HIV

Medical Management
HIV is treated using a combination of medicines to fight the infection. This is called antiretroviral therapy (ART). ART isn’t a
cure, but it controls the virus to allow a longer and healthier life while reducing the risk of transmitting HIV to others.

ART involves taking a combination of HIV medicines (called an HIV regimen) every day, exactly as prescribed. These
medicines prevent HIV from multiplying, which reduces the amount of HIV present in the body. Having less HIV in your
body gives your immune system a chance to recover and fight off infections. A reduced amount of the virus in your body
also reduces the risk of transmitting the virus to others.

ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. If left
untreated, HIV will attack the immune system and eventually progress to AIDS.

HIV Drug Classes

HIV medicines are grouped into six drug classes according to how they fight HIV. The six drug classes are:

1. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) : bind to and block HIV reverse transcriptase
(an HIV enzyme). HIV uses reverse transcriptase to convert its RNA into DNA (reverse transcription). Blocking reverse
transcriptase and reverse transcription prevents HIV from replicating. An example is zidovudine (azidothymidine, AZT,
ZDV).

2. Nucleoside reverse transcriptase inhibitors (NRTIs): block reverse transcriptase (an HIV enzyme). HIV
uses reverse transcriptase to convert its RNA into DNA (reverse transcription). Blocking reverse transcriptase and
reverse transcription prevents HIV from replicating. Examples include nevirapin, rilpivirine, etravirine e.t.c.

3. Protease inhibitors (PIs): block protease (an HIV enzyme). By blocking protease, PIs prevent new (immature) HIV
from becoming a mature virus that can infect other CD4 cells. Examples include atazanavir, darunavir, indicator e.t.c.

4. Fusion inhibitors: Fusion inhibitors block the HIV envelope from merging with the host CD4 cell membrane
(fusion). This prevents HIV from entering the CD4 cell. An example is enfuvirtide

5. CCR5 antagonists (CCR5s) (also called entry inhibitors): block the CCR5 coreceptor on the surface of
certain immune cells, such as CD4 T lymphocytes (CD4 cells). This prevents HIV from entering the cell. An example is
maraviroc.

6. Integrase strand transfer inhibitors (INSTIs): block integrase (an HIV enzyme). HIV uses integrase to insert
(integrate) its viral DNA into the DNA of the host CD4 cell. Blocking integrase prevents HIV from replicating. Examples
include dolutegravir, raltegravir e.t.c

Choosing A HIV Regimen

The choice of HIV medicines to include in an HIV regimen depends on a person’s individual needs. When choosing an HIV
regimen, people with HIV and their health care providers consider the following factors:

 Other diseases or conditions that the person with HIV may have
 Possible side effects of HIV medicines
 Potential interactions between HIV medicines or between HIV medicines and other medicines the person with HIV is
taking
 Results of drug-resistance testing (and other tests). Drug-resistance testing identifies which, if any, HIV medicines
won’t be effective against a person’s HIV.
 Convenience of the regimen. For example, a regimen that includes two or more HIV medicines combined in one pill is
convenient to follow.
 Any issues that can make it difficult to follow an HIV regimen, such as a busy schedule that changes from day to day
 Cost of HIV medicines
Nursing Management

Nursing Care Plan

Nursing Diagnosis Nursing Nursing Intervention Rationale Evaluation

Objectives

Risk for Deficient fluid Patient will •Monitor for signs of
volume related to show no dehydration, such as poor skin
decreased fluid intake signs of turgor, oliguria, and orthostatic
and increased output. dehydration hypotension.
within •Increase fluid to 2500 mL daily.
Risk for infection Patient will •Use strict aseptic technique for
related to altered Remain free all invasive procedures.
immune protection. of infections •Teach patient to avoid
and their exposure to infection and people
complica- with known illnesses.
tions. •Administer antiretroviral
medications and antibiotics as
prescribed, and monitor
response.
Anxiety related to Verbalize •Provide opportunities for
diagnosis evidenced by awareness of verbalization of feelings.
patients verbalization. feelings and
healthy ways
to deal with •Avoid false reassurances.
them.
•Provide appropriate and
adequate information about
HIV/AIDS.
•Teach safer sex practices and
other measures to prevent HIV
transmission.
•Teach anxiety-controlling
techniques, such as deep
breathing and meditation.
•Indicators of fluid status. Patient maintained
hydration.
•Maintains fluid balance, reduces
thirst, and keeps mucous
membranes moist.
• This aids prevention of infections. Verbalized awareness
of feelings and
• Increased knowledge helps healthy ways to deal
patients reduce their risk for with them.
infection.
• Helps prevent the occurrence of
opportunistic infections.
•Helps patient feel accepted in Patient verbalised
present condition without feeling reduced fear
judged, and promotes sense of concerning diagnosis.
dignity and control.
•Allows for better interpersonal
interaction and reduction of
anxiety and fear.
•Can reduce anxiety and enable
patient to make decisions and
choices based on realities.
• Helps improve patients self
esteem concerning disease.
•Improves patients coping ability
with anxiety in the absence of care
givers.
AIDS
Medical Management
1.USE OF ANTIRETROVIRAL AGENTS

Without treatment, an AIDS patient will face death sooner then when antiretrovirals are used. The decision to start
antiretroviral therapy should be considered with care and consideration. Discussions with the patient and perhaps a close
relative may be necessary (especially in an HIV-infected child or a patient with AIDs-related dementia). This is important
because the drugs are toxic and require close follow-up, monitoring, compliance and cooperation of the patient.
Zidovudine (ZDV), a nucleoside analogue, when phosphorylated inside HIV-infected cell, inhibits reverse transcriptase. ZDV
improves quality of life in AIDS patients and decreases the frequency of occurrence of opportunistic infections.

