HIV/ AIDS

Description
HIV is the human immuno deficiency virus. It is the virus that can lead
to acquired immune deficiency syndrome, or AIDS.
o H Human This particular virus can only infect human
beings.
o I Immunodeficiency HIV weakens your immune system by
destroying important cells that fight disease and infection. A
"deficient" immune system can't protect you.
o V Virus A virus can only reproduce itself by taking over a
cell in the body of its host.

Human Immunodeficiency Virus is a lot like other viruses, including

those that cause the "flu" or the common cold. But there is an
important difference over time, your immune system can clear most
viruses out of your body. That isn't the case with HIV the human
immune system can't seem to get rid of it. Scientists are still trying to
figure out why.

We know that HIV can hide for long periods of time in the cells of your
body and that it attacks a key part of your immune system your Tcells or CD4 cells. Your body has to have these cells to fight infections
and disease, but HIV invades them, uses them to make more copies of
itself, and then destroys them.

Over time, HIV can destroy so many of your CD4 cells that your body
can't fight infections and diseases anymore. When that happens, HIV
infection can lead to AIDS.

To understand what AIDS is, lets break it down:

o A Acquired AIDS is not something you inherit from your
parents. You acquire AIDS after birth.
o I Immuno Your body's immune system includes all the
organs and cells that work to fight off infection or disease.
o D Deficiency You get AIDS when your immune system is
"deficient," or isn't working the way it should.
o S Syndrome A syndrome is a collection of symptoms and
signs of disease. AIDS is a syndrome, rather than a single
disease, because it is a complex illness with a wide range of
complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV

infection. People at this stage of HIV disease have badly damaged

immune systems, which put them at risk for opportunistic infections

(OIs).
You will be diagnosed with AIDS if you have one or more specific OIs,
certain cancers, or a very low number of CD4 cells. If you have AIDS,
you will need medical intervention and treatment to prevent death.
Causes
HIV causes AIDS. Two HIV strains have been identified: HIV-1 and
HIV-2. HIV-1 is the prototype virus and is responsible for most cases
of AIDS in the United States. HIV-2 is found chiefly in West Africa,
appears to be less easily transmitted, and has a longer incubation
period.

Susceptibility to infection is unclear. The presence of sexually

transmitted infections (STIs) with open lesions, such as herpes and
syphilis, may increase the patients susceptibility to viral entry.

People with cytomegalovirus and Epstein-Barr virus infections may

also be more susceptible because of an increased number of target
cells. Routes of transmission are through sexual contact (male to
male, male to female, female to male, and female to female); by blood
to blood or transfusion contact (generally blood products given
between 1977 and 1985); through the use of needles contaminated by
an HIV-infected person; by blood or other HIV-infected fluids coming
in contact with open lesions or mucous membranes; and by mother to
child during the in utero period, during delivery, or by breastfeeding.

The time from the onset of HIV transmission to the development of

AIDS varies from a few months to years. The median incubation period
is 10 years.

Pathophysiology
1. Human beings produce antibodies against specific infections.
2. When HIV infection takes place, anti-HIV antibodies are produced but
they do not appear immediately. This is called the window effect.
3. In some cases, antibodies to HIV become detectable 4 to 6 weeks after
infection.
4. When HIV is in circulation, it invades several types of cells the
lymphocytes, macrophages, the Langerhans cells, and neurons within
the CNS.
5. HIV attacks the bodys immune system.
6. The organism attaches to a protein molecule called CD4 which is found
in the surface of T4 cells.

