Pathophysiology of the Human Immunodeficiency Viruses - Case Study Example

HIV Case Study Name Course/Unit Instructor 15 September 2012 Introduction Since it was discovered about 30 years ago, HIV has been identified as a retrovirus that destroys the body’s immune system (Porth, 2010). The destruction process of immune system associated with HIV in most cases involves destruction of CD4 T cells (Porth, 2010). As the CD4 T cell count decreases, the body becomes susceptible to opportunistic infections. The following is a case-study that details the patho-physiology of HIV in an identified victim known as M J. Why two antibody tests were carried out? Emergence of HIV has led to innovation of different laboratory methods (Shastry et al., 2008). In the case of M J, the two antibody-tests; immune-absorbent assay (ELISA) and Western blot, were carried out to detect and confirm presence of HIV in the victim (Sax, Cohen and Kuritzkes, 2012). In most cases, tests that are conducted to detect antibody responsible for HIV are categorized into two: screening assays that detect the infection and confirmatory assays that identify individuals not infected but who appear to have positive reactive screening test. As a result, ELISA test, which is a screening test, has high degree of sensitivity, while Western blot is a confirmatory test that has high specificity (Sax, Cohen and Kuritzkes, 2012). ELISA (high sensitivity) test produces few negative results that are false, while on its part, Western blot (high specificity) produces few positive results that are false. When these two tests are carried out on an individual, chances increase for generated results to be highly accurate, reliable, protect blood and help to diagnose HIV infection. Why AIDS manifest as reduced resistance? When compared to other diseases such as opportunistic infections, HIV appear to have a long latency period, that is, the time between infection and manifestation of symptoms (Kourtis & Bulterys, 2012). As a result, AIDS is in most cases likely to manifest itself as reduced resistance as compared to others. Difficulties in producing and testing vaccine against HIV infection The discovery of HIV virus provided an opportunity for stakeholders especially in the medical scientific fields to embark on a process of developing an effective vaccine to address the virus. But for about 20 years, no meaningful results have been realized that can help address the virus in terms of vaccines. A number of factors have been identified that make the process of developing a vaccine difficult. First, HIV has been found to have tendency of transforming its genetic materials from RNA to DNA immediately it infects cells (Dyk, 2008). Thereafter, the transformed genetic material is hid away within the CD4 T cells, where it becomes hard to find, although the genetic material in this environment is capable of producing more particles of HIV. What this means is that developing an effective HIV vaccine has to possess the ability of stimulating an immune response that is long-term in nature in order to curtail the production of HIV in the body it infects (Dyk, 2008). The second reason given is that when an individual gets infected by the HIV virus, the immune cells are profoundly destroyed. In successful vaccine studies, immune cells have been found to play an important role especially where they provide appropriate environment for vaccine to be successful (Lashley & Durham, 2009). The third reason is that HIV has genes that are diverse, where the three primary types, have different genes making the process of developing vaccine more complicated (Dyk, 2008). This is to say, the HIV genes demonstrate variability of their structures, both within and between patients, a situation that has disabled appropriate response of vaccines (Lashley & Durham, 2009). Reasons for M J peripheral neuropathy and confusion Studies that have been carried out have shown that increase of peripheral neuropathy among HIV individuals is caused by presence of numerous opportunistic infectious (Cichocki, 2009). These infectious damage the nerve endings. At the same time, drugs that are used to treat or manage HIV have been linked to related infections that contribute heavily to nerve damage among those with HIV (Cichocki, 2009). Besides, peripheral neuropathy manifest in most cases during late stages of HIV development as in the case of M J. As a result, the profound damage of nerve endings leads to occurrence of peripheral neuropathy. On the part of confusion, HIV victims experience great instances of emotional and psychological problems due to their health state, which in turn increase their anxiety, confusion, and depression (Cichocki, 2009). Conditions rare in diagnosing presence of AIDS There are symptoms that have become common with HIV infections. The symptoms, which sometimes constitute conditions, have been used for a long time to diagnose HIV among individuals. The conditions in most cases are categorized into two groups: short term or minor symptoms, and long-term of major symptoms (Ramaiah, 2008). Minor symptoms include unproductive chronic cough that does not respond to routine treatment, enlargement of lymph nodes, fungal infection of the mouth (candidiasis), and recurrent infections of herpes group of viruses (Ramaiah, 2008). Major conditions include prolonged diarrhea, cramp-like pain in the abdomen and vomiting, excessive loss of weight, continuous fever and increased sweating at night (Ramaiah, 2008). Diagnosis of MJ shows that the patient demonstrates common conditions used in detecting HIV. For example, loss of weight, non-productive cough, shortness of breath, perioanal lesion, and Pneumocystis carinii, tuberculosis, and host of other common signs (Dyk, 2008). Nevertheless, unusual case is identified, where part of the conditions identified include loss of appetite. This is a condition that is rare in diagnosis of HIV; it is a condition that cannot be entirely attached to HIV since it applies across different ailments and diseases (Edlin & Golanty, 2009). Therefore, in most cases, the condition is ignored or less considered. Apart from loss of appetite, it is also rare in most cases for anemia to be considered as a serious symptom of HIV especially in the initial stages of the disease (Edlin & Golanty, 2009). Anemia is linked to inadequate supply of red blood cells, which in most cases may not be suppressed until during the late stages of HIV development. How is HIV virus transferred from one person to another? HIV, which is one of the many human viruses, has been found to be exclusively derived from the human sources (Hannon, Pooler & Porth, 2009). This is to say, people act as sources of the virus in that those who have been infected actively secrete infectious viruses that are used to infect more people. As a result, individuals infected with HIV virus are potential sources of infectious viruses. Transmission of HIV virus takes place largely through body fluids that include blood, semen and vaginal fluid. In recent times, studies of breastfeeding HIV mothers have also indicated breast milk has the potential to transmit the virus from the infected mother to the child (Hannon, Pooler & Porth, 2009). Therefore, HIV viruses can be said to transmit often during sexual intercourse among straight, bisexual or heterosexual individuals. At the moment, heterosexual contact has been identified as the leading means of HIV transmission in many parts of the world (Ahluwala, 2005). Apart from sexual contact, it has been established that HIV transmit greatly through contact with blood or other body fluids, blood products or tissues of an infected person. The most common case here is that transmission of HIV occurs by inoculation through activities like needle sharing among individuals using illicit drugs, splashes of blood from victims like when accidents take place, or when blood contacts open wounds of infected individuals (Ahluwala, 2005). Besides, mucosal contact in most cases with infected person is likely to be another form of transmission. Lastly, there have been rare cases where people in hospitals have been given blood through (blood transfusion) that is infected with HIV (Ahluwala, 2005). In such cases, failure of proper blood screening has been identified as one of the primary reasons for such rare occurrences. Another credible method of transfusion is where the HIV virus transfers from an infected mother to her infant child. This may happen before, during and shortly after birth. One major means of transmission with this method is where the infected mother breastfeed the child without appropriate care. Developments in recent times have ensured this form of transmission is reduced through undertaking certain steps. For example, cesarean delivery and prenatal antiretroviral therapy is always infected among the infected expectant mothers (Ahluwala, 2005). Moreover, antiretroviral therapy is also administered to the newborn immediately after deliver. Numerous research studies have established that transmission mode for HIV vary between countries and regions; a situation that can be explained by different factors. According to Onyango (2008), transmission mode for HIV vary between developed and developing countries; where unlike developing countries, developed countries have good PMTCT care, have best treatment options, hence less cases of transmission. Furthermore, availability and accessibility of key economic and social facilities in developing countries tend to be limited to majority of people, thereby increasing vulnerability. The situation is further exacerbated by cultural factors that increase vulnerability of minorities and women in developing societies to exposure of HIV (Onyango, 2008). How reverse transcriptase inhibitor and protease inhibitor affect viral replication? Reverse transcriptase inhibitor and protease inhibitor act in different points in the replication of HIV virus (Barber, 2012). The use of these drugs is aimed at delaying the onset of resistance in any kind therapy adopted. The use of reverse transcriptase inhibitors is largely to block the action of reverse transcriptase, which is critical in enabling HIV virus enter the nucleus of human cell for further replication and spread (Barber, 2012). On its part, protease inhibitors are largely used to block the stage of viral replication in the cell in cases that viral RNA manages to make a copy of its genetic blueprint onto the DNA, where it is later carried to the nucleus of human cell (Barber, 2012). When used together, the two inhibitors dramatically decrease viral replication, halt disease progression and promote immune reconstitution. Conclusion Analysis of the case-study has successfully addressed the key questions that were part of the case-study. In summary, HIV has become an area of study that continues to draw enthusiasm and interest. Understanding patho-physiology of the disease is understood to be one way of dealing effectively with the disease. References Ahluwala, M. (2005). HIV/AIDS - Transmission, Prevention (New). New Delhi: Lotus Press. Barber, P. R. (2012). Essentials of Pharmacology for Nurses. Berkshire: McGraw-Hill International. Cichocki, M. (2009). Living With HIV: A Patient's Guide. North Carolina: McFarland. Dyk, A. C. (2008). HIVAIDS Care & Counselling. Johannesburg: Pearson South Africa. Edlin, G., & Golanty, E. (2009). Health and Wellness. Burlington: Jones & Bartlett Publishers. Hannon, R.A., Pooler, C., & Porth, C. M. (2009). Porth Pathophysiology: Concepts of Altered Health States. Philadelphia: Lippincott Williams & Wilkins. Kourtis, A. P., & Bulterys, M. (2012). Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding: Science, Research Advances, and Policy. New York: Springer. Lashley, F. R., & Durham, J. D. (2009). The Person with HIV/AIDS: Nursing Perspectives. New York: Springer Publishing Company. Onyango, D. (2008). Great Challenges to PMTCT in the South: The Role of the Developed Nations in Supporting Strategies That Work. Retrovirology, 5(1): 1-2. Porth, C. M. (2010). Essentials of Pathophysiology: Concepts of Altered Health States. Philadelphia: Lippincott Williams & Wilkins. Ramaiah, S. (2008). HIV / AIDS: Health Solutions. New Delhi: Sterling Publishers. Sax, P. E., Cohen, C. J., & Kuritzkes, D. R. (2012). HIV Essentials 2012. Burlington: Jones & Bartlett Publishers. Shastry, S., Katharia, R., Dubey, A., Elhence, P., & Chaudhary, R. K. (2008). Comparison of Western blot to rapid anti-HIV testing: Usefulness in Confirming True Positivity. Asian Journal of Transfusion Science, 2(1): 27-28. Read More