ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) DEFINITION AIDS is acquired, which means it is neither hereditary nor inborn.

It involves an immune deficiency. When a persons immune system breaks down, he or she becomes susceptible to many infections, which eventually lead to death. It is a syndrome, a combination of signs and symptoms that form a distinct clinical picture of disorder. HIV refers to the human immunodeficiency which causes AIDS. It is a retro virus belonging to the family of lentiviruses, which are sometimes called slow viruses. They are described as such because the time between infection and the appearance of symptoms tends to be much longer, allowing greater opportunity for these microorganisms to be transmitted to other hosts. The period between infection and the appearance of AIDS can take from 7 to 12 years. PATHOPHYSIOLOGY Human beings produce antibodies against specific infections. When HIV infection takes place, anti-HIV antibodies are produced but they do not become detectable immediately. This is called the window effect. In some cases, however, antibodies to HIV become detectable 4 to 6 weeks after infection. When HIV is in circulation, it invades several types of cells the lymphocytes, macrophages, the Langerhans cells, and neurons within the CNS. HIV attacks the bodys immune system. The organism attaches to a protein molecule called CD4, which is found on the surface of T4 cells. Once the virus enters the T4, it inserts its genetic materials into the T4 cells nucleus, taking over the cell to replicate itself. Eventually, the T4 cell dies after having been used to replicate HIV. The virus mutates rapidly, making it more difficult for the bodys immune system to recognize the invaders. HIV infection progresses through several stages. The clinical course of HIV infection begins when a person becomes infected with HIV through: 1. Sexual contact with an infected person 2. Injection of infected blood or blood products, and 3. Perinatal or vertical transmission

MODIFIED CLASSIFICATION (STAGES) OF HIV INFECTION (U.S. CDC) CLINICAL STAGE 1: ASYMPTOMATIC Asymptomatic/acute HIV infection characterize by genera lymphadenopathy CLINICAL STAGE 2: EARLY (MILD) Weight loss greater than 10% of body weight Minor mucocutaneous manefistation, like; a. b. c. d. e. Seborrhic dermatitis Fungal nail infection Recurrent oral ulceration Angular cheilitis Recurrent respiratory infection (rhinitis, tonsilopharyngitis)

CLINICAL STAGE 3: INTERMEDIATE (MODERATE) Weight loss greater than 10% Chronic unexplained diarrhea for more than one month Oral candidiasis (thrush) Oral hairy leukoplakia Severe bacterial infection, like pneumonia CLINICAL STAGE 4: LATE (SEVERE) AIDS HIV wasting syndrome Pneumocystis carinii pneumonia Toxoplasmosis of the brain Cryptosporidiosis with diarrhea for more than one month Herpes simplex virus infection Progressive multifocal leukoencephalopathy Disseminated endemic myocosis

HIV infection

Acute illness (fever, rash, joint and muscle pain, sore throat)

Chronic illness Opportunistic infections Weight loss, diarrhea Lympadenopathy, fatigue

AIDS Kaposis sarcoma Pneumocystis carinii Pneumonia Cryptococcal meningitis

SIGNS AND SYMPTOMS A person may remain asymptomatic, feeling and appearing healthy for years even though he or she is infected with HIV. While he or she does not exhibit AIDS, the immune system starts to be impaired. The person may exhibit neurological symptoms such as memory loss, altered gait, depression, sleep disorders, and gastrointestinal symptoms such as chronic diarrhea. This set of symptoms is often called AIDS- related complex (ARC) by clinicians. As the symptoms progress, the patient becomes an AIDS patient. Normal CD4 count ranges from 500-1500. The CD4 count is a criterion that determines whether the client is HIV positive or whether the illness is already categorized as AIDS. A viral load of less than 10,000 is considered low, and a viral load of more than 10,000 is high. The higher the viral load, the faster the CD4. T-cells are killed by HIV. Thus, a CD4 count of 230 viral load of 350,000 would be considered of a serious risk for disease progression to AIDS and HIV and treatment is absolutely indicated. MINOR SIGNS 1. 2. 3. 4. 5. 6. Persistent cough for 1month Generalized pruritic dermatitis Recurrent herpes zoster infection Oropharyngeal candidiasis Chronic disseminated herpes simplex infectin Generalized lymphadenopathy

MAJOR SIGNS 1. Loss of weight 10% of body weight 2. Chronic diarrhea for more than one month 3. Prolonged fever for one month TOP 10 SYMPTOMS OF HIV/AIDS 1. 2. 3. 4. 5. 6. 7. 8. Depression Diarrhea Thrush Weight loss Lipodystrophy (fat redistribution syndrome) Sinus infection Fatigue Nausea and vomiting

9. Lactic acidosis lactic acid builds up in the clients body due to damage in the mitochondria, the power house of the cell 10. Burning and tingling of the feet and hands ( peripheral neuropathy ) COMMON OPPOTUNISTIC INFECTIONS 1. Bacterial a. MAC mycobacterium avium complex, a TB-like manifestation tha usually occurs when the patients CD4 count is below 50 b. Tuberculosis c. Salmonillosis 2. Viral a. Herpes b. Hepatitis c. Genital warts d. CMV(cryptomegalovirus) can cause retinitis, pain on swallowing and numbness of the legs. This can be transmitted through semen, vaginal secretions, blood and breast milk. e. Molluscum contagiosum a disease of the skin and mucous membranes characterized by dome-shape papules that usually occur on the face, trunk and extremities. 3. Fungal a. Candidiasis b. Cryptococcal meningitis c. Histoplasmosis- small lesions that appear on the skin usually transmitted by direct contact; it is autoinoculable. The organism is resistant to treatment. When the CD4 count falls below 200, lesions tend to proliferate and start to spread. Other symptoms are fever, adenopathy, cough, shortness of breath, and weight loss. 4. Pneumonias a. Bacterial b. Pneucystis carinii pneumonia(PCP) an atypical type of pneumonia 5. Cancers a. Kaposis sarcoma- a cancerous lesion caused by overgrowth of blood vessels. KS typically appears as painless pink or purple spots or nodules on the surface of the skin or oral cavity. It can also occur internally, especially on the intestine, lymph nodes, and lungs. The cancer can spread and can also attack the eyes.

