Chapter 16- Acquired

Chapter 16- Acquired Immunodeficiency Syndrome Page 1

• While teaching about HIV/AIDS to a group of high school seniors, the school health

nurse will begin by explaining the basic facts that will likely include which of the following information?

• Like all viruses, HIV is a genetic material made from DNA with long molecules

that carry genetic information.

• HIV is different from other viruses since it is a retrovirus that selectively attacks

the body's immune cells.

• There are two types of HIV, but the one that is endemic to the United States is

HIV type 2.

• HIV type 1 for some reason rarely develops into full-blown AIDS.

Ans: B

Feedback:

HIV is a retrovirus that selectively attacks the CD4 + T lymphocytes, the immune cells responsible for orchestrating and coordinating the immune response to infection. It must change from RNA to DNA through a series of stages in order to get in a cell and begin replication. HIV type 2 is endemic in West Africa but is rarely seen in other parts of the world. People with HIV-2 tend not to develop AIDS.

• As part of her prenatal education, a 29-year-old woman who is pregnant with her first

child is receiving teaching from her primary care provider. Which of the following statements by the woman reflects an accurate understanding of HIV transmission?

• “I know my baby is safe from HIV while in the womb, but the delivery will place

him or her at real risk.”

• “It's discouraging to know that my breast milk can pass on HIV to my baby.”
• “I know it's possible, but it's comforting that the chances of my child contracting

my HIV are actually very low.”

• “I'm relieved to learn that a caesarean delivery will protect my baby from being

born HIV positive.”

Ans: B

Feedback:

Transmission from mother to infant is the most common way that children become infected with HIV. HIV may be transmitted from infected women to their offspring in utero, during labor and delivery, or through breast-feeding. Ninety percent of infected children acquired the virus from their mother. The risk of transmission of HIV from mother to infant is approximately 25%, with estimates ranging from 15% to 45%, depending on what country they live in.

Page 2

• A potential donor is angry at the personal nature of the questions about HIV risk factors

that he is required to answer at a blood collection center and states that simple blood testing should suffice. How can the nurse at the center best respond?

• “There are some very uncommon subtypes of the HIV virus that are not detectable

by current testing methods.”

• “There's a chance that persons who are asymptomatic, but HIV positive can have

their antibodies missed by serum testing.”

• “There's a period shortly after someone is infected with HIV when blood tests

might still be negative.”

• “Even though blood tests are completely accurate, the high stakes of blood

donation and transfusion mean that double measures are appropriate.”

Ans: C

Feedback:

The time after infection and before seroconversion is known as the window period, during which HIV antibody screening may be negative. Potential donors are thus screened to identify potential risk factors. Undetectable subtypes of HIV do not exist, and individuals who are asymptomatic are still able to be accurately tested.

• A 40-year-old male who has been HIV positive for 6 years is experiencing a new

increase in his viral load along with a corresponding decrease in his CD4 + count. Which of the following aspects of his immune system is likely to remain most intact?

• Presentation of major histocompatibility molecules on body cells
• Orchestration of natural killer cells as part of cell-mediated immunity
• Activation of B lymphocytes
• Phagocytic function of monocytes and macrophages

Ans: A

Feedback:

The expression of MHC on various cells of the body is not noted to be directly influenced by HIV. However, infected CD4 + cells are compromised in their ability to guide the action of NK cells, to direct phagocytic function of macrophages, and to present antigens that activate B cells.

Page 3

• A 19-year-old intravenous drug user was exposed to the HIV 3 weeks ago and is

experiencing a rapid proliferation in viral load. Which of the following statements best captures an aspect of the process of HIV replication that underlies this proliferation?

• Free HIV RNA is able to attach to the cell coat of CD4

+ cells.

• The cytoplasm of CD4

+ cells provides a protected environment for the replication of RNA by HIV.

• Expression of reverse transcriptase by CD4

+ cells allows replication of HIV cells rather than new lymphocytes.

• HIV is able to change its RNA into DNA to allow for replication by CD4

+ cells.

Ans: D

Feedback:

In order for the HIV to reproduce, it must change its RNA into DNA. It does this by using the reverse transcriptase enzyme. Reverse transcriptase makes a copy of the viral RNA and then in reverse makes another mirror-image copy. The result is double-stranded DNA that carries instructions for viral replication. HIV RNA does not directly attach to CD4 + cells, and RNA is not replicated by HIV itself in the CD4 +

cytoplasm. Reverse transcriptase is not produced by CD4 + cells, and CD4 + cells do not directly produce new lymphocytes.

• Utilizing the World Health Organization (WHO) framework of clinical categories for

persons with acquired immunodeficiency syndrome (AIDS) over 15 years of age, a visitor to the United States goes to a city clinic complaining of diarrhea, weight loss of 20 lb, and feeling like he is running a temperature. These manifestations have been occurring for the past 5 weeks. The nurse would identify this patient to be in which clinical stage?

• Stage 1
• Stage 2
• Stage 3
• Stage 4

Ans: C

Feedback:

Clinical stage 3 includes unexplained chronic diarrhea for greater than 1 month, persistent oral candidiasis, oral hairy leukoplakia, TB, neutropenia, anemia, and thrombocytopenia.

Page 4

• Which of the following patients would be considered to be in the latent period of HIV

infection?

• A 16-year-old prostitute who has open sores on her labia that drain purulent

secretions

• A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his

axilla and cervical neck region for the past 4 months

• A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood

that started 2 weeks ago

• A 24-year-old college student who has developed a chronic cough that will not go

away, even after taking two courses of antibiotics.

Ans: B

Feedback:

In the latent period, which can last up to 10 years, the CD4 + count falls gradually to approximately 200 cells/µL. Some people experience swollen lymph nodes that are chronically swollen for more than 3 months in at least two locations, not including the groin. The lymph nodes may be sore or visible externally.

• A person who has been diagnosed with HIV infection 12 years ago and still has a CD4

+

cell count of 800 cells/µL and a low viral load is considered clinical to be a

• rapid progressor.
• typical progressor.
• slow progressor.
• long-term nonprogressor.

Ans: D

Feedback:

There is a subset of slow progressors: the long-term nonprogressors, who account for 1% of all HIV infections. These people have been infected for at least 8 years, are antiretroviral naive, have high CD4 + cell counts, and usually have very low viral loads.They are being investigated to determine how they maintain viral suppression of HIV.

• A 39-year-old female with HIV infection has been characterized as a typical progressor

by her care team and is experiencing an increase in her manifestations and health complaints as her CD4 + count declines. Which of the following health problems would her care team most likely attribute to a cause other than her HIV?

• Her recent diagnosis of bacterial pneumonia
• Her esophagitis that has been linked to herpes simplex infection
• Her decreased bone density and recent fractures
• Her increasing confusion and disorientation

Ans: C

Feedback:

While pneumonia, esophagitis, and cognitive deficits are all well-documented manifestations of HIV, changes in bone density are less likely to be a direct result of the virus.