MANAGEMENT OF PATIENT WITH

AIDS

MATHEW VARGHESE V
MSN(RAK),FHNP (CMC Vellore),CPEPC
Nursing officer
AIIMS Delhi
INTRODUCTION
 HIV continues to be a major global public health
issue, having claimed more than 32 million lives so
far.
 However, with increasing access to effective HIV
prevention, diagnosis, treatment and care, including
for opportunistic infections, HIV infection has
become a manageable chronic health condition,
enabling people living with HIV to lead long and
healthy lives.
 There were approximately 37.9 million people
living with HIV at the end of 2018.
HIV AND AIDS IN INDIA
BASIC FACTS ABOUT HIV

 HIV stands for human immunodeficiency virus.

 The virus destroys a type of white blood cell in the
immune system called a T-helper cell (CD4 cells) and
makes copies of it inside these cells
 As HIV destroys more CD4 cells and makes more
copies of it, it gradually weakens a person’s immune
system.
 If HIV is left untreated, it may take up to 10 or 15 years
for the immune system to be so severely damaged
 However, the rate at which HIV progresses varies
depending on age, general health and background
BASIC FACTS ABOUT HIV

 People with HIV can enjoy a long and healthy life

by taking ART which is effective and available to all.

 It’s possible for antiretroviral treatment to reduce

the level of HIV in the body to such low levels that
blood tests cannot detect it.

 People living with HIV whose viral load is confirmed

as undetectable cannot pass on HIV.

 Regular for HIV is important to know your status.

BASIC FACTS ABOUT AIDS

 AIDS stands for acquired immune deficiency

syndrome; it’s also called advanced HIV infection or
late-stage HIV.

 AIDS is a set of symptoms and illnesses that

develop as a result of advanced HIV infection which
has destroyed the immune system.

 Although there is no cure for HIV, with the right

treatment and support, people living with HIV can
enjoy long and healthy lives.
 CAUSATIVE AGENT OF AIDS-
HUMAN IMMUNODEFICIENCY VIRUS

 HIV is a retrovirus that contains only RNA.

 The most common type is known as HIV-1

 There is also an HIV-2 that is much less common

and less virulent, but eventually produces clinical
findings similar to HIV-1.

 The HIV-1 type itself has a number of subtypes (A

through H and O) which have differing geographic
distributions but all produce AIDS similarly.
THE STRUCTURE OF HIV
MODE OF TRANSMISSION
WHO CLINICAL STAGING OF HIV DISEASE IN
ADULTS, ADOLESCENTS AND CHILDREN
 IMMUNOLOGICAL STAGING OF HIV
INFECTION

Stage CD4 cell count

 Not significant >500/mm3

immunosuppression
 Mild immunosuppression 350 −499/mm3

 Advanced 200−349/mm3
immunosuppression
 Severe immunosuppression <200/mm3
 IMPLICATIONS FOR CLINICAL AND IMMUNOLOGICAL
CRITERIA FOR INITIATING ART IN ADULTS AND
ADOLESCENTS

Clinical ART
stage
4 Treat.

3 Consider treatment: CD4, if available, can guide

the urgency with which ART should be started.

1 or 2 Only if CD4<200/mm3
OPPORTUNISTIC INFECTIONS COMMON TO
HIV/AIDS
CANCERS COMMON TO HIV/AIDS
Kaposi's sarcoma.
A tumor of the blood
vessel walls, this cancer is
rare in people not infected
with HIV, but common in
HIV-positive people. It
usually appears as pink,
red or purple lesions on
the skin and mouth.
Lymphoma.
This cancer starts in the
white blood cells. The
most common early sign is
painless swelling of the
lymph nodes in your neck,
armpit or groin.
COMPLICATIONS

Wasting syndrome

Neurological
complications

Kidney disease.
DIAGNOSIS OF HIV INFECTION

Serologic testing for HIV

• HIV antibody assays by ELISA and Western
blot
• Rapid tests / Card Test
• HIV p24 antigen assay

Urine and saliva Test

Viral Load Test

TESTS TO STAGE DISEASE AND TREATMENT

• CD4 T cell • Viral load • Drug

count. (HIV RNA). resistance.
TESTS FOR COMPLICATIONS

Tuberculosis Hepatitis

Sexually
Toxoplasmosis transmitted
infections

Liver or kidney Urinary tract

damage infection
DIAGNOSIS OF CLINICALLY SYMPTOMATIC CLIENTS
DIAGNOSIS OF CLINICALLY ASYMPTOMATIC
CLIENTS
ART TREATMENT

Patients
Factor 1

willingness The stage

Factor 2
and of disease
readiness
to begin Other

Factor 3
therapy health
problems
WHEN IS ART GIVEN?
AIDS MEDICATIONS

 Nucleoside Reverse Transcriptase Inhibitors

(NRTI)
These drugs interrupt the virus from duplicating,
which may slow the spread of HIV in the body. They
include:
 Abacavir (Ziagen, ABC)
 Didanosine (Videx, dideoxyinosine, ddI)
 Emtricitabine (Emtriva, FTC)
 Lamivudine (Epivir, 3TC)
 Stavudine (Zerit, d4T)
 Tenofovir (Viread, TDF)
 Zalcitabine (Hivid, ddC)
 Zidovudine (Retrovir, ZDV or AZT)
PROTEASE INHIBITORS (PI)

