1. Chapter 85: HIV and AIDS

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

3. 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 (SIV).
In 1982, AIDS was added to the list of conditions that are formally tracked by the Centers for Disease Control and Prevention (CDC).

4. Action of HIV
*HIV is an infectious human retrovirus that invades a healthy, normal cell.
*The virus uses its own RNA to change a healthy cells existing DNA into cells that replicate
*The retrovirus commonly invades T cells and B cells.
*lymphocytes are one of the 5 types of WBC’s which become the T cells, B cells and CD4 cells
*The main cell affected by HIV is the helper T4 lymphocytes, better known as CD4 cells.
* HIV destroys CD 4 cells
When the CD 4 cell count is below 200 and opportunistic sx have developed then AIDS Dx is confirmed*

5. Action of HIV Viral load/viral count
Amount of virus in the body is high**
HIV positive individuals are highly infectious**

6. Three Stages of HIV
Primary acute infection: occurs typically 2 to 4 weeks after initial exposure to the virus; flu-like symptoms such as sore throat, mild fever, aches, mouth ulcers, rashes, and night sweats may occur or person may be asymptomatic
Chronic latent infection; follows the acute phase; the virus becomes less active; viral load may be “clinically undetectable” but HIV is active and infectious
AIDS: last stage of the disease characterized by severe damage to the immune system

7. Transmission
HIV is transmitted through infected body fluids found inside the:
Mouth, Rectum
1. vagina
2. opening of penis
*standard precautions are the healthcare workers primary protective measures against infections carried by bodily fluids.
*rarely a healthcare worker has an accidental exposure to infected blood via a needlestick (*wash hands first)
**never recap a needle!!!!
**wear a gown if it’s a draining wound

8. Transmission It can be passed to another through
1.Unprotected sexual contact with infected person
oil or petroleum based lubricants can damage condoms*
2.Sharing of infected needles
3.Accidental exposure to infected blood
4. cleaning up the vomit of an infected person
Transmission from an infected pregnant woman to her fetus, and breastfeeding
1. *wear mask gown gloves if splashing may occur
2. *wash hands after client care

9. Body Fluids that Carry HIV
Blood
Semen
Pre-seminal fluid
Rectal fluids
Vaginal fluids
Breast milk

10. Box 85-1 Opportunistic Infections
Bacterial infections
Viral infections
CMV
Hep C
Protozoal infections
Fungal infections
candidiasis
Wasting syndrome
Chronic diarrhea
malignancies

11. Signs and Symptoms of HIV Infection
Fatigue
Rapid weight loss
*lymphadenopathy-persistent enlargement of lymph nodes
*Recurring fever, *soaking 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

12. Signs and Symptoms of HIV Infection
Neurologic complications lead to confusion, forgetfulness, depression, anxiety and difficulty walking
AIDS dementia complex AKA HIV associated neurocognitive disorders includes behavioral changes and diminished mental functioning, HIV assiciated kidney disease referred to as HIV Associated nephropathy*

13. Diagnostic Tests Preliminary testing if HIV is suspected:
ELISA (EIA) followed by Western blot
*false + may occur if they have had syphilis, lupus or Lyme disease
Window period can range from 2-8 weeks or about 25 days on average, months may be needed before an accurate HIV positive result is obtained
CD4 count, viral load
Complete blood count, blood chemistries, urinalysis
Testing for hepatitis, TB, or toxoplasmosis
Testing for sensitivities or drug resistance to specific HIV medications
HIV antibody testing, HIV antigen testing

14. Diagnostic Tests (cont.)
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

15. Signs and Symptoms of HIV Infection in Women
HIV infection may be overlooked and attributed to genital ulcer disease, sexually transmitted diseases, 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

16. HIV Medications *the current antiretroviral drug therapy has 5 classes
Each drug designed to attack different developmental cycles which usually results in a lower viral load*
*with strong suppression of the virus with multiple drug therapies, the immune system may be able to repair. Clients often increase their T cell count, decreasing susceptability to OI’s

17. HIV/AIDS Medications Effective after entering a CD4 cell
Nucleoside reverse transcriptase inhibitors (NRTIs)
Ex: zidovudine
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
Protease inhibitors (PIs)disable a protein that HIV needs for replication
Saquinavir
Side effects: hyperglycemia, bone loss, thrombocytopenia and leukopenia

18. HIV/AIDS Medications Prevent HIV from entering CD4 cells
Entry inhibitors (including fusion inhibitors)
Integrase inhibitors
Block a protein that the HIV uses to infect a CD4 cell
Also used in PEP prophylaxis
Antiretroviral therapy

19. 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.
*AIDS wasting: loss of about 10-12% of body weight with weakness, fever, chronic diarrhea for the past 35 days

20. Opportunistic Infections
Candidiasis
cryptococcus
Fungus found in the soil
cytomegalovirus (CMV)
Herpes simplex

21. Opportunistic Infections
Histoplasmosis
Fungal infection caused by inhaling spores of a fungus often found in bird and bat droppings
*s/s-blisters on lips, nose and mouth
Mycobacterium avium complex (MAC)
Pneumocystis jiroveci pneumonia (PJP)
Causes infections of the lungs
Toxoplasmosis
A variety of other fungal, viral, and bacterial infections may also occur, causing constitutional disease and neurologic disorders.

22. Treatment *must be compliant with treatment *prevent OI’s
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.
*altered oral mucosa
Lubricate the lips to prevent cracking and infection

23. Mortality Leading cause of death ages 25-44
Men who have sex with men (MSM) are the fastest growing population with HIV/AIDS*

24. Nursing Implications for Clients with AIDS
*condoms do not guarantee safe sex
Individuals in later stages of the disease are more likely to require special nursing care or total nursing care*
*the entire team, client, and family will evaluate the outcomes of care

25. Educating Family *proper disposal for sharps and contaminated objects
*oral progesterone (megace)as an appetite stimulant
*zinc supplements if taste is altered
Prevent foodborne illnesses:
1. thoroughly cook meats
2. choose foods low in fat
3. eat small, frequent meals

26. HIV Exposure to Healthcare Workers
Post-exposure prophylaxis (PEP)
Used within 72 hours or 3 days after a single high risk event
Post-exposure treatment
Counseling, laboratory tests, and follow-up testing
*test for antibodies immediately and in 3 months
Always use Standard Precautions

27. HIV Reporting State health department Partner-notification laws
Third party notification

28. Sexually Transmitted Infections (STI)
Chlamydia
Painful intercourse, burning with urination, purulent vaginal discharge
Viral STI’s-affected for life (herpes)
Gonorrhea
Caused by Neisseria gonorrhoeae
Men will have burning when urinating and yellow penile discharge
Women initially asymptomatic, eventually a yellow green purulent vaginal discharge

29. Sexually Transmitted Infections (STI)
Syphilis
Caused by treponema pallidum
3 stages, if untreated-lack of muscle coordination, poor vision and moderate dementia
Herpes-wear CONDOM!!!
Bacterial Vaginosis
s/s vaginal fishy odor
Tx with metronidazole

30. Lifetime Considerations r/t STD’s
1. cause infections that lead to PID
2.cause infertility
3. cause significant side effects and or death in newborns
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