Chapter 85 HIV and AIDS

HIV and AIDS HIV: Human immunodeficiency virus AIDS: Acquired immunodeficiency syndrome HIV affects the work of the immune system and often leads to AIDS.

History of HIV/AIDS HIV-1 is the predominate strain of the virus that causes HIV/AIDS. An international team of researchers has concluded that HIV-1 was introduced to human populations when hunters became exposed to infected blood from a subspecies of chimpanzees native to west equatorial Africa. In 1982, AIDS was added to the list of conditions that are formally tracked by the Centers for Disease Control and Prevention (CDC).

Action of HIV HIV is an infectious human retrovirus that invades a healthy, normal cell. The virus overtakes the biosynthesis of existing cells to duplicate and spread HIV within the body. The retrovirus commonly invades T cells and B cells. The main cell affected by HIV is the helper T4 lymphocytes, better known as CD4 cells. Also as a direct consequence of the invasion, the individual is vulnerable to many opportunistic infections (OIs).

Human Immunodeficiency Virus

OIs Related to HIV/AIDS Bacterial infections Viral infections Protozoal infections Fungal infections Other conditions and complications Wasting syndrome malignancies (cancers) Neurologic conditions

HIV Medications Effective after entering a CD4 cell Nucleoside reverse transcriptase inhibitors (NRTIs) Nonnucleoside reverse transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs) Prevent HIV from entering CD4 cells Entry inhibitors (including fusion inhibitors) Integrase inhibitors Antiretroviral therapy

Transmission HIV is transmitted through infected body fluids. It can be passed to another through Unprotected sexual contact Sharing of infected needles Accidental exposure to infected blood Transmission from an infected pregnant woman to her fetus, and breastfeeding.

Question Is the following statement true or false? Nurses must strongly advocate HIV testing for all pregnant women.

Answer True Early detection and treatment of HIV/AIDS as part of maternal prenatal care can prevent HIV infection in the newborn. HIV-infected pregnant women should be treated for HIV because this reduces the risk of infection in the newborn.

Diagnostic Tests Preliminary testing if HIV is suspected: CD4 count, viral load Complete blood count, blood chemistries, urinalysis Testing for sexually transmitted infections (STIs) Testing for hepatitis, TB, or toxoplasmosis Testing for sensitivities or drug resistance to specific HIV medications HIV antibody testing, HIV antigen testing

Diagnostic Tests (cont’d) Nursing considerations and HIV testing An informed consent must be obtained from the client before testing. Pre- and posttest counseling is required regardless of the test results. Results cannot be given over the telephone. Ensure client confidentiality; it is essential. The laboratory must be approved by the state for HIV testing.

Signs and Symptoms of HIV Infection Rapid weight loss, lymphadenopathy Recurring fever, night sweats, diarrhea, anorexia General malaise, dry cough, oral thrush White spots on tongue, in mouth, or throat Herpes zoster infection or shingles, pneumonia Spots on or under the skin, inside the mouth, nose, or eyelids Memory loss, lipoatrophy, lipodystrophy

Signs and Symptoms of HIV Infection in Women HIV infection may be overlooked and attributed to genital ulcer disease, sexually transmitted infections, HPV infections, and pelvic inflammatory disease (PID). Other common HIV-related signs and symptoms include: Recurrent vaginal candidiasis Menstrual abnormalities, including amenorrhea or bleeding between periods Abnormal Pap tests Cervical cancer

Question Is the following statement true or false? Persons with HIV show symptoms immediately, and there may be no need for testing such individuals.

Answer False Persons with HIV can be asymptomatic for many years, and individuals who have not been tested may not know they are infected.

Treatment The main treatment concept is to use medications specifically designed to combat a part of the retroviral replication cycle of HIV. Antiretroviral drugs include Nucleoside/nucleotide reverse transcriptase inhibitors Nonnucleoside reverse transcriptase inhibitors Protease inhibitors, entry inhibitors, integrase inhibitors Immune-based therapies

AIDS HIV-positive individuals with a T-cell count below 200/mm3 belong in the group of individuals who may be considered to have a diagnosis of AIDS. Persons with HIV and certain OIs or cancers also are considered to have AIDS. AIDS is ultimately a terminal condition; the emotional, physical, and financial implications can be enormous.

Opportunistic Infections Candidiasis, cryptococcus, cytomegalovirus (CMV) Herpes simplex Histoplasmosis Mycobacterium avium complex (MAC) Pneumocystis carinii pneumonia (PCP) Toxoplasmosis A variety of other fungal, viral, and bacterial infections may also occur, causing constitutional disease and neurologic disorders.

Treatment The ideal approach to the management of AIDS involves prophylaxis and the early treatment of such infections when they occur. The use of antiretroviral medications has resulted in the decline or delay in the number of individuals who progress from HIV to AIDS. HIV/AIDS medication therapy demands strict adherence to a complicated regimen. The client and the nurse must be aware of the requirements of each medication.

Nursing Process Data collection Planning and implementation Nursing implications for clients with HIV Nursing implications for clients with AIDS Evaluation

Question Is the following statement true or false? HIV and its treatment can complicate the aging process.

Answer True Healthcare for the older population typically includes heart disease, hypertension, diabetes, cancer, and respiratory problems, which may need pharmaceutical or surgical therapies. Potentially hazardous drug interactions may occur.

HIV Exposure to Healthcare Workers Postexposure prophylaxis (PEP) Postexposure treatment Counseling, laboratory tests, and follow-up testing Always use Standard Precautions

End of Presentation