NLE Immune System & Immunologic Disorders — Autoimmune Disorders and HIV/AIDSConcept Map

Related concepts

Concept connections

• Autoimmunity→Loss of Self-ToleranceAutoimmunity results from the failure of the immune system to distinguish self from non-self antigens, leading to aberrant activation of B cells and T cells against the body's own tissues
• Loss of Self-Tolerance→Autoantibody ProductionWhen self-tolerance is lost, B cells produce antibodies against self-antigens; these autoantibodies circulate and form immune complexes that deposit in tissues
• SLE→Type III Immune Complex DiseaseSLE is pathologically characterized as a Type III (immune-complex mediated) hypersensitivity reaction in which anti-DNA and anti-Smith antibodies form complexes that deposit in tissue, activating complement and causing inflammation
• Autoantibody Production→Immune Complex DepositionCirculating autoantibodies bind to self-antigens in the blood and deposit in tissues such as glomeruli, skin, and joints; complement fixation leads to inflammation and tissue damage
• Immune Complex Deposition→Lupus NephritisImmune complexes deposited in the renal glomeruli activate complement, causing glomerulonephritis characterized by proteinuria, hematuria, and progressive renal failure
• SLE Manifestations→Flare TriggersSLE follows a relapsing-remitting course; flares are provoked by identifiable triggers including UV exposure, infection, stress, fatigue, pregnancy, and cessation of medications
• Photosensitivity→Sun Protection EducationBecause UV exposure is a major flare trigger, nursing education must emphasize strict photoprotection using sunscreen SPF 30+, protective clothing, and avoidance of peak sun hours
• Hydroxychloroquine→Eye ExaminationsHydroxychloroquine carries the risk of retinal toxicity with prolonged use; baseline and periodic ophthalmologic examination are mandatory for early detection of retinopathy
• Scleroderma→Collagen FibrosisScleroderma is characterized by excessive deposition and crosslinking of collagen in the skin and internal organs, resulting in fibrosis, tissue stiffness, and organ dysfunction
• Raynaud Phenomenon→Cold ExposureRaynaud phenomenon is an episodic vasospastic response of peripheral blood vessels to cold or emotional stress, causing triphasic color changes (white-blue-red); it is often the earliest sign of scleroderma
• Esophageal Dysmotility→GERD and DysphagiaScleroderma-related fibrosis of the esophagus impairs peristalsis and reduces lower esophageal sphincter pressure, leading to chronic GERD and difficulty swallowing
• Sjögren's Syndrome→Exocrine Gland DestructionSjögren's is an autoimmune disorder in which lymphocytes infiltrate and destroy lacrimal and salivary glands, resulting in keratoconjunctivitis sicca and xerostomia
• Xerostomia→Dental Caries RiskLoss of protective saliva in Sjögren's syndrome dramatically increases the risk of rapid caries development; meticulous dental hygiene and regular dental follow-up are essential
• HIV→CD4+ T Helper Cell DestructionHIV is a retrovirus that targets and destroys CD4+ T helper lymphocytes (also called CD4+ T cells), the central coordinators of cell-mediated immunity; progressive CD4 depletion leads to immunodeficiency
• Reverse Transcriptase→HIV Genomic IntegrationHIV uses reverse transcriptase to convert its RNA genome into DNA, which then integrates into the host cell's DNA via integrase; this establishes persistent infection
• CD4 Count→Disease StagingCD4 count is the primary marker of immune status; normal is 500–1,600 cells/mm³; a count below 200 cells/mm³ defines AIDS and indicates severe immunodeficiency with high risk of opportunistic infections
• Viral Load→Disease Activity and TransmissibilityViral load measures the number of HIV RNA copies in the blood; higher viral load correlates with faster disease progression, greater infectivity, and the need for rapid ART initiation
• Window Period→Testing LimitationsThe window period is the interval between HIV infection and the point at which diagnostic tests can reliably detect it; during this period, a person is infected and infectious but may test antibody-negative, requiring repeat testing
• Opportunistic Infections→CD4 Count ThresholdDifferent opportunistic infections occur at specific CD4 thresholds; PCP typically occurs below 200 cells/mm³, while cytomegalovirus occurs below 50 cells/mm³
• PCP Prophylaxis→CD4 Below 200When CD4 count falls below 200 cells/mm³, co-trimoxazole prophylaxis is initiated to prevent Pneumocystis jirovecii pneumonia, the classic AIDS-defining opportunistic infection
• Tuberculosis→Philippine HIV ContextTB is a leading opportunistic infection and cause of death in people living with HIV in the Philippines; TB-HIV coinfection requires coordinated treatment with both antiretroviral and antituberculous therapy
• Antiretroviral Therapy→Combination TherapyART uses a combination of at least three drugs from two or more classes targeting different steps in the HIV lifecycle; combination therapy prevents the development of drug resistance
