)AIDS(

is a disease of the human immune system caused by the human )AIDS(

immunodeficiency virus (HIV). Discuss stages of AIDs and nursing strategies for
. AIDS preventions

• Abstract

AIDS is the last outcome of HIV infection. AIDS has 4 different stages begin with Acute HIV
infection and ends with AIDS. as the HIV infection is undetected and left uncontrolled it progress
to AIDS, in AIDS, the immune system becomes severely damaged making the body without
protection against Opportunistic infections. There's no Cure for AIDS but there's a treatment for
.controlling and preventing disease progression

• Introduction

AIDS "Acquired immune Deficiency Syndrome" is the most severe final outcome of HIV
infection. HIV "Retrovirus" is a lentivirus means that is slowly attacks the immune system and
destroy it, leaving the body without defense against opportunistic infections, the main type of cell
that HIV attacks is Helper T cells or CD4+ "it's a special type of lymphocytes in our immune
system that plays a critical role in protecting the body against infections" as the Infection progress
to AIDS, the number of Helper T cells are critically reduced, making the patient become more
likely to get infection that may end with death if left uncontrolled. AIDS is a disease of human
immune system that can be transmitted among humans through different body fluids such as
blood, semen, vaginal secretions and breast milk.(EKB, Brirannica ACADEMIC. (2019). AIDS.)

HIV infection has 4 stages that shows the progression of HIV Infection over years, these stages
are Primary HIV infection, Asymptomatic stage, HIV Symptomatic stage and AIDS. (HIV Ireland
.organization. (2018) Stages of HIV infection)

• Objectives

To Determine the ways of HIV Transmission, To Describe and explain the Stages of HIV infection
, To assess people with high risk behaviors and provide adequate prevention , To Provide
information and guidance about AIDS prevention
•Definition

Is a potentially life-threatening chronic illness, caused by the human immunodeficiency

virus ( HIV). HIV interferes with the body's ability to combat infections and diseases by
.weakening the immune system

HIV is an illness transmitted by sexual intercourse. It may also spread during pregnancy ,
.childbirth or breast-feeding by contact with infected blood, or from mother to child

)Medical Surgical Notes(2019-2020) AIDS(

•High Risk Groups

People that are risky to get HIV infection are having sexual contact with infected person ,users
of intravenous drugs who share infected needles or syringes, receiving blood products infected
with HIV, Babies born to HIV positive mothers. (EKB,Brirannica ACADEMIC. (2019). AIDS.)

• Pathophysiology

HIV's main cell target is a special type of white blood cells that are essential to the immune syste
m known as Helper T lymphocytes or CD4+ T Cell. Once the HIV enters the body, it attach itself
to the surface of the CD4+ T cell, when the virus entered a T cell, HIV uses the viral enzyme
reverse transcriptase to insert its RNA into a double stranded DNA, and began to make thousands
copies of itself inside the cell results in killing the CD4 cell, these thousands copies began to find
another CD4 cell and kill it , leading to increased HIV viral Load and decreased in the number of
CD4+ T cells, as a result of this our immune system stops working. (EKB,Brirannica
.ACADEMIC. (2019). AIDS) / (Medical Surgical Notes(2019-2020) AIDS)

• Stages of HIV infection

: Stage 1: Primary HIV infection or Sero-conversion

It also called Acute HIV infection. It's the earliest Stage of HIV infection which generally occurs
within 2 weeks to month after initial infection with HIV. During this time the HIV is intensively
replicates himself and rapidly spread in the body, producing large amounts of Viral particles in
the blood, in turn our immune system begins to respond and produce antibodies against HIV.
Which this process is called Sero-conversion. Common symptoms began to appear during this
time, some people will have mild influenza like symptoms such as fever, diarrhea, sore throat,
headaches and rash , these symptoms are presented in >65% of HIV infection cases. Detection
of HIV antigens or anti-HIV antibodies in blood samples are usually the diagnosis of this stage.
If the patient is negative but have known history of high risk behavior, it's recommended to do
confirmatory tests.(Rastogi,S., Pratap,U,. Agrahari,S. and Verma,A,.(2011)

also at this stage some patient will develop opportunistic infections .(WHO, (2007), and also
may occur gastrointestinal symptoms as diarrhea or vomiting and neurological symptoms of
peripheral neuropathy. These symptoms during this stage usually persist for one to 2 weeks.
these symptoms are not specific enough to recognized as a signs of HIV infection at this stage,
and may be misdiagnosed with the symptoms of many common infectious diseases, people with
unexplained fever and rash with high risk behavior are considered infected with HIV at this
.stage.( Blaser,M., Bennett,J., and Dolan,R. (2010)

