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HIV/AIDS

DEFINITION
● Acquired immunodeficiency
syndrome (AIDS) is defined as the
most severe form of a continuous
illness associated with HIV.
● Human immunodeficiency virus (HIV)
infection belongs to a group of
viruses known as retroviruses.

RISK FACTORS

● IV/Injection drug use

● Sexual relation w/ infected
individuals (both gender)
● Person who receive BT products
contaminated w/ HIV
STAGES OF HIV DISEASE
1. Primary infection “Acute HIV
infection/Acute HIV syndrome”
CAUSE
2. HIV asymptomatic “CDC Category A”
*RETROVIRUS*
More than 500 CD4+ T-
Lymphocytes/mm3.
PATHOPHYSIOLOGY 3. HIV symptomatic “CDC Category B”
200 – 499 CD4+
T-Lymphocytes/mm3.
4. AIDS “CDC Category C” less than 200
CD4+ T-Lymphocytes/mm3.

Sx/S

RESPIRATORY MANIFESTATION
● SOB
● Dyspnea
● Cough
● Chest pain
● Fever

COMMON INFECTION
● Pneumocystis Carinii
Pneumonia(PCP)
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● Mycobacterium Avium ● MAC

Complex(MAC) ● Meningitis
● TB ● Cytomegalovirus Retinitis
● Wasting Syndrome
GI MANIFESTATION ● Lymphoma
● Loss of appetite ● Neurologic complication
● N/V
● Oral & esophageal candidiasis LAB TEST/DX TEST
● Chronic Diarrhea
● Wasting Syndrome ● ELISA (Enzyme linked
immunosorbent assay) or EIA
ONCOLOGIC MANIFESTATION (Enzyme immunoassay)
● Kaposi’s Sarcoma ● Western Blot
● B-Cell Lymphoma ● Viral load
● CD4/CD8 ratio
NEUROLOGIC MANIFESTATIONS
● HIV Encephalopathy
● Cryptococcus neoformans
MED MNGT
● Progressive Multifocal
Leukoencephalopathy
● Other Neurologic Disorders PCP
● Trimethoprim -
DEPRESSIVE MANIFESTATION Sulfamethoxazole (TMP-SMZ)
● Irrational guilt & shape ● Alternative therapeutic
● Loss of self-esteem regimens
● Feeling helpless & worthlessness (mild–to–moderate)
● Suicidal ideation 1. Dapsone & TMP
2. Primaquine + clindamycin
INTEGUMENTARY MANIFESTATION 3. Atovaquone suspension
● Dry, flaking skin/atopic dermatitis – (mild–to–severe)
ECZEMA PSORIASIS 1. Primaquine + clindamycin
2. IV pentamidine
ENDOCRINE MANIFESTATION
● Infiltration & destruction from A/E
Opportunistic infection/Neoplasm ● ↓HPN
● Damaged of endocrine fx ● Impaired glucose metabolism leading
to the ff.
GINECOLOGIC MANIFESTATION ➔ DM
● Genital ulcer disease ➔ Damage to the pancreas
● Venereal warts ➔ Renal damage
➔ Hepatic dysfunction
➔ Neutropenia
COMPLICATION & INFECTIONS
MAC
● HIV - infected adults & adolescents
● PCP
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➔ Chemoprophylaxis against 1. Possible bone Marrow Suppression

MAC if they have a CD4+
count fewer than 50 cells/uL
● Azithromycin (zithromax) &
Clarithromycin (Biaxin)
= Prophylactic Agent
● Rifabutin – alternative prophylactic
agent
MENINGITIS
● IV amphotericin B w/ or w/o oral
flucytosine (5-FC, Ancobon)
● Fluconazole (diflucan)
A/E
● Anaphylaxis
● Renal & hepatic impairment
● Anemia
● Fever
● Severe Chills
(producing a ↓ in WBC &
platelet count)
2. Oral Candidiasis & liver & renal
Impairments, require close
monitoring.
OTHER INFECTION
● Oral acyclovir
● Famciclovir
● Valacyclovir
❖ Used to treat infection
caused by herpes
simplex/herpes zoster.
● Esophageal/Oral candidiasis
➔ Treated topically w/
clotrimazole (mycelex) oral
troches/nystatin suspension.