b. Cervical dysplasia and cancer researchers found out that women with HIV have higher rates of this type of cancer. Cervical 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 the HIV infection. 6. Parasitic a. Toxoplasmosis Parasitic disease that causes neurologic symptoms b. Cryptosporidiosis is cause by the microscopic parasite cryptosporidium, commonly known as crypto. It can cause severe illness in people with HIV. If the CD4 count is below 200, crypto may cause symptoms for a long time. If the CD4 count is above 200, symptoms may appear only for one to three weeks. Cryptosporidiosis spreads by having contact with feces containing crypto. It is not transmitted by contact with blood. There is no drug cure for crypto. However, anti-retroviral medicines decrease or get rid of symptoms. SIGNS AND SYMPTOMS Watery diarrhea Abdominal cramps Low-grade fever Weight loss due to persistent diarrhea

PREVENTIVE MEASURES AGAINST CRYPTO 1. 2. 3. 4. 5. Wash hands thoroughly after contact with feces Practice safe sex Be careful not to swallow water when swimming Wash and/or cook food properly Drink safe water

MODE OF TRANSMISSION 1. Sexual intercourse 2. Blood transfusion and sharing of infected syringes and needles among intravenous drug users 3. Vertical or perinatal transmission ( from a pregnant woman to the fetus during pregnancy, child delivery, or breast feeding) There are several ways of receiving infected blood: 1. Blood transfusion 2. Sharing of unsterilized syringes and needles used for intravenous injection

3. Transmission during pregnancy a. May be transplacental b. There is greater risk of transmission when the mother has develop advanced AIDS 4. Organ donation 5. Accidental exposure in hospitals or clinics DIAGNOSTIC EXAMINATION 1. 2. 3. 4. 5. 6. EIA or ELISA enzyme linked immunosorbent assay Particle agglutination (PA) test Western blot analysis confirmatory diagnostic test Immunofluorescent test Radio immune-precipitation (RIPA) HIV antibody test When HIV antibodies are not detectable at the time of examination, it is considered a negative antibody test. When HIV antibodies are present in the blood in the positive antibody test the person is considered HIV-positive

TREATMENT MODALITIES AIDS drugs are medicines used to treat but not cure HIV infection. These drugs are sometimes referred to as anti-retroviral/anteroviral Drugs. These work by inhibiting the reproduction of the virus. There are two groups of anteroviral drugs-reverse transcriptase inhibitors and protease inhibitors: 1. Reverse transcriptase inhibitors they inhibit the enzyme called reverse transcriptase, which is needed to copy information for the virus to replicate these drugs are: a. Zedovudine (ZDV) Retirvir b. Zalitabine Havid c. Stavudine Zerit d. Lamivudine Epivir e. Nevirapine viramune f. Didanosine Videx 2. Protease inhibitors. They work by inhibiting the enzyme which are neede of viral particles. These drugs are: a. Saquinavir invarase b. Ritonavir norvir c. Indinavir crixivan

NURSING MANAGEMENT 1. Health Education. The health care worker must: a. Give practical advise b. Inform the client of the disease process and the mode of transmission c. Emphasize the AIDS awareness program d. Avoid judgemental and moralistic messages e. Be consistent and concise in giving instructions, especially those about taking medications f. Use positive statement g. Encourage client to trace or identify previous contacts for proper management 2. Practice universal/standard precaution a. There is a need for a thorough medical handwashing after every contact with each patient and after removing the gown and gloves, and before leaving the rooms of an AIDS suspect or known AIDS patient. b. Use universal barriers or personal protective equipment (PPE) e.g., cap, mask, gloves, CD gown, face shield/ googles, is very necessary. 3. Prevention a. Care should be taken to avoid accidental pricks from sharp instruments contaminated with potentially infectious materials from an AIDS patient. b. Gloves should be worn when handling blood specimens and other body secretions, as well as surfaces, material, and objects exposed to them. c. Blood and the other specimens should be labelled with a special warning such as AIDS Precautions d. Blood spills should be cleaned immediately using common household disinfectants, such as chlorox e. Needles should not be bent after use, but should be disposed into a puncture resistant container. f. Personal articles, like razor or razor blades and toothbrushes, should not be shared with other members of the family. Razor blades may be disposed in the same manner as needles. g. Patients with active AIDS should be isolated. h. Clients considered at risk HIV should not be allowed to donate blood or any organ of the body. i. Encourage monogamous relationships j. HIV-infected pregnant women should go into regular prenatal, interpartal, and postpartal care. k. Speak openly with partners about safer sex techniques and HIV status.

COMMON NURSING DIAGNOSIS Knowledge deficit Social isolation Risk for infection Anxiety Self-esteem disturbance Altered role performance

THE FOUR Cs IN THE MANAGEMENT OF HIV/AIDS (DOH 2000, P. 296) 1. Compliance- making sure the client sticks with the program. 2. Counseling/education a. Giving instructions about the treatment b. Disseminating information about the disease c. Providing guidance on how to avoid contracting STD again d. Sharing facts about HIV and AIDS 3. Contact tracing tracing and providing treatment to partners 4. Condoms promoting the use of condoms by giving away samples and providing information on their proper use.