: Stage 2: HIV Asymptomatic stage or (chronic HIV infection or clinical latency)

after the seroconversion stage, asymptomatic stage comes. HIV at this stage still active but it's
replication slows down to very low rate. HIV load in peripheral blood decreases to very low
level, and there is a slow decrease in the CD4+ T cells. Usually the CD4+T cell count is above
500 cells/mm3. also some patient at this stage shows CD4 T- cell count below 500 cells/mm.
The main goal of any treatment strategy at this point is to keep viral replication to a minimum in
order to reduce the worsening of the immune status. (Rastogi,S., Pratap,U,. Agrahari,S. and
Verma,A,.(2011)

Without treatment, people at this stage stays for 10 or 15 years (on average about 8 to 10 years)
but some people may move faster through this stage .During this time patient will not feel any
symptoms or feel sick. But the patient is capable of transmitting the infection even there's no
symptoms appear on the patient. taking HIV treatment (ART) exactly as ordered and stay virally
.suppressed, makes the patient less likely to transmit HIV

: Stage 3 : HIV Symptomatic stage

 CD4+T cells counts are gradually falls over time, the CD4+ T cells value is from 200 to 499
cell/mm3. at this stage the symptoms develops as the immune system is damaged and
weakened , making the body without protection against opportunistic infections, these
symptoms may include fatigue, weight loss, mouth ulcers, thrush and severe diarrhea. (HIV
.Ireland organization. (2018)

• : Stage 4 : AIDS

HIV infection has 4 stages and AIDS is the last most severe stage of HIV infections, In this
stage the CD4 T-cell level dips under 200 cells/mm3, when the CD4+T cells count reaches to
less than 100cells/mm3, at this point the immune system is severely damaged and can't fight
off opportunistic infections. opportunistic infection are the infections and infection induced
cancers that are more severe and occurs frequently in people with weakened immune systems
(as in AIDS patients)than in people with healthy immune system, multisystem diseases may
caused by these infections .without explicit treatment, around half of individuals contaminated
with HIV create AIDS inside ten years. pneumocystis pneumonia, cachexia as HIV squandering
disorder, and esophageal candidiasis are the most common recognized conditions that alert the
presence of AIDS, Other common signs include recurrent respiratory tract infections. Also
patients with AIDS have an expanded danger of creating different viral-induced cancers.
Kaposi's sarcoma and lymphoma are the most common cancers in patient with AIDS. (
.Blaser,M., Bennett,J., and Dolan,R. (2010)

• Diagnosis

Antibody/Antigen tests :- for patients with HIV, (ELISA) is the most widely used )ELISA( -
test. This test is done by taking a blood sample from a vein. This can take two to six weeks for
.the combination antigen / antibody tests to become positive after exposure

tests which check for viral RNA and thus enable virus detection after very recent )PCR( -
.exposure. (EKB,Brirannica ACADEMIC. (2019). AIDS)

-: Tests for the purpose of staging

CD4 T cell count :- the main target of HIV is CD4+ T Cells, these cells are destroyed by HIV, -
when CD4 T cell counts dips below 200 cell/mm3, this indicate progression of the disease to
.AIDS
 Viral Load HIV test :- this test used to measuring the amount of HIV Virus in blood-

• Nursing Strategies in AIDS Prevention

Nurses play an essential role in handling the human immunodeficiency virus (HIV), Unless an
efficient vaccine is developed, nurses must prevent HIV infection by instructing patients how
risky habits can be eliminated or reduced. Primary prevention measures are vital for control and
prevention through successful education programmes such as use of medication used in HIV
treatment to reduce risk, reducing sexual transmission risk, reduce risk from drug use, and reduce
.the risk of HIV transmission from mother to her child

HIV treatment can be used in prevention :- This is one of the most effective ways to prevent -
HIV transmission that involve using of HIV medications inorder to prevent HIV transmission
: through two prevention methods

Pre-Exposure Prophylaxis (PrEP): Pre-exposure prophylaxis is a way for people that do not
have HIV but are at extremely high risk of having HIV by taking a pill every day to avoid HIV
infection, this pill is sold under the name Truvada and another pill called Descovy , each single
pill contains two anti HIV medicines, Truvada pill contains (emtricitabine and tenofovir
.disoproxil fumarate), and Descovy pill contains (emtricitabine and tenofovir alafenamide)

Post-exposure prophylaxis(PEP): it involves taking a short course of HIV medicines very soon
after a possible exposure to HIV, it must be taken within 72 hours after the exposure to HIV, to
prevent becoming infected with HIV. Educate the patient about going to the emergency room as
soon as possible if he recently exposed to HIV positive person. tech the patient that he must take
PEP as prescribed, once or twice daily for 28 days .(Centers for Disease Control and Prevention.
(2019). AIDS Prevention)

Preventive Education:- educating the public regarding more safer sexual activities to reduce -
the risk of transmitting HIV infection to sexual partners by (1) Instruct the patient about avoid
sharing sexual fluids, (2) the number of sexual partners should be only one, (3) advise him to
always wear latex condoms during sexual intercourse, (4) tech the patient about the proper use of
condoms, and avoid reusing it, (5) give patient information about nonpenetrating sexual activities
such as social kissing, (6) warn patient about share of needles, razors, toothbrushes or other
contaminated blood articles (7) educate the patient with HIV positive to avoid sexual intercourse
or sharing needles with another HIV Positive person (8) HIV seropositive patient should be
.advised to do not donate blood, plasma or body organs