 These FDA-approved drugs interrupt virus

replication at a later step in the virus life cycle.
Protease inhibitors include:
 Amprenavir (Agenerase, APV)
 Atazanavir (Reyataz, ATV)
 Fosamprenavir (Lexiva, FOS)
 Indinavir (Crixivan, IDV)
 Lopinavir (Kaletra, LPV/r)
 Ritonavir (Norvir, RIT)
 Saquinavir (Fortovase, Invirase, SQV)
OTHER AIDS MEDICATIONS

 Fusion Inhibitors
 Fusion inhibitors are a new class of drugs that act
against HIV by preventing the virus from fusing with
the inside of a cell, preventing it from replicating.
 The group of drugs includes Enfuvirtide, also
known as Fuzeon or T-20.
Non-Nucleoside Reverse Transcriptase Inhibitors
(NNRTI)

 Non-nucleoside reverse transcriptase inhibitors

(NNRTIs) block the infection of new cells by HIV.
These drugs may be prescribed in combination with
other anti-retroviral drugs.
 NNRTs include:
 Delvaridine (Rescriptor, DLV)
 Efravirenz (Sustiva, EFV)
 Nevirapine (Viramune, NVP)
Highly Active Antiretroviral Therapy (HAART)

 In 1996, highly active antiretroviral therapy

(HAART) was introduced for people with HIV and
AIDS.
 HAART — often referred to as the anti-HIV
"cocktail" — is a combination of three or more
drugs, such as protease inhibitors and other anti-
retroviral medications.
 The treatment is highly effective in slowing the rate
at which the HIV virus replicates itself, which may
slow the spread of HIV in the body.
 The goal of HAART is to reduce the amount of virus
in your body, or the viral load, to a level that can no
longer be detected with blood tests.
PREVENTION

 Use a new condom every time you have

sex.
 Consider pre exposure prophylaxis
(PrEP).
 Tell your sexual partners if you have HIV

 Use a clean needle.

 If you're pregnant, get medical care right

away.
 Consider male circumcision
NURSING MANAGEMENT
NURSING DIAGNOSES
 Nursing Diagnosis: Diarrhea related to enteric
pathogens or HIV infection
 Goal: Resumption of usual bowel habits

 Nursing Diagnosis: Risk for infection related to

immunodeficiency
 Goal: Absence of infection

 Nursing Diagnosis: Ineffective airway clearance

related to Pneumocystis carinii pneumonia, increased
bronchial secretions, and decreased ability to cough
related to weakness and fatigue
 Goal: Improved airway clearance
NURSING DIAGNOSES
 Nursing Diagnosis: Imbalanced nutrition, less than
body requirements, related to decreased oral intake
 Goal: Improvement of nutritional status

 Nursing Diagnosis: Deficient knowledge related to

means of preventing HIV transmission
 Goal: Increased knowledge concerning means of
preventing disease transmission

 Nursing Diagnosis: Social isolation related to stigma of

the disease, withdrawal of support systems, isolation
procedures, and fear of infecting others
 Goal: Decreased sense of social isolation
NURSING DIAGNOSES
 Nursing Diagnosis Risk For compliocations :
Opportunistic infections; impaired breathing;
wasting syndrome and fluid and electrolyte
imbalances; adverse reaction to medications
 Goal: Absence of complications
 Opportunistic Infections
 Impaired Breathing
 Wasting Syndrome and Fluid and Electrolyte
Disturbances
 Reactions to Medications
STUDY

 Nursing Practice to Support People Living

With HIV With Antiretroviral Therapy Adherence
 A Qualitative Explorative Study (16 Samples)

 Rouleau, Geneviève RN, MSc*; Richard, Lauralie

RN, PhD; Côté, José RN, PhD; Gagnon, Marie-
Pierre PhD; Pelletier, Jérôme RN, MSc
 Author InformationJournal of the Association
of Nurses in AIDS Care: July-August 2019 - Volume
30 - Issue 4 - p e20-e37
 doi: 10.1097/JNC.0000000000000103
RESULTS
 We explored HIV nursing practice, particularly the
challenges that nurses face in promoting ART
adherence and opportunities for practice
development in the field.
 The nurse–patient relationship was at the forefront
of nursing practice to support PLWH.
 This practice translated into a range of nursing
activities to foster ART adherence by supporting
PLWH in their whole situation, including the
assessment of an array of dimensions related to
PLWH health, teaching and sharing knowledge,
coordinating care, and connecting PLWH with
resources.
RESULTS
 Providing HIV nursing care, especially ART-related care,
to PLWH was challenging in three areas:
 (a) performing nursing roles at the interface of social
and biomedical boundaries,
 (b) misalignment between nurse and patient
expectations regarding ART (non) adherence,
making nurses feel powerless when faced with
situations of nonadherence, and
 (c) dealing with sociopolitical determinants affecting
access to health care resources and
 services. Nurses mobilized a range of resources—
knowledge, networks, and strategies—to build capacity
and overcome challenges relating to their practices with
PLWH.
REFERENCES

 UNAIDS ‘Overview: India’ accessed November 2019)

 World Bank, ‘Data: India’ (accessed November 2019)
 UNAIDS ‘Overview: India’ accessed November 2019)
 https://www.mayoclinic.org/diseases-conditions/hiv-
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 https://www.mayoclinic.org/tests-procedures/hiv-
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 https://webpath.med.utah.edu/TUTORIAL/AIDS/AIDS.html
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 https://www.who.int/news-room/fact-sheets/detail/hiv-aids
 https://www.healthline.com/health/hiv-aids
