Chapter 21: HIV and Other Immune Deficiencies

• HIV

o Etiology and Genetic Risk: the human immune deficiency

virus

o Effects of an HIV infection:

 The immune system becomes an HIV factory. Up to

10 billion virus particles are produced daily.

 Everyone who has AIDS has the HIV infection,

however; not everyone who has HIV infection has
AIDS.

 When a person is infected with HIV, the first

manifestations are fever, night sweats, chills,
headache, and muscle aches.

 Poor CD4 cell function as a result of HIV infection

leads to these immune system abnormalities:
Lymphoctyopenia, Increased production of
incomplete and nonfunctional antibodies, and
abnormally functioning macrophages.

 A diagnosis of AIDS requires that the person be HIV

positive and have either a CD4 count of less than
200 and/or an opportunistic infection.

o HIV Classification

 The person with HIV infection can transmit the virus

to others at all stages of the disease, but the recently
infected person with a high viral load can be
particularly infectious.

 Category A

• HIV positive, asymptomatic OR persistent

generalized lymphadenopathy OR acute HIV
infection with accompanying illness or history
of acute infection

 Category B

• Used to describe a patient who has HIV

infection who also has one or more of the
problems found in the chart
  Category C

• Used to describe an HIV positive patient who

has AIDS if any one of the health problems
listed on the chart

o HIV progression

 Development of AIDS ranges from months to years

 Personal factors that may influence progression to

AIDS include frequency of re-exposure to HIV,
presence of other STDs , nutritional status, and
stress.

o Incidence/Prevalence

 AIDS hits the hardest between 21 and 44 years

 Most AIDS cases are among men who have sex with
other men and persons of either gender who have
used injection drugs.

 HIV can occur at any age

 Women with HIV have a poorer outcome than men.

o Health Promotion and Maintenance

 The most important way to prevent the transmission

of HIV is education.

 Sexual Transmission

• ABC sex method (Abstinence, Be faithful,

Condoms)

• The virus concentrates most heavily in blood

and seminal fluids.

• More easily transmitted from infected male to

uninfected female

• Anal intercourse is the riskiest route!

• The higher the blood level of HIV, the greater

the risk for sexual and perinatal transmission.

• Safer sex practices: latex condoms, barriers,

 and gloves.

 Parenteral Transmission

• Clean a used needle and syringe with clear

water then bleach for 30 to 60 seconds

 Perinatal Transmission

• The risk for this type of transmission to infants

in pregnant patients with HIV infection is about
25% in women who are not using drug therapy
and only 8% for those using drug therapy for
HIV.

 Transmission to Health Care workers

• The best prevention for health care providers is

the consistent use of Standard Precautions for
all patients.

• Chart 21-4 pg. 369

 Testing

• All sexual active people should know their HIV

status

• Testing for antibodies or other features of the

virus this also helps play a role in prevention.

o Assessment

 History – ask about age, gender, occupation, and

where the person lives. Assess the health history
about receiving blood transfusions between 1978
and 1985 in the US. Ask about the sexual practices.

 Physical Assessment/Clinical Manifestations pg. 371

Chart 21-6

 Other Manifestations – AIDS wasting syndrome,

dementia, and skin changes

 Psychosocial assessment – assess the patient’s

anxiety level, mood, cognitive ability, level of energy,
self-esteem, and body image.

o Lab Assessment
  Lymphocyte Counts –

• WBC count less than 3500

• CD4 fewer than 500

 Antibody Tests – measure the patient’s response to

the virus

• ELISA - inexpensive and accurate test

 Viral load testing – measures the presence of the HIV

genetic material and viral proteins in the body

 Also check for hepatitis A, B, and C

o Drug Therapy pg. 376-378