Clinical assessment by the attending physician is essential before starting therapy. The assessment includes:

1. Current weight of the patient.

2. Any evidence of opportunistic infections (which should be treated first before commencing on ZDV therapy).

3. Immunological status (as evidence by the level of CD4+ T-lymphocyte counts or CD4+/CD&+ ratio).

Side effects of Zidovudine:

1. General symptoms (first few weeks of therapy): Headache, Nausea, Diarrhoea, Myalgia, Anorexia, Vomitting.

2. Haematologic: Macrocytosis, Anaemia and Neutropenia, Malaise and fatigue.

3. Others include: Proximal myopathy, Encephalomyelopathy, Hepatotoxicity and Nail pigmentation.

2. COMBINATION THERAPY

Zidovudine, the first antiretroviral nucleoside analogue, has been shown to improve quality of life and decrease the
frequency of occurrence of opportunistic infections. However, it is toxic and using zidovudine alone as a single drug
therapy has caused the development of resistant strains. Therefore the current strategy in the management of HIV
infection is in the use of combination therapy.

Combination therapy may have:

1. Additive or synergistic effects.

2. Decrease toxicity.

3. Prevent the development of resistant strains.

4. May have different attack points on the HIV.

3. FOLLOW-UP MANAGEMENT OF AIDS PATIENTS

Regular out-patient follow-up of HIV-infected patients is the key in providing good medical and health services. Follow-up
management requires dedicated health care professionals who will provide continuity of care and link-up with other
services that the patient requires. The concept of "holistic medicine" and "total care" should be provided to people with
HIV and AIDS. Supportive counselling and medical care will help detect problems earlier.

In the medical follow-up management of AIDS patients, it is useful to monitor the following: Weight gain, General well-
being, presence of infections

Laboratory Tests

•Full Blood Count & ESR CD4+ cells

 •A Karnofsky score chart is useful in the clinical assessment and monitoring of disability due to disease.

Nursing Management

Nursing Care Plan

Nursing Diagnosis Nursing Nursing Intervention Rationale Evaluation

Objectives
Imbalanced nutrition The patient •Plan diet with patient •Including patient in planning The patients
(less than body will be free and suggest foods from gives sense of control of weight was
requirements) of signs of home if appropriate. environment and may enhance maintained
related to increased malnutritio intake. within
metabolic rate/ n through •Weigh as indicated. •Indicator of nutritional normal range
nutritional needs out period adequacy of intake. throughout
evidenced by weight of •Provide rest period •Increases energy available for hospitalizatio
loss. hospitalizat before meals. work of eating. n.
ions. •Corrects vitamin deficiencies
•Give vitamin resulting from decreased food
supplements intake

Fatigue related to Patient will •Assess sleep patterns •Multiple factors can cause The patient
decreased metabolic report and note changes in fatigue, like sleep deprivation, performed
energy production, improved thought processes and emotional distress, side effects ADLs, with
evidenced by sense of behaviour. of drug. assistance as
inability to maintain energy •Recommend •Planning allows patient to be necessary.
usual routines. within a scheduling activities for active during times when
week of periods when patient energy level is higher, which
 nursing has most energy. Plan may restore a feeling of well-
interventio care to allow for rest being and a sense of control.
n. periods. Frequent rest periods are
needed to restore or conserve
energy.
•Refer to physical •Programmed daily exercises
and/or occupational and activities help patient
therapy. maintain and increase strength
and muscle tone, enhance
•Provide supplemental sense of well-being.
O2 as prescribed. •Presence of anemia or
hypoxemia reduces oxygen
available for cellular uptake and
contributes to fatigue.
Social isolation Patient will •Ascertain patient’s •Isolation may be partly self- Patient
related to altered participate perception of situation. imposed because patient fears verbalised an
state of wellness in rejection/reaction of others. improved
evidenced by activities/p •Spend time talking •Patient may experience sense of
expressed feelings of rograms at with patient during and physical isolation as a result of belonging.
rejection. level of between care activities. current medical status and
ability/desi Be supportive, allowing some degree of social isolation
re within 2 for verbalization. Treat secondary to diagnosis of AIDS.
weeks of with dignity and regard
nursing for patient’s feelings.
interventio •Identify support •When patient has assistance
n. systems available to from Such, feelings of loneliness
patient, including and rejection are diminished.
presence of and/or
relationship with
immediate and
extended family.
•Encourage open •Participation with others can
visitation (as allowed), foster a feeling of belonging.
telephone contacts, and
social activities within
tolerated level.
Risk for infection Patient will •Inspect wounds and •Early identification and Patient was
related to not site of invasive devices, treatment of secondary free from
depression of the develop noting signs of local infection may prevent sepsis. new
immune system. new inflammation and infections
infections infection. and old
during •Wash hands before •Reduces risk of cross- infections
period of and after all care contamination. were
hospitalizat contacts. Instruct controlled.
ions. patient to wash hands
as indicated.
•Provide a clean, well- •Reduces number of pathogens
ventilated environment. presented to the immune
Screen visitors and staff system and reduces possibility
for signs of infection of patient contracting a
and maintain isolation nosocomial infection.
precautions as
indicated.
•Monitor vital signs, •Provides baseline data;
including temperature. frequent temperature
elevations and onset of fever
indicates the body's response to
a new infection or that
medications are not effectively
controlling incurable infections.