HIV/AIDS:

AIDS – 1st described in San Francisco in 1981, as being caused by Human Immunodeficiency
Virus

More than 20 million people are infected globally

Prevalence is greatest in sub-Saharan Africa

According to the Ministry of Education (2014), in Kenya;

101,560 Kenyans were infected with HIV In 2013

12,940 children

50,530 women

38,090 men were infected with HIV in 2013

65% of new HIV infections occur in 9 out of 47 counties

 County
 Homa Bay
 Kisumu
 Siaya
 Migori
 Kisii
 Nakuru
 Turkana
 Nyamira
 Bomet

21% of new adult HIV infections occur among young women aged 15–24 every year.

1.6 million Kenyans were living with HIV in 2013.

191,840 children were living with HIV In 2013.

63% of men and 80% of women know their HIV status

The link between STIs and AIDS

Sexually transmitted infections make it easier for HIV to pass from one person to another

This is particularly true with those STIs that cause genital ulcers like syphilis and chancroid
STIs may increase the risk of HIV transmission 2-9 times

The link between HIV infection and STI may partially explain why HIV has spread rapidly in
Africa than in developed countries

Basic facts about HIV:

HIV transmission is acquired through;

- sexual intercourse with an infected partner. More than 90% of adults in Sub Saharan Africa
acquire HIV infection from unprotected sex with infected partners

- exposure to infected blood or blood products (genital secretions). Transmission can also be thru
cerebral spinal fluid, pleural fluid and amniotic fluid

- an infected mother to her unborn child, during delivery or from breast milk

- Saliva, urine and sweat transmission is not likely

Pathophysiology of HIV:

Attachment of the HIV virus to CD4 receptor

Internalization & uncoating of the virus with viral RNA & reverse transceiptase

DNA synthesis - HIV changes its genetic material from RNA to DNA thru action of reverse
transcriptase, resulting in double- stranded DNA that carries instruction for viral replication

Integration –New viral DNA enters the nucleus of the CD4- T cell & thru action of integrase, is
blended with the DNA of the CD4- T cell, resulting in a permanent, lifelong infection.

Prior to this step, the uninfected person has only been exposed to, not infected with HIV

With this step, HIV infection is permanent

Transcription – When the CD4- T cell is activated, the double stranded DNA forms single-
stranded messenger RNA (mRNA) which builds new viruses

Translation – The mRNA creates chains of new proteins & enzymes (polyproteins) that contain
the components needed in the construction of new viruses

Cleavage – The HIV enzyme protease cuts the polyprotein chain into the individual proteins that
make up new virus

Budding – New proteins & viral RNA migrate to the membrane of the infected CD4- T cell, exit
from the cell and start the process all over

There are other unknown factors which lead to rapid depletion of CD4 + T lymphocytes
The reduction of CD4 + T lymphocytes count is a reflection of a declining cellular immunity

A low immunity is thus manifested by the appearance of opportunistic infections

Initial infection with HIV is characterized with a brief period of high – level acute virus
replication

Newly infected people are highly infectious although they may test negative for HIV

This stage may take 3 months but eventually stabilizes at an individual’s “set point”

This is followed by an asymptomatic phase of infection. The CD4 + T lymphocytes gradually

reduce. The rate of reduction varies among patients

Factors that are known to influence the rate of CD4+ T lymphocyte reduction in a patient
include;

Genetic factor

Viral load at the “set point”. A high “set point” is associated with rapid disease progression

Stages of HIV:

1. Primary Infection/ Acute Infection:

Within 2-4 weeks after HIV infection many

Most people develop flu-like symptoms, often described as “the worst flu ever”

Symptoms can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains,
and headache

This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s
natural response to the HIV infection

During this early period of infection, large amounts of virus are being produced in the body

The virus uses CD4 count to replicate & destroys them in the process

Because of this, your CD4 cells can fall rapidly

Eventually the immune response will begin to bring the level of virus in the body back down to a
level called a viral set point, which is a relatively stable level of virus in the body

At this point, the CD4 count begins to increase, but it may not return to pre-infection levels

It may be particularly beneficial to your health to begin ART during this stage.
During the acute HIV infection stage, the client is at high risk of transmitting HIV to sexual
partners because the levels of HIV in the blood stream are very high

For this reason, it is very important to take steps to reduce your risk of transmission