7. Once the virus enters the T4, it inserts its genetic materials into the T4
cells nucleus taking over the cell to replicate itself.
8. Eventually the T4 cell dies after having been used to replicate HIV.
9. The virus mutates rapidly making it more difficult for the bodys
immune system to recognize the invaders.
10.
HIV infection progresses through several stages.
11.
The clinical course of HIV infection begins when a person
becomes infected with HIV through:
o sexual contact with infected person
o injection of infected blood or blood products
o Perinatal or vertical transmission.
Transmission
HIV is transmitted by three main routes: sexual contact, exposure to
infected body fluids or tissues, and from mother to child during pregnancy,
delivery, or breastfeeding (known as vertical transmission).There is no risk
of acquiring HIV if exposed to feces, nasal secretions, saliva, sputum, sweat,
tears, urine, or vomit unless these are contaminated with blood.It is possible
to be co-infected by more than one strain of HIVa condition known as HIV
superinfection.
Sexual
The most frequent mode of transmission of HIV is through sexual
contact with an infected person.Worldwide, the majority of cases of
transmission occur through heterosexual contacts (i.e. sexual contacts
between people of the opposite sex).However, the pattern of
transmission varies significantly between countries. In the United
States, as of 2009, most sexual transmission occurred in men who
have sex with men, with this population accounting for 64% of all new
cases.
Body fluids
The second most frequent mode of HIV transmission is via blood and
blood products. Blood-borne transmission can be through needlesharing during intravenous drug use, needle stick injury, transfusion of
contaminated blood or blood product, or medical injections with
unsterilized equipment
Mother-to-child
HIV can be transmitted from mother to child during pregnancy, during
delivery, or through breast milk. This is the third most common way
way in which HIV is transmitted globally.In the absence of treatment,
the risk of transmission before or during birth is around 20% and in
those who also breastfeed 35%. As of 2008, vertical transmission
accounted for about 90% of cases of HIV in children.With appropriate

treatment the risk of mother-to-child infection can be reduced to about

1%.Preventive treatment involves the mother taking antiretroviral
during pregnancy and delivery, an elective caesarean section, avoiding
breastfeeding, and administering antiretroviral drugs to the
newborn.Many of these measures are however not available in the
developing world.If blood contaminates food during pre-chewing it
may pose a risk of transmission.
Signs and symptoms
There are three main stages of HIV infection: acute infection, clinical latency
and AIDS.
Acute Infection
As early as 2-4 weeks after exposure to HIV (but up to 3 months later),
people can experience an acute illness, often described as the worst flu
ever. This is called acute retroviral syndrome (ARS), or primary HIV
infection, and its the bodys natural response to HIV infection. During
primary HIV infection, there are higher levels of virus circulating in the
blood, which means that people can more easily transmit the virus to others.
Symptoms can include:
Fever
Chills
Rash
Night sweats
Muscle aches
Sore throat
Fatigue
Swollen lymph nodes
Ulcers in the mouth
Clinical Latency
After the initial infection and seroconversion, the virus becomes less active
in the body, although it is still present.During this period, many people do
not have any symptoms of HIV infection. This period is called the chronic
or latency phase. This period can last up to 10 yearssometimes longer.
AIDS
When HIV infection progresses to AIDS, many people begin to suffer from
fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even
wasting syndrome at late stages. Many of the signs and symptoms of AIDS
come from opportunistic infections which occur in patients with a damaged
immune system.

HIV-Positive Without Symptoms

Many people who are HIV-positive do not have symptoms of HIV
infection. Often people only begin to feel sick when they progress
toward AIDS (Acquired Immunodeficiency Syndrome). Sometimes
people living with HIV go through periods of being sick and then feel
fine.
While the virus itself can sometimes cause people to feel sick, most of
the severe symptoms and illnesses of HIV disease come from the
opportunistic infections that attack a damaged immune system. It is
important to remember that some symptoms of HIV infection are
similar to symptoms of many other common illnesses, such as the flu,
or respiratory or gastrointestinal infections.
Common Opportunistic Infections
1. Pneumocystis carinii pneumonia
2. Oral candidiasis
3. Toxoplasmosis of the CNS
4. Chronic diarrhea/wasting syndrome
5. Pulmonary/extra-pulmonary tuberculosis
6. Cancers
a. Kaposis sarcoma affects small blood vessels and internal
organs
b. Cervical dysplasia and cancer. Researchers found out that
women with HIV have higher rates of this type of cancer. Cervial
carcinoma is associated with Human Papilloma Virus (HPV).
c. Non-Hodgkins lymphoma cancerous tumor of the lymph
nodes. This is usually a late manifestation of HIV infection.
Diagnostic Examination:
Normal
Abnormality
Test
Result
with Condition
Enzyme-linked
immunosorbent
Negative for
Positive for HIV
assay (ELISA)
HIV antibodies antibodies
and Western blot
B and T cell values
T lymphocyte
B cells: 65
decreased. CD4 counts
and B
4785/mL; CD4
less than 500/mL are
lymphocyte
T cells: 450
generally associated
subsets; CD4
1400/mL; CD4
with symptoms; CD4
counts, CD4
to CD8 T cell
counts less than
percentages
ratio: 1:3.5
200/mL are associated