CMV RETINITIS ● Ketoconazole (Nizoral)

● Oral Valganciclovir, IV ganciclovir, ● Fluconazole (Diflucan)
followed by oral valganciclovir ➔ Used to treat Chronic
● IV foscarnet Refractory infection w/
● IV cidofovir candidiasis or esophageal
involvement.
A/E of GANCICLOVIR
● Neutropenia, w/c limit the PREVENTION OF INFECTION
concomitant use of zidovudine 1. People w/ HIV infection who have a
(azidothymidine, Compound S, T-cell count of fewer than 200
Retrovir) cells/mm3 should receive
A/E of FOSCARNET chemoprophylaxis w/ TMP–SMZ to
● Nephrotoxicity prevent PCP.
● Acute renal failure 2. PCP prophylaxis can be safely
● Electrolyte Imbalances discontinued in pt’s who are
➔ Hypocalcemia responding to HAART w/ a sustained
➔ Hyperphosphatemia ↑ in T–lymphocytes.
➔ Hypomagnesemia 3. Antidiarrheal Therapy
● Seizures 4. Chemotherapy
● Gi tract disturbance a. Kaposi's Sarcoma – Radiation
● Anemia therapy
● Phlebitis at the infusion site b. Lymphoma – Radiation
● Low back pain Therapy & Chemotherapy
5. Antidepressant Therapy

Severe depression – ECT
6. Nutrition Therapy
❖ Diarrhea – ↓ fat, lactose,
insoluble fiber, caffeine, and
↑ soluble fiber
a. Calorie count should be
obtained
b. Appetite stimulants
c. Oral supplements
7. Health promotion & Illness
Prevention Safe Sex & Safer behavior
“PRADDDAI”
● Practice abstinence
● Reduce the number of sexual
partners to one.
● Avoid anal intercourse
● Do not reuse condom
● Do not ingest urine or semen
● Do not share needles
● Always use condom
● If you are HIV seropositive, do not
donate blood & body organs
NX MNGT
Assessment
➔ Nutritional Status
◆ Obtain dietary Hx
◆ Identify factors that interfere
oral intake
◆ Measure nutritional status
➔ Skin & Mucous membrane
◆ Inspect daily for breakdown,
ulceration, and Infection
◆ Monitor oral cavity
◆ Assess perianal area
◆ Obtain wound cultures
➔ Respiratory Status
◆ Assess other parameters of
pulmonary fxn
◆ Monitor for cough, sputum
production, SOB, orthopnea,
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tachypnea & chest pain,
assess breath sounds.
➔ Neurologic Status
◆ Assess mental status as early
as possible
◆ Observe for motor
impairments
◆ Observe for seizure activity
➔ FLD and electrolyte status
◆ Examine skin & tongue
turgor
◆ Assess for dehydration
◆ Monitor electrolyte
imbalance
◆ Assess for Sx/S of electrolyte
deficit
➔ Level of Knowledge
◆ Evaluates pt’s knowledge of
the disease & transfusion
◆ Assess level of Knowledge of
family and friends about
HIV/AIDs
◆ Explore how pt has dealt w/
illness & major life stressors
in the past
DIAGNOSIS
● Diarrhea r/t enteric pathogen or
infection.
● Risk for infection r/t IM.
● Ineffective airway clearance r/t
Pneumocystis carinii pneumonia, ↑
bronchial secretions & ↓ability to
cough r/t weakness & fatigue.
● Imbalanced nutrition, less than body
requirements r/t ↓ oral intake.
● Deficient knowledge r/t means of
preventing HIV transmission.
● Social isolation r/t stigma of the
disease, withdrawal of support
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system, isolation procedures & fear

of infecting others.
● Opportunistic infections; Impaired
breathing; wasting syndrome; FLD
and Electrolyte imbalance; adverse
reaction & Medications
COLLABORATIVE/POTENTIAL
COMPLICATION
● Opportunistic Infection
● Impaired breathing/respiratory
failure
● Wasting syndrome & FLD and
electrolyte imbalance
● Adverse reaction to medications
PLANNING
● Resumption of usual bowel habits
● Absence of infection
● Improved airway clearance
● Improvement of nutritional status
● ↑ Knowledge concerning means of
preventing disease transmission
● ↓Sense of social isolation
● Absence of complications
INTERVENTIONS
● Promoting Skin Integrity
● Maintaining perianal skin integrity
● Promoting Usual bowel patterns
● Preventing Infections
● Improving Activity Tolerance
● Maintaining thought process
● Improving airway clearance
● Relieving pain & discomfort
● Improving nutritional status
● Decreasing sense of social isolation
● Coping w/ Grief
● Monitoring & managing potential
complications
● Promoting home & community based
care
● Continuing care
EVALUATION
1. Maintain skin integrity
2. Resumes usual bowel habits
3. Experiences no infection
4. Maintain adequate level of activity
intolerance
5. Maintain usual level of thought
process
6. Maintain effective airway clearance
7. Experiences ↑ sense of comfort &
less pain
8. Maintain adequate nutritional status
9. Experiences ↓ sense of social
isolation
10. Progresses through grieving process
11. Reports ↑ understanding of AIDs &
participates in self–care activities as
possible
12. Remains free of complications
PROGNOSIS
According to the Centers for Disease
Control & Prevention (CDC, 2014) estimates
that the average person lives to 79 Y.O. w/
HIV tx, Someone diagnosed w/ HIV as a 20
Y.O. can live up to 71 years on average.
However w/o tx, the prognosis is grim:
Someone diagnosed w/ HIV as a 20 Y.O. w/o
medication lives to 32 years of age on
average