2. Clinical Latency Stage/ “asymptomatic HIV infection” or “chronic HIV infection

“Latency” means a period where a virus is living or developing in a person without producing
symptoms

During the clinical latency stage, people who are infected with HIV experience no symptoms, or
only mild ones

The HIV virus continues to reproduce at very low levels, although it is still active

If one takes ART, one may live with clinical latency for several decades because treatment helps
keep the virus in check

For people who are not on ART, the clinical latency stage lasts an average of 10 years, but some
people may progress through this stage faster

People in this symptom-free stage are still able to transmit HIV to others, even if they are on
ART, although ART greatly reduces the risk of transmission

3. AIDS

This stage of HIV infection occurs when the immune system is badly damaged and one becomes
vulnerable to opportunistic infections

Without treatment, people who progress to AIDS typically survive about 3 years

Once one have a dangerous opportunistic illness, life-expectancy without treatment falls to
about 1 year

However, if one is taking ART & maintain a low viral load, then he/she may enjoy a near normal
life span

One will most likely never progress to AIDS

Management of HIV/AIDS Clients:

Diagnosis:

Provider Initiative Testing and Counselling (PITC) to be tested and access care and treatment

These sites can link clients to;

Care and treatment clinics (CTC) for treatment and care including ARVs
Other services ie. TB, reproductive health, family planning, social/ spiritual support and home
based care services

Education on the mode of HIV transmission, disease progression and management of disease
symptoms

2. Management of Antiretroviral drugs:

Proper use ensures proper use of resources to get quality drugs to patients

HIV/AIDS related commodities are expensive, therefore they require proper handling to ensure
effective use

Misuse of these drugs may lead to unwanted consequences to either the individual or population
such as;

Treatment failure

Rapid development of drug resistance

An increase in the risk of toxicity

Wastage of money

Drugs to be dispensed appropriately with clear instructions and advice if any

HIV/AIDS: Cont

3. Nutrition:

Malnutrition can be observed in HIV infected persons as a result of the infection itself or side
effects of some medications. Common symptoms/ illnesses which can lead to malnutrition
include;

Loss of appetite

Diarrhoea and fever

Nausea and frequent vomiting

Thrush

Anaemia

Tips of Healthy and Nutritious Lifestyle of PLHAs:

Eat a variety of foods,

Eat small frequent meals

Be physically active

Avoid taking alcohol and smoking

Add nutrient dense foods (nuts, oil, fat, milk)

Use spices to boost appetite and absorption (ginger, garlic, lemon)

Observe food safety, improved cooking methods, food hygiene principles

Germinating and sprouting seeds increases nutrient content and improves digestion and
absorption

Prevention and control of HIV:

Effective treatment and prevention of STIs

Ensure adequate drugs, commodities (condoms) and consumables (reagents)

Partner management

Compliance with treatment

Regular training and supportive supervision of health care providers

Prevention of mother to child transmission (PMTCT) of HIV

Quality PMTCT services integrated within Reproductive and Child Health (RCH) services to
include;

Counselling and testing at RCH clinics

Provision of ARV prophylaxis to HIV +ve mother and her infant to prevent Mother to Child
Transmission (MTCT)

Infant feeding counselling and support

Safe delivery practices including planned delivery mechanisms

Effective condom both male and female

Easy access to condoms within and outside (appropriate social marketing) health care settings

Consistent education on proper use of condoms

Work place HIV/AIDS policy and health sector

Availability of supportive policies on HIV/AIDS at work place

Orientation on basic principles and intervention of HIV prevention, care, treatment and support

Provide protection gears including Post Exposure Prophylaxis

Prevention of HIV transmission through blood transfusion

The National Blood Transfusion service to ensure regular availability of adequate safe blood in
all transfusing health facilities

The government to ensure regular availability of reagents and supplies for safe blood transfusion

HIV/ AIDS prevention for sex workers and other vulnerable groups – homosexuals, drug abusers

Increased access to services and interventions for these groups to reduce transmission of HIV

Youth (in and out of school) and HIV/ AIDS

- Initiation of quality youth friendly health services, implementation of youth focuses promotion
activities and behaviour tracking

Design innovative condom promotion programs

Voluntary Counsel and Testing (VCT)

Easily accessible

User friendly

Linked to a health facility (PITC)

Family planning services

Prevent unintended pregnancies among HIV infected women

Decrease the possibility of infecting their children

Respond to their reproductive rights

Condom promotion to promote dual protection

Reduction of stigma and discrimination