What is HIV?

- human Immunodeficiency Virus (HIV) is a virus that attacks cells that help the body fight
infection
- there is no cure, but it is treatable with medicine

Pathophysiology of HIV/ AIDS?

- caused by the human immunodeficiency virus
- retrovirus single strand RNA virus that replicates via reverse transcription
- blood and sexual intercourse

-A retrovirus unknown until

early 1980s:
1 . Cannot replicate outside of living host cells
2. Contains only RNA; no DNA
3.Destroys the body's ability to fight infections. – thry destroy the cd4 count
4.Infects CD4 cells - the primary target of HIV infection

- HIV attacks T cells or lymphocytes

- T Cells are lymphocytes
- Have a special receptor on cell surface
- Different subsets of T cells
- CD4+ helper T Cells (release cytokines) instrumental in initiating the immune response both with B
lymphocytes, macrophages and NK cells – included in the inflammatory response against infection
- lymphatic system – is the one who filtrates foreign microorganisms
- Massive viremia- means spread of HIV virus
- they primarily attack T and B lymphocytes
- skin cancer- common symptoms

From infection to disease: Pathophysiology

•Infected body fluids are introduced into the body of an uninfected person
•The HIV virus crosses into the T-4 Cell count
•The virus uses the genetic mechanisms of the cell to produce millions of new viruses
•The cell dies and the new viruses are released into the blood to infect new un- infected cells 􀀁
•The T-4 cells are killed and the patient becomes immuno deficient
•The person becomes susceptible to opportunistic infections or AIDS related cancers.

ACQUIRED IMMUNODEFFICIENCY SYNDROME

➢ Caused by HIV
➢ Transmitted through blood, blood products, semen, vaginal fluid, breast milk
➢ Diagnosed by enzyme-linked immunosorbent assay (ELISA)
➢ Confirmed by western blot test

SYMPTOMS OF AIDS
➢ Extreme weakness and fatigue
➢ Rapid weight loss
➢ Frequent fevers with no explanation
➢ Heavy sweating at night - diaphoresis
➢ Swollen lymph glands
➢ Minor infections that cause skin rashes and mouth, genital, and anal sores.
➢ White spots in the mouth or throat
➢ Chronic diarrhea
➢ A cough that won’t go away
➢ Short-term memory loss

Myalgia – pain in a muscle

Arthralgia – joint pain

Fact or Fiction?
You can get AIDS from a mosquito bite - Fiction
Fact or Fiction?
You can get AIDS by having oral sex with an infected person - fact
Fact or Fiction?
HIV survives well in the environment, so you can get it from toilet seats and door knobs- fiction
Fact or Fiction?
You can get AIDS by hugging a person with HIV who is sweating - fiction
Fact or Fiction?
You can get AIDS by kissing someone who is HIV infected - fiction
Fact or Fiction?
Condoms aren't really effective in preventing HIV transmission- fiction
Fact or Fiction? There is a connection between other STDS and HIV – fact up to 10 %
Infection
How A Healthy Immune System Works
➢ Physical Barriers: Skin, Mucous Membrane
➢ Innate Immune System: WBC, leukotrienes, cytokines, all types of WBC – activated when there is an
inflammatory response like dog bite, mosquito bite
➢ Acquired Immune System: include both natural acquired and artificial acquired
- natural acquired – chicken pox, mumps, measles
- artificial acquired – all forms of vaccines

How does HIV interrupt the Normal Functioning of the Immune System?
➢ HIV infects T-cell
Phases of HIV/AIDS
1. Infection
2. Window period
3. Seroconversion
4. Asymptomatic period
5. HIV/AIDS - related illness
6. AIDS

CD4 counts
➢ Number of CD4 cells in blood provides a measure of immune system damage
➢ CD4 count reflects phase of disease
➢ CD4 count:
• 500 – 1200: Normal
• 200 – 500: Beginning of HIV illness
• < 200: AIDS

Window period
➢ Time between infection & enough antibodies
➢ Duration: approximately 3 months
➢ No symptoms or signs of illness
➢ HIV test is negative
➢ Virus is multiplying rapidly - viral load is high
➢ Person is very infectious

Seroconversion
➢ Point at which HIV test becomes positive
➢ Body starts making antibodies to HIV a few weeks after infection
➢ HIV test becomes positive
➢ Person may have a mild flu-like illness, lasting a week or two
➢ Afterwards, the person is well again
Asymptomatic period
➢ Time period between seroconversion and onset of HIV/AIDS-related illness
➢ Duration variable: < 1 year to > 15 years
➢ Most people remain healthy (asymptomatic) for about three years
➢ Duration may depend on socio-economic factors
➢ The CD4 count is above 500 cells/ml

