Exam 4 Study guide 

TB  phases pg 542
1.	Transmission- *airborne particles* are exhaled and infected person and inhaled by uninfected person 
2.	Primary infection – estimated that 30% of people exposed to TB become infected and develop a mild, pneumonia-like illness that is often undiagnosed. About 6-8 wks after exposure positive reaction to TB skin test. Within about 6 months of exposure, spontaneous healing occurs as the bacilli are encapsulated in calcified tubercles.  
3.	*Latent TB infection (LTBI) – immune system is able to stop bacterial growth in most. Bacteria  become inactive but remain alive in the body and can later become active. No symptoms, do not feel sick, do not spread TB to others, usually positive skin-test reaction.
4.	*Active TB- TB bacteria usually becomes active and causes TB when a person’s immune system becomes weak as result of a disease, immunosuppressive drugs or aging. 

TB drugs 

Isoniazid
Most common Isoniazid (INH) 
Nontoxic , bacterialcial, ralativley inexpensive can be given orally or by injection
Serious side effects* hepatotoxicity * and peripheral neuropathy 

Rifamipin
Bacterialcidal 
Adverse side effects GI upset, skin rashes, hepatitis, and a harmless red-orange discoloration of urine, tears and swear and other body fluids. 

*HIV patients do not give live vaccines *

HIV therapy

*HARRT (highly active antiretroviral therapy) 
Not a cure, but a slow progression very expensive*
Goal of therapy decreasing viral load ( less than 400 copies/ml) restore immune function, halt disease progression . 

Viral load- measure of number HIV RNA particles within the blood; it does not measure viral levels in tissues, where viral replication reproduction may be continuing  

A degree of adherence is required because lack of adherence may lead to lack of effectiveness an emergence of drug-resistant viral strands. 

NOT recommended to take herbal products with antiretroviral med. St. John’s wart decrease blood levels of some anti-HIV meds. Echinacea stimulates viral replication. Do not take abacavir or efavirenz with high-fat meal. 

Combination antiretroviral therapy is standard of care. commonly used three-drug regimen includes two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor (NNRTI) (most commonly efavirenz) or three NRTIs