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HIV inflammation within the Colon and Lymphoid Tissue

HIV inflammation within the Colon and Lymphoid Tissue. Marian K erbleski, RN UCSF AIDS Division San F rancisco G eneral Hospital. Disclaimer. none. Background.

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HIV inflammation within the Colon and Lymphoid Tissue

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  1. HIV inflammation within the Colon and Lymphoid Tissue Marian Kerbleski, RN UCSF AIDS Division San Francisco General Hospital

  2. Disclaimer • none

  3. Background • Despite receiving combination antiretroviral therapy, HIV persists in individuals in ‘hidden’ reservoirs of GUT and lymphatic tissues causing inflammation and damage to the immune system • The interaction with the immune system, HIV T-cells in the rectal, colon, ileum, and lymph nodes seem to give a clue to the on/off immune process, the HIV memory cells located in these reservoir tissues • Ultimately, these questions need to be answered before we have a ‘cure’ for HIV

  4. Objectives • Understand and explain to patients the risks and benefits of HIV research to obtain Colon (GUT) and Lymphatic tissue (Lymph node) • Identify two additional safety concerns in preparing HIV patients for Colon and Lymph Node procedures • Awareness that with HIV inflammation, the patient is at added risk for abnormal GI pathophysiology • Knowledge of ‘terms’ related to HIV labs, medications, cell entry and replication

  5. HIV related Terms • ARV’s (antiretroviral therapy • CD4, CD8, nadir CD4 • Viral replication (VL) • Inflammation • Reservoir tissue, memory cell • Cell entry • WBC • GUT tissue, intestinal lining • Lymph Node (LN)

  6. Theoretical Model of Cumulative HIV-related Disease Risk by CD4 Count

  7. Health of Immune System • Blood test to calculate the number and ratio of immune cells called CD4 and CD8 lymphocytes • Cell count and now ‘ratio’ is most important • Initial Biopsies of rectal tissues : clue to the inflammation process and CD4 • Colon and Ileum: preserve cells and replication

  8. Gut Mucosal Inflammation • A large portion of the body’s immune system resides in the lining of the intestines and colon • Protects the body from infections • Over action can cause Abnormal inflammation and gastrointestinal diseases • Increase risk for colon cancer • With HIV infection, immune cells living in the ‘gut’ may be reduced leading to abnormal barrier function • Current Research limitation: inability to preserve immune cells

  9. Colon & Rectal Biopsy risks • Bleeding • Several tissue biopsies taken (~30) • Avoid ASA and NSAIDS • Anemia risk, several blood draws with research visits • Preparation • Adequate housing and bathroom • Infection • Avoid any rectal insertion x 7 days • Discomfort

  10. Stool and Blood Samples • Additional stool samples brought in the day of procedure, not part of clinical care • Blood to be used for measurement of markers of inflammation and immune function (CD4 & CD8) • Inform patient that tissue is not stored as a ‘tissue bank’ • Blood results available under a ‘coded ID number’

  11. Persistent Inflammation and ImmuneDamage May Contribute to Clinical Risk Inflammation Residual Immune Dysfunction Co-Morbidities of Aging [CVD, Cancer, Bone, Liver, Kidney]

  12. Lymph nodes & HIV Infection • HIV persists mostly in lymphatic tissues: Lymph Node • Does HIV keep replicating in LN’s even when taking HIV medications and the VL cannot be measured in blood? • Is the HIV virus that is measured in blood actually coming from lymph Nodes? • Are lymph Nodes a site of persistent HIV replication

  13. Lymph Node Biopsy • • LN is size of a pea; under skin in groin • Same day procedure under local anesthesia • Important to understand if immune problems improve where HIV causes damage • Risks: • Discomfort • Scar • Infection, Bleeding • Swelling • Seroma (collection of fluid under the skin)

  14. LN Teaching Preparation • Assess CD4 • Coags (PT/PTT) • Surgeon not to burn LN tissue • Pt to understand to limit post activity • No work-outs • No Swimming • Incision=Scar= healing issues • Ice to site for 24 hours

  15. End of AIDS? HIV Cure? • HIV as a chronic disease • Success of antiretroviral Therapy • Motivation to take therapy as a lifelong therapy • Although ARV’s often restore CD4 counts, persistent immune dysfunction and inflammation persists • Functional cure in special subset populations: acute infection • Curative intervention has been slow

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