Immune Disorders
Two immune deficiency disorders will be discussed in the following text, human immunodeficiency virus (HIV) and psoriasis. Pathophysiology, drug therapy, and adverse effects will be discussed. Furthermore, variations in each disease process will also be presented. The purpose of this discussion post is to further understand the disease process of HIV and psoriasis.
HIV
Human immunodeficiency virus is a viral infection that targets the CD4-positive Th cells, which are needed for the development of plasma cells and T cells. The result of this cell depletion results in a negative immune response. With the immune system suppression, the development of acquired immunodeficiency syndrome (AIDS) is possible (Huether & McCance, 2017), p. 194).
Drug Therapy
After HIV is diagnosed, the goal of action is to control the virus and prevent the progression to AIDS. Drug therapy is designed to do five things for the patient: suppress the viral load, restore the immune system function, maintain quality of life, prevent HIV related complications, and prevent HIV transmission (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 846).
Medication regimens have been designed and it is important to note the each patient responds differently. The different classes of drug regimens include: nucleoside reverse transcriptase inhibitors (NRTI), nonnucleaoside reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), fusion inhibitors, integrase trans transfer inhibitors (INSTI), and CCR5 Antagonists.
When using NRTI drugs such as, Ziagen, Videx, Emtriva, Epivir, Zerit, and Retrovir, it is important to know that they prevent the transcription of RNA into DNA (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 849).
When working with NNRTIs drug such as, Rescriptor, Sustiva, Intelence, Viramune, and Edurant, the drug binds to the reverse transcriptase and prevents the conversion of RNA into DNA Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 851).
Protease inhibitors target the cell replication in the later stages. They prevent the development of the polyproteins, which are needed to create new HIV RNA copies. Examples of PIs are Reyataz, Prezista, Lexiva, Crixivan, Kaletra, Viracept, Norvir, Invirase, and Aptivus (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 852).
Fusion inhibitors prevents HIV from entering the cells by blocking the fusion process of the virus to the membrane of the CD4 T cells. Fuzeon is the only available drug from this particular class (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 853).
The INSTIs available for use are Trivicy, Vitekta, and Isentress. These drugs prevent the HIVs DNA from entering the genome of the host cell. They are often used in conjunction with NRTI drugs (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 853).
The final drug class is the CCR5 Antagonists and Selsentry is the only medication amiable. This medication works on the membrane of CD4 T cells and prevents HIV from entering the cells by blocking the CCR5 receptors (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 854).
Each medication regimen is carefully selected for the patient. Each patient will have a different response. It is also important to note, the HIV is not curable, as no medication has been proven to eliminate the virus.
Pediatrics
Unfortunately, HIV in children is something that needs discussion. It can be detected and diagnosed in infancy. When infants contract HIV it it typically from their mother during birth. Treatment with drug therapy varies as children grow. Interactions may occur with food and other medications. Compliance and frequent follow ups are needed as these children are treated. Providing each child with a life full of quality and low adverse effects is essential (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 855).
Adverse Effects
Adverse effects depend vary depending on the patient’s medication regimen. For example, when patients are taking a NRTI they need to conscious of the development of gastrointestinal (GI) symptoms such as nausea, vomiting, and abdominal pain. These symptoms could be indicative of lactic acidosis with hepatic sweatosis. This rare side effect could lead to possible death. When taking NNRTIs, patients could also experience GI symptoms in addition to dizziness, difficulty concentrating, hallucinations, and odd dreaming. Liver function impairment is also a risk when taking NNRTIs. Gastrointestinal symptoms, as well as liver transmitases, are side effects related to PIs. Fusion inhibitors are administered via subcutaneous injections; therefore, a common side effect is irritation at the injection site. Rash and fever are another possibility. Adverse effects of INSTIs vary from headache, diarrhea, reduced renal function, and hypersensitivity. CCR5 antagonists can case hepatotoxicity, which can lead to a systematic allergic reaction. Because of this side effect, CCR5 antagonists are not recommended as a front line management of HIV (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 849-854).
