number of sexual partners
Use latex condoms & avoid reuse
Avoid using cervical caps or diaphragms with out using a
condom as well
Use dental dams for oral- genital or anal stimulation
Avoid anal intercourse
Patient education on non penetrative sexual activities

30. Safe
sexual
practices
Advise to avoid sharing needles, sex toys and blood
contaminated articles
Advise HIV-Seropositive patients to inform previous, present
partners about their positive status
Advise HIV-seropositive patients to avoid having
unprotected sex with another HIV seropositive person
Advise to avoid donating blood , plasma, body organs or
sperm

31. • Family planning
• Use of estrogen- oral contraceptives
• Use of intrauterine contraceptive devises
• artificial insemination
• Perinatal Antiretroviral therapy
• Breast feeding
Related reproductive education

32. •Transmission to health care
providers
• Standard precautions
• Post exposure prophylaxis
• Vaccinations

33. Standard precautions
Hand hygiene
Personal protective
equipment (PPE)
Soiled patient care
equipment
Environmental
control
Textiles and
laundry
Patient
resuscitation
Patient placement
Respiratory
hygiene/cough
etiquette

34. Post
exposure
prophylaxis
Alert supervisor
Identify the source
Report as quickly to the employee health services, ED
Give consent for baseline testing (Serology)
Get postexposure prophylaxis (4weeks)
Follow up post exposure testing at 1 month , 3 months ,
and 6 months and perhaps 1 year
Document the exposure

35. Vaccinations
• A vaccine efficacy trial was halted in September 2007,
after interim results showed that the vaccine being tested
did not protect against HIV and did not reduce viral load
after infection
• Cooperation among all nations continues to grow, and
resources are being allocated to develop a vaccine and to
create and support the infrastructure needed to facilitate
vaccine testing.

36. Medical management of
HIV infection

37. Medical management -Outcome
• To maintain the persons health
• Initiate and maintain an effective antiretroviral regimen
and prevent infectious complications

38. Medical management of HIV infection
• Maintain health
• Detailed laboratory and clinical assessment
• CBC
• Annual tuberculin test
• Chest X ray
• Pap smear
• Pregnancy test
• Screening for STI
• Hepatitis Antibody testing
• Testing for pathogens of opportunistic infections
• CD4 cell counts and viral load testing

39. Antiretroviral therapy
Nucleoside and nucleotide
analog reverse
transcriptase inhibitors
◦ Inhibits action of viral
reverse transcriptase, an
enzyme in the conversion
of RNA to DNA.
◦ Abacavir
◦ Didanosine
◦ Emtricitabine
◦ Lamivudine
Protease inhibitors
Blocks the function of the
enzyme protease needed for
viral formation and growth.
Atazanavir
Darunavir
Fosamprenavir
Lopinavir/Ritonavir

40. Nonnucleoside reverse
transcriptase inhibitors
(NNRTIS)
◦ Binds to viral reverse
transcriptase and disrupts
the conversion of RNA to
DNA
◦ Efavirenz
◦ Etravirine
◦ Nevirapine
Fusion inhibitors
Prevents viral entry.
Enfuvirtide
Integrase inhibitors
Blocks the action of the
viral enzyme integrase.
Raltegravir

41. Prevent infection
• Prophylaxis
• Pneumonia
• Tuberculosis
• CMV
• Candidiasis
• Cryptococcosis
• Histoplasmosis
• Pneumococcal vaccine
• Influenza vaccinee

42. Management of AIDS
Opportunistic infections

43. Management of AIDS
• Management of Opportunistic infections
• Bacterial
• Viral
• Fungal
• Protozoal
• Management of Neoplasms
• Kaposi’s sarcoma (KS)
• Non-Hodgkin’s Lymphoma
• Invasive cervical cancer
• Management of Other conditions
• HIV wasting syndrome
• HIV encephalopathy

44. Bacterial infections
• Pneumocystis pneumonia
• Sulfamethoxazole/trimethoprim (treatment of choice)
• Parenteral pentamidine
• Adjunctive corticosteroids should be started as early
• Alternative therapeutic regimens
• Mild to moderate
• Dapsone and TMP
• Primaquine plus clindamycin
• Atovaquone suspension
• Moderate to severe
• Primaquine plus clindamycin
• IV pentamidine
• The recommended duration of therapy for PCP is 21 days

45. • Mycobacterium Avium Complex
• Azithromycin (Zithromax) or clarithromycin (Biaxin) –(prophylactic
agents)
• Rifabutin (alternative prophylactic agent)
• Cryptococcal Meningitis
• IV amphotericin B with or without oral flucytosine (5-FC, Ancobon)
or fluconazole (Diflucan)- Current primary therapy
• Cytomegalovirus Retinitis
• Oral valganciclovir, IV ganciclovir,
• IV ganciclovir followed by oral valganciclovir,
• IV foscarnet, IV cidofovir, and
• the ganciclovir intraocular implant coupled with valganciclovir are
all effective treatments for CMV retinitis

46. • Other Infections
• Oral acyclovir, famciclovir, or valacyclovir-
herpes simplex or herpes zoster
• clotrimazole (Mycelex) oral troches or nystatin
suspension -Esophageal or oral candidiasis

47. Prevention of Opportunistic Infections
• TMP-SMZ (Bactrim, Cotrim, Septra) is an antibacterial agent
used to treat various organisms causing infection.

48. • Antidiarrheal Therapy
• Octreotide acetate (Sandostatin)- a synthetic analogue of somatostatin
• Chemotherapy
• Kaposi’s Sarcoma
• Radiation therapy
• Alpha-interferon
• Lymphoma
• Combination chemotherapy and radiation therapy
• Antidepressant Therapy
• Imipramine (Tofranil), desipramine (Norpramin), and fluoxetine
(Prozac)
• Psychostimulant such as methylphenidate (Ritalin)- to manage
adverse effects
• Electroconvulsive therapy

49. • Nutrition Therapy
• Oral diet, enteral tube feedings, or parenteral nutritional
support
• For patients with diarrhea, a diet low in fat, lactose, insoluble
fiber, and caffeine and high in soluble fiber is helpful
• Oral supplements should be lactose-free, High in calories and
easily digestible protein, low in fat with the fat easily digestible,
palatable, inexpensive, and tolerated without causing diarrhea

50. • Complementary and alternative modalities
• Spiritual or psychological therapies
• Nutritional therapies
• Drug and biologic therapies
• Treatment with physical forces and devices
• Supportive therapy

51. Nursing management

52. Nursing management
• Assessment
• History and examination
• Demographic details
• Complaints
• Nutritional status
• Skin integrity
• Respiratory status
• Neurologic status
• Fluid and electrolyte balance
• Knowledge level

53. Nursing management
• Nursing diagnosis
1. Ineffective airway clearance
2. Disturbed thought process
3. Acute pain
4. Imbalanced nutrition less than body requirement
5. Impaired skin integrity
6. Activity intolerance
7. Diarrhea
8. Risk for infection
9. Social isolation
10.Knowledge deficit
11.Discomfort

54. Interventions………………………..
• Your turn

55. Rehabilitation
• Teaching patients self-care
• Controlling infection
• Regular health care appointments
• Symptom management
• Nutrition
• Rest and
• Exercise
• Administer medications, including IV preparations
• Provide ongoing teaching and support for the patient and family
• Continuing care
• Maintain independence
• Introduction to community based organizations
• Home visit

56. Conclusion