Reproductive education :- an accurate information about risks of transmitting HIV infection -

 should be given to the women considering pregnancy, in order to prevent transmission of HIV to
themselves, their partner, and their future children. Tech them about the importance of taking
antiretroviral agents to reduce perinatal HIV transmission. Because HIV virus can be transmitted
by breast milk, HIV seropositive women should be instructed not to breast feed their infants.
Certain contraceptive methods may cause additional risks for HIV transmission such as estrogen
.containg oral contraceptives and The intrauterine contraceptive device (IUD)

--: Health care providers Education

Standard Precautions:- these precautions are used to prevent and reduce risk of transmission of
HIV among health care workers includes :- (1) Washing of hands :hand washing immediately
after removing gloves, touching blood, body fluids, secretions or any contaminated object. (2)
protective personal equipments :- Gloves are used to touch blood, bodily fluids, secretions,
excretions, and infected objects, as well as to touch mucous membranes and intact skin ,-Gown
are used when touching clothing or exposed skin with blood or body fluids, secretions and
excretions is expected during procedures and patient care activities, -Masks and eye shields are
used in procedures that is likely to cause splashes or sprays of blood, body fluids and secretions.
(3)patient care Soiled equipment :- handle in a way that prevents microorganisms from being
transferred to others and to the environment; wear gloves when visibly contaminated and wash
hands. (4) Control patient's care area :- involve cleaning and disinfecting the environmental
surfaces particularly frequently touched surfaces in areas of patient care. (5) During
resuscitation of patient :- avoid contact with mouth and oral secretions through use of
mouthpiece and resuscitation bag. (6)accidental injuries should be avoided :- during any
procedure take care when dealing with sharp equipments such as needles, blades, laboratory
. instruments

.Vaccination :- till this time There is no vaccine is available to prevent infection with HIV -

) Smeltzer,S.,Bare,B.and Nokes,K.(2010).Brunner ,12th. ed(

•Treatment

Nowadays there's no cure of AIDS, only there's treatment for controlling the Disease, managing
symptoms and improve quality of life for those who develop symptoms. The treatment involve
Antiretroviral therapy which is a combination of antiretroviral drugs that are effective in
.decreasing the amount of HIV(Viral load) in the blood

-: Antiretroviral therapy has five classes*

Nucleoside reverse transcriptase inhibitors (NRTIS) it blocks the HIV viral reverse transcriptase -1
to stop HIV replication ex lamivudine

non nucleoside reverse transcriptase inhibitors (NNRTIS) it works on different sites of Viral -2
enzyme ex Efavirenz

Protease inhibitors : it acts directly on the virus and inhibit the HIV protase ex Indinavir -3

integrase inhibitors : it blocks the protein that HIV uses to send it's genetic material into cells -4
ex : Dolutegravir

.Entry inhibitor:- it's stops the HIV from attach to the cell receptors ex : Enfuvirtide -5

)Medical Surgical Notes(2019-2020) AIDS(

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• References

EKB, Brirannica ACADEMIC. (2019). AIDS . Available at https://06107h7qk-1103-y-https-(-1

) academic-eb-com.mplbci.ekb.eg/levels/collegiate/article/AIDS/4173 .Retrieved on 5/12/2020

HIV Ireland organization. (2018). Stages of HIV infection. Available at (-2

)https://www.hivireland.ie/hiv/stages-of-infection/ .Retrieved on 12/5/2020

.)Medical Surgical Notes(2019-2020) AIDS(-3

Rastogi,S., Pratap,U,. Agrahari,S. and Verma,A,.(2011) Clinical Staging of HIV. Biolixir ; ( -4

Available at .)volume 1: 29-3
https://www.researchgate.net/publication/323850916_Clinical_Stages_of_HIV .Retrieved on
.)12/5/2020

Blaser,M., Bennett,J., and Dolan,R. (2010). Principles and Practice of Infectious Diseases : ( -5
)Chapter 118 12th ed

WHO, (2007). WHO case definitions of HIV for surveillance and revised clinical staging and -6
)immunological classification of HIV-related disease in adults and children. France: WHO library

Centers for Disease Control and Prevention.(2019). AIDS Prevention available at ( -7

)https://www.cdc.gov/hiv/basics/prevention.html Retrieved on 14/5/2020

Smeltzer,S.,Bare,B.,Hinkle,J.,Cheever,K, and Nokes,K.(2010). Brunner and Suddarth's (-8

)Textbook of Medical-Surgical, 12th ed:Canda ,Library of congress

HIV.gov.(2019). Symptoms of HIV. Available at (-9

https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv .Retrieved on
) 5/12/2020