Psoriasis
Psoriasis is the inflammatory process of the skin, scalp, or nails, in which their cell replication is faster than normal. For example, the epidermis usually sheds in a 14-20 time frame. With psoriasis, the epidermis sheds in 3-4 days. During this inflammatory process, the is a conflicting interaction between macrophages, fibroblasts, dendritic cells, natural killer cells, T helper cells, and regulatory T cells. This interaction leads to the production of inflammatory mediators. In addition, the epidermis and dermis become thicker than normal because of their cellular hyperproliferation, the alteration in kerotinocyte, and the expanded dermal vasculature. Skin cells no longer mature and keratinze, but instead thicken and plaque formation begins. Because cell metabolism is increased, their is an increase in blood flow to the skin. This causes redness and inflammation. The inflammatory process waxes and wanes depending on triggering factors (Huether & McCance, 2017, p. 1062).
When you hear psoriasis, one typically thinks of skin. It is also important for health care providers to be educated in psoriatic arthritis. Typically, it presents itself later in ones life, but it is possible that children can could experience it as well. Signs and symptoms include joint pain or stiffness (Van Onselen, 2013).
Drug Therapy
When treating psoriasis, medications are aimed at treating the inflammatory mediators. Treatment is aimed at restoring skin moisture, reducing cells turnover, and controlling pruritus. Each patient’s treatment is different and depends on the degree of severeness. In mild cases, topical corticosteroids, moisturizing creams, Vitamin D analogs, and keratolytic agents are utilized. Narrow-band ultraviolet light therapy is also used. In severe cases, a more systemic treatment approach is needed. Approved medications included methotrexate, acitretin, and cyclopsporine. New therapies are being developed as the pathophysiology of psoriasis is further learned. Such treatment includes biologics. The safety and efficiency of this drug group is still under investigation (Huether & McCance, 2017, p. 1062-1063).
Pediatrics
The pathophysiological process of developing psoriasis is the same for children as for adults. It is more often seen in adults over children. There is some genetic linking to psoriasis, but exact details are still unknown. Typically, environmental and systemic triggers will still begin the initial presentation. Triggers include infection, skin trauma, medications, hormonal changes, smoking, or alcohol (Vam Onselen, 2013).
When treating children with psoriasis, emollients are commonly used to help with skin dryness. Emollients also have an anti-inflammatory property that make them a first line treatment for children. Other options to treat are topical corticosteroids, Vitamin D analogues, ditheranol, tar, topical calcineurin inhibitors, and photosynthesis treatment. Thorough education is necessary for both the child and parents when treating psoriasis. Allowing the child to demonstrate putting on his or her own cream may be a beneficial activity. Psychological support may be necessary while the child is being treated (Van Onselen, 2013).
Reducing Side Effects
Side effects can be managed and reduced by seeking medical advice as soon as symptoms begin. By completing thorough education, encouraging follow-up, and avoiding triggering agents side effects can also be limited. Patients often have preconceived ideas that nothing can help them. It is important to recommend dermatology consultation when needed and to encourage each patient to be open to different therapies. Treatments do not work the same for each patient. Furthermore, patients need to be taught how to be compliant with their treatment (Renton, 2018).
Comparing HIV and Psoriasis
Immune disorders can be frustrating for patients. For HIV, the patient may have inner guilt or feelings of embarrassment depending on how they got HIV. Outsiders looking in may never know they have HIV, but the patient will feel like everyone knows and everyone is talking about them. Furthermore, patients with psoriasis may also feel embarrassed, but more because of the physical evidence. It may be difficult for these individuals to wear shorts or go swimming without feeling self conscious. It is important to show patients respect and to give support as they are facing maladaptive and physiological responses. By giving these patients a positive outlook, positive outcomes are more likely to follow.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.).
(2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.).
Ambler, PA: Lippincott Williams & Wilkins.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby.
Renton, C. (2018). Late-onset psoriasis: Diagnosis, assessment and management. British
Journal Of Community Nursing, 23(2), 58-63.
Van Onselen, J. (2013). Managing psoriasis in children and young people. Nurse Prescribing,
11(7), 330-336.