Explanation
Positive ELISA
test is confirmed
by a Western blot

HIV infects cells

with the CD4
protein marker

with severe immune

suppression. Any
HIVinfected person
with a CD4 level less
than 200/mL is
considered to have
AIDS
Detects number of
copies/mL; test has a
lower limit of 400
Quantitative
Viral load:
copies/mL but can
assay that
polymerase chain Negative
reach levels at 30,000 measures amount
reaction (PCR)
copies/mL and higher; of HIV-1 RNA in
ultrasensitive assay
plasma
has a lower limit of 40
copies/mL
Other Tests: Complete blood count; HIV p24 antigen, viral culture, indirect
fluorescent antibody
PRIMARY NURSING DIAGNOSIS
Risk for infection related to immune deficiency
OUTCOMES. Immune status; Respiratory status: Gas exchange; Respiratory
status: Ventilation; Thermoregulation
INTERVENTIONS. Infection control; Infection protection; Respiratory
monitoring; Temperature regulation
Pharmacologic Treatment
AIDS Drugs are medicines used to treat but not to cure HIV
infection.
These drugs are sometimes referred to as anteroviral drugs.
These work by inhibiting the reproduction of the virus. There are two
groups of anteroviral drugs:
1. Reverse trancriptase inhibitors they inhibit the enzyme called
reverse transcriptase which is needed to copy information for the virus to
replicate. These drugs are:
1. Zedovudine (ZDV) Retirvir
2. Zalcitabine Havid
3. Stavudine Zerit
4. Lamivudine Epivir
5. Nevirapine Viramune
6. Didanosine Videx

2. Protease inhibitors. They work by inhibiting the enzyme protease which

are needed for the assembly of viral particles.
These drugs are:
1. Saquinavir Invarase
2. Ritonavir Norvir
3. Indinavir Crixivan
Nursing Management:
1. Health education The healthcare worker must:
o Know the patient
o Avoid fear tactics
o Avoid judgmental and moralistic messages
o Be consistent and concise
o Use positive statement
o Give practical advice
2. Practice universal/standard precaution
o There is a need for a thorough medical handwashing after every
contact with patient and after removing the gown and gloves,
and before leaving the room of an AIDS suspect or known AIDS
patient.
o Use of universal barrier or Personal Protective Equipment (PPE)
e.g., cap, mask, gloves, CD gown, face shield/goggles are very
necessary.
3. Prevention
o Care should be taken to avoid accidental pricks from sharp
instruments contaminated with potentially infectious materials
form AIDS patient.
o Gloves should be worn when handling blood specimens and
other body secretions as well as surfaces, materials and objects
exposed to them.
o Blood and other specimens should be labeled with special
warning AIDS Precaution.
o Blood spills should be cleaned immediately using common
household disinfectants, like chlorox.
o Needles should not be bent after use, but should be disposed
into a puncture-resistant container.
o Personal articles like razor or razor blades, toothbrush should not
be shared with other members of the family. Razor blades may
be disposed in the same manner as needles are disposed.
o Patients with active AIDS should be isolated.

The Four Cs in the Management of HIV/AIDS

1. Compliance giving of information and counseling the client which
results to the clients successful treatment, prevention and
recommendation.
2. Counseling/education
o Giving instruction about the treatment
o Disseminating information about the disease
o Providing guidance on how to avoid contracting STD again
o Sharing facts about HIV and AIDS
3. Contact tracing
o Tracing out and providing treatment or partners
4. Condoms
o Promoting the use of condom, giving instructions about its use,
and giving away available condoms