N 512 Disorders Of The Immune System Final Project Final Project This assignment entails the development of a PowerPoint Presentation (PPP) on your choice of an immunodeficiency disease incorporating evidence-based practice literature and reliable electronic sources.

N 512 Disorders Of The Immune System Final Project Final Project This assignment entails the development of a PowerPoint Presentation (PPP) on your choice of an immunodeficiency disease incorporating evidence-based practice literature and reliable electronic sources.

Example Discussion Approach

The underlying disease responsible for pneumocystis pneumonia would be Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Following the infection of the CD4 T lymphocytes, the genetic RNA code is released into the cell and is converted by the HIV produced reverse transcriptase enzyme into DNA (Cachay, 2019). The reverse transcriptase is error prone and easily mutates during the conversion of RNA to DNA (Cachay, 2019), allowing for HIV heterogeneity to develop rapidly (Hammer & McPhee, 2019).

Following the viral DNA entry into the cell’s nucleus and with help from the HIV integrase enzyme the viral DNA becomes integrated in the host chromosome (Hammer & McPhee, 2019). According to Hammer & McPhee, the integrated HIV DNA is referred to as “provirus” and depending upon the activation state of the host cell, the “provirus” could remain latent or become transcriptionally active (Hammer & McPhee, 219). When cellular activation occurs, it “triggers NF-kß which is a cytoplasmic transcription factor that migrates to the nucleus and initiates viral gene expression (Hammer & McPhee, 2019).

The HIV protein Nef is “abundantly expressed during infection and reroutes a variety of cell surface proteins to disrupt host immunity and promote the viral replication cycle” (Buffalo et al, 2019). Budding occurs when the “viral proteins and RNA are packaged at the infected cell’s exterior membrane” (Hammer & McPhee, 2019) and the budded virus is considered to be mature when “HIV protease cuts structural proteins in the virus and causes them to rearrange” (Cachay, 2019). There are 7 steps in the HIV life cycle 1) binding, 2) fusion, 3) reverse transcription, 4) integration, 5) replication, 6) assembly, and 7) budding (U.S. Department of Health and Human Services, 2020).

There are two main stages of HIV infection 1) Acute HIV infection and 2) Chronic HIV infection (Sax & Hirsch, 2019). The chronic HIV infection can be subdivided into three stages 1) Chronic infection without AIDS, 2) AIDS which is characterized by a CD4 cell count <200 cells/microL or the presence of any AIDS defining condition, and 3) AIDS and Advanced HIV infection which is characterized by a CD4 cell count <50 cells/microL (Sax & Hirsch, 2019).

There is a rapid viral replication and infection of CD4 cells and the HIV RNA levels are very high in early HIV infection (Sax & Hirsch, 2019). During the acute infection 60% of individuals with early HIV infection will be asymptomatic and symptomatic individuals may experience fever, lymphadenopathy, sore throat, rash, myalgia/arthralgia, diarrhea and headache (Sax & Hirsch, 2019). 

Depending upon the sensitivity of serologic tests, seroconversion can be detected within the first several weeks following HIV infection (Sax & Hirsch, 2019). Seroconversion is the development of detectable antibodies against HIV antigens (Sax & Hirsch, 2019) and after about 6 months of infection, the plasma viremia has reached a steady level known as the viral set point (Sax & Hirsch, 2019).

The chronic HIV infection without AIDS stage maintains a stable viral level with a progression in the decline of CD4 cells and the individual will present with no symptoms or generalized symptoms of fatigue, sweats, weight loss, and lymphadenopathy (Sax & Hirsch, 2019). As the CD4 cell counts decrease, individuals may present with oropharyngeal or vulvovaginal candidiasis, oral hairy leukoplakia, seborrheic dermatitis, bacterial folliculitis, methicillin-resistant staphylococcus aureus (MRSA), herpes simplex virus, varicella-zoster virus, human papillomavirus (HPV), and streptococcus pneumoniae (Sax & Hirsch, 2019).

When individuals present with some of these infections or a CD4 cell count <200 cells/microL they are considered to have AIDS (Sax & Hirsch, 2019). As the CD4 cell count declines to <50 cells/microL, immunosuppression allows for opportunistic illnesses, such as pneumocystis jirovecii pneumonia, esophageal candidiasis, Kaposi sarcoma, wasting syndrome, disseminated Mycobacterium avium, cytomegalovirus disease, cryptococcal meningitis, and encephalopathy, to occur more frequently (Sax & Hirsch, 2019).

The plan of care for D.S. following discharge from the hospital to the medical respite care floor at the homeless shelter would include continuation of antibiotic treatment, ART medications, and steroids. D.S would be monitored for fever, rash, difficulty sleeping, difficulty breathing, chest pain, coughing up blood, lip and/or nail beds turning b