• ART Adherence→Viral SuppressionStrict, lifelong adherence to ART is critical for sustained viral suppression; missed doses allow viral replication and selection for drug-resistant mutants, leading to treatment failure
• Viral Suppression→U equals UWhen antiretroviral therapy achieves and maintains an undetectable viral load (usually below 50 copies/mL), the person with HIV cannot transmit HIV sexually to an HIV-negative partner; this is the U=U message
• PEP→72-Hour WindowPost-exposure prophylaxis (PEP) must be started within 72 hours of potential HIV exposure—ideally within 2 hours—and continued for 28 days to prevent infection; delayed initiation reduces efficacy
• PrEP→High-Risk IndividualsPre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine is offered to HIV-negative individuals at high risk of acquisition (sex workers, men who have sex with men, serodiscordant couples) under DOH programs
• PMTCT→Maternal Viral SuppressionPrevention of mother-to-child transmission (PMTCT) relies on ART during pregnancy to suppress maternal viral load; vertical transmission risk drops to below 1-2% with undetectable viral load
• Standard Precautions→Hand HygieneHand hygiene before and after every patient contact is the single most important element of standard (universal) precautions for preventing occupational HIV acquisition and other bloodborne infections
• Needlestick Injury→PEP EvaluationAfter a needlestick or mucous-membrane exposure to potentially infectious blood, the exposed healthcare worker should wash the site and immediately report for urgent PEP evaluation within 72 hours
• RA 11166→Confidentiality and Non-DiscriminationThe Philippine HIV and AIDS Policy Act of 2018 (RA 11166) mandates strict confidentiality of HIV status and prohibits discrimination in employment, education, healthcare, and travel; nursing practice must uphold these rights
• Voluntary HIV Testing→Age of ConsentUnder RA 11166, the age of consent for voluntary HIV testing was lowered to 15 years, with provisions for testing younger adolescents under specified conditions; this facilitates early detection and treatment initiation
• Transplant Immunosuppression→Rejection PreventionLifelong immunosuppression is necessary to prevent rejection of a transplanted organ; the challenge is balancing sufficient suppression to protect the graft with the risk of infection and malignancy from over-suppression
• Acute Rejection→Type IV HypersensitivityAcute transplant rejection is a Type IV (cell-mediated) hypersensitivity reaction in which T cells recognize foreign major histocompatibility complex (MHC) on graft endothelium, causing inflammation; it is often reversible with increased immunosuppression
• Calcineurin Inhibitors→Drug Level MonitoringCalcineurin inhibitors (cyclosporine, tacrolimus) have a narrow therapeutic window; therapeutic drug monitoring is required to ensure adequate immunosuppression while avoiding toxicity (nephrotoxicity, hypertension, tremor)
• Immunosuppression→Infection Risk in TransplantThe pharmacologic immunosuppression required to prevent rejection increases susceptibility to opportunistic infections; fever may be masked by corticosteroids, necessitating heightened infection vigilance
• Live Vaccines→Contraindication in TransplantLive vaccines are contraindicated in transplant recipients because the weakened vaccine strain may cause active infection in the immunosuppressed host; only inactivated vaccines should be administered
• Grapefruit Juice→Calcineurin Inhibitor LevelsGrapefruit juice inhibits cytochrome P450 metabolism of calcineurin inhibitors, raising serum levels and risk of toxicity; patients must be counseled to avoid grapefruit and grapefruit juice
• Multisystem Involvement→Holistic Nursing AssessmentBecause both SLE and HIV can affect multiple organ systems, comprehensive nursing assessment must evaluate skin, joints, kidneys, lungs, heart, nervous system, and hematologic function; single-system focus may miss critical complications
• Immunodeficiency→Opportunistic InfectionsBoth HIV/AIDS and iatrogenic immunosuppression in transplant recipients increase vulnerability to opportunistic infections; vigilant monitoring for fever, respiratory symptoms, neurologic changes, and GI symptoms is essential
• Chronic Inflammatory Disease→Patient EducationAutoimmune disorders like SLE and scleroderma are chronic conditions requiring lifelong management; patient education about disease course, triggers, medication adherence, and self-monitoring is foundational to nursing care
• Medication Adherence→Disease ControlWhether in SLE (immunosuppressants, corticosteroids), HIV (ART), or transplant (immunosuppressants), consistent medication adherence is essential for achieving therapeutic goals and preventing disease progression or rejection

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