HIV/AIDS-Related Illness
➢ Time period between onset of illness & diagnosis of AIDS
➢ Duration is variable: average about 5 years
➢ Illnesses initially mild, with gradual increase in frequency and severity
➢ CD4 count is between 500 & 200 cells/ml

AIDS
➢ Final phase of HIV/AIDS
➢ Duration: without antiretroviral drugs, less than 2 years with antiretrovirals, potentially many years
➢ CD4 count is below 200 cells/ml
➢ Viral loads are high & the person is very infectious

Important Facts
➢ Duration of different phases of HIV/AIDS will vary in different people
➢ Factors affecting the course of HIV/AIDS include nutrition, emotional stress, and access to health care
➢ People infected with HIV can infect others at any phase of the disease

Mother-to-Child Transmission
➢ 25–35% of HIV positive pregnant mothers will pass HIV to their newborns
➢ 30% of transmission in utero- because the blood of the mother is circulating
➢ 70% of transmission during the delivery
➢ 14% transmission with breastfeeding

Interventions to Reduce Mother-to-Child Transmission

➢ HIV testing in pregnancy
➢ Antenatal care – example prenatal care
➢ Antiretroviral agents
➢ Obstetric interventions
o Avoid amniotomy – artifial rupture bag of water
o Avoid procedures: Forceps/vacuum extractor, scalp electrode, scalp blood sampling
o Restrict episiotomy – para walang open the blood vessel
o Elective cesarean section
o Remember infection prevention practices – immediate through drying
➢ Newborn feeding: Breastmilk vs. formula

Antenatal Care or prenatal

▪ Watch for signs/symptoms of AIDS and pregnancy-related complications – like urinary tract infection
▪ Unless complication develops, no need to increase number of visits – first tri- every month, 2nd tri –
every 2 weeks, and 3rd tri - every week
▪ Treat STDs and other coinfections – like congenital warts like herpes
▪ Counsel against unprotected intercourse
▪ Avoid invasive procedures and external cephalic version
▪ Give antiretroviral agents
▪ Counsel about nutrition

Pregnant women: timing of HIV Testing

- test as early as possible during each pregnancy, to show for timely therapeutic decision
- repeat HIV test during third trimester (preferably <36 weeks)
- consider for all pregnant women
- recommended for:
- in areas with elevated incidence of HIV or aids among women
- facilities with > or equal to 1/1000 pregnancy HIV infected women
- women at high risk of pregnancy
- women with sign and symptoms of acute HIV infection

Anti-retrovirals
➢ Zidovudine (ZDV):
-Long course
- Short course
➢ Nevirapine
➢ ZDV/lamivudine (ZDV/3TC)

Obstetric Procedures to be avoided

➢ Amniotomy
➢ Fetal scalp electrode/sampling
➢ Forceps/vacuum extractor
➢ Episiotomy
➢ Vaginal tears

Intrapartum Management
➢ Goal is to minimize duration of labor ,
➢ Do not rupture membranes
➢ Avoid invasive monitoring
➢ Avoid episiotomy or instrumental delivery when possible
Delivery: Cesarean vs. Vaginal Birth
➢ Cesarean section before labor and/or rupture of membranes reduces risk of mother-to-child
transmission by 50–80%
➢ Cesarean section, however, increases morbidity and possible mortality to mother – specially if there
is a lot of blood loss. (Post partum hemorrhage)
➢ Give antibiotic prophylaxis for cesarean section in HIV-infected women

Recommended Infection Prevention Practices

➢ Needles:
o Take care! Minimal use
o Suturing: Use appropriate needle and holder
o Care with recapping and disposal – using a forceps to remove the needle
➢ Wear gloves, wash hands with soap immediately after contact with blood and body fluids
➢ Cover incisions with watertight dressings for first 24 hours

Use:
▪ Plastic aprons for delivery
▪ Goggles and gloves for delivery and surgery
▪ Long gloves for placenta removal
➢ Dispose of blood, placenta and waste safely – yellow bin
➢ PROTECT YOURSELF!

Newborn
➢ Wash newborn after birth, especially face
➢ Avoid hypothermia
➢ Give antiretroviral agents, if available
- test to CBC, CD4 count

Breastfeeding Issues
➢ Warmth for newborn
➢ Nutrition for newborn
➢ Protection against other infections
➢ Safety – unclean water, diarrheal diseases
➢ Risk of HIV transmission
➢ Contraception for mother
➢ Cost

Breastfeeding Recommendations
➢ promote exclusive breastfeeding for 6 months
➢ counsel on the safe and appropriate use of formula
➢ HIV-positive and chooses to breastfeed,
promote exclusive breastfeeding for 6 months
- no water and vitamins
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