HIV/AIDS

HIV

• Human:
This virus only affects humans.
• Immunodeficiency:
HIV weakens your immune system by destroying important cells that fight
disease and infection. A "deficient" immune system can't protect you.
• Virus:
HIV is a S.T.D. which attacks a key part of your immune system- disease
fighting cells.
HIV invades these cells and uses them to make more copies of itself. Then, after
multiplying to great amounts, it destroys these disease fighting cells.
Human Immunodeficiency Virus
• (HIV) is a disease in which there is a severe loss of the body's cellular immunity, greatly lowering
the resistance to infection and malignancy.
AIDS
• Acquired:
AIDS is acquired after birth; it is not genetic.
• Immunodeficiency
The immune system is all the organs and cells that work to fight off infection or
disease.
• Deficiency:
AIDS is contracted when your immune system is deficient, not working properly.
• Syndrome:
AIDS is a syndrome, a complex illness with a wide range of complications and
symptoms.
AQUIRED IMMUNODEFICIENCY SYNDROME 

• (AIDS) is a severe immunodeficiency caused by HIV (HUMAN

IMMUNOVIRUS), which allows normally benign organisms to flourish and
cause disease.
 Primary infection
(Acute/Recent HIV
Infection). The period from
The stages of HIV disease  infection with HIV to the
development of HIV-specific
antibodies is known as
primary infection.

HIV asymptomatic (CDC

HIV symptomatic (CDC
Category A). After the viral
Category B). Category B
set point is reached, HIV-
consists of symptomatic
positive people enter into
conditions in HIV-infected
a chronic stage in which
patients that are not included
the immune system cannot
Classificatio
in the conditions listed in
eliminate the virus despite its
category C.
best efforts.

n
AIDS (CDC Category
C). When the CD4+ T-cell
level drops below 200
cells/mm3 of blood, the
person is said to have AIDS.
Causes
People transmit HIV in bodily fluids, including:
• blood
• semen
• vaginal secretions
• anal fluids
• breast milk
Risk Factors for HIV Infection and AIDS

01 02 03
Intravenous or Sexual relations Also at risk are
injection drug use with infected people who
as well as those individuals (both received blood or
who inject drugs male and female) blood products
intradermally.  contaminated with
HIV 
Pathophysiology
 • EARLY SYMPTOMS
• The early symptoms of HIV infection may include:
• fever
• chills
• joint pain
Clinical • muscle aches
Manifestations • sore throat
• sweats. particularly at night
• enlarged glands
• a red rash
• tiredness
• weakness
• In many cases, after the symptoms of acute retroviral syndrome, symptoms might not occur for
many years.
• During this time, the virus continues to develop and cause immune system and organ damage.
Without medication that prevents the replication of the virus, this slow process can continue for an
average of around 10 years.
LATE STAGE
• SYMPTOMS
• Symptoms of late-stage HIV infection may include:
• blurred vision
• diarrhea, which is usually persistent or chronic
• dry cough
• a fever of over 100 °F (37 °C) lasting for weeks
• night sweats
• permanent tiredness
• shortness of breath, or dyspnea
• swollen glands lasting for weeks
• unintentional weight loss
• white spots on the tongue or mouth
• GI MANIFESTATIONS 
The GI manifestations of AIDS include loss of appetite, nausea, vomiting, oral and
esophageal candidiasis, and chronic diarrhea. 
•  Oral Candidiasis. 
• ONCOLOGIC MANIFESTATIONS 
• Patients with AIDS have a higher than usual incidence of cancer, possibly related
to HIV stimulation of developing cancer cells or to the immune deficiency
allowing cancer-causing substances.
• Kaposi’s Sarcoma. Kaposi’s sarcoma (KS), the most common HIV-related
malignancy, is a disease involving the endothelial layer of blood and lymphatic
vessels
Assessment and
Diagnostic Findings
• Confirming Diagnosis: Signs and symptoms may occur at any time after infection, but AIDS isn’t
officially diagnosed until the patient’s CD4+ T-cell count falls below 200 cells/mcl or associated clinical
conditions or disease.
• PPD: Determines exposure and/or active TB disease. Of AIDS patients, 100% of those exposed to
active Mycobacterium tuberculosis will develop the disease.
• Western blot test: Confirms diagnosis of HIV in blood and urine.
• STD screening tests: Hepatitis B envelope and core antibodies, syphilis, and other common STDs
may be positive.
Selected Laboratory Tests for Diagnosing and Tracking HIV
and Assessing Immune Status

TEST FINDINGS IN HIV INFECTION 

• EIA (enzyme immunoassay), formerly • Antibodies are detected, resulting in positive
results and marking the end of the window period.
referred to as ELISA (enzyme-linked
•  Also detects antibodies to HIV; used to confirm
immunosorbent assay)
EIA
•  Western  •  Measures HIV RNA in the plasma

• blot Viral load •  These are lymphocytes. HIV kills CD4 cells,
which results in a significantly impaired immune
•  CD4/CD8 ratio system.
Medical Management

• Treatment of opportunistic infections. For Pneumocystis pneumonia, TMP-

SMZ is the treatment of choice; for mycobacterium avian
complex, azithromycin orclarithromycin are preferred prophylactic agents;
for cryptococcal meningitis, the current primary treatment is IV 
amphotericin B.
• Antidiarrheal therapy. Therapy with octreotide acetate (Sandostatin), a
synthetic analog of somatostatin, has been shown to be effective in managing
severe chronic diarrhea.
• Antidepressant therapy. Treatment for depression in patients with HIV
infection involves psychotherapy integrated with imipramine, desipramine or
fluoxetine.
• CHEMOTHERAPY
• Nutrition therapy. For all AIDS patients who experience unexplained weight
loss, calorie counts should be obtained, and appetite stimulants and oral
supplements are also appropriate.
Prevention

• Safe sex. Other than abstinence, consistent and correct use of condoms is the

only effective method to decrease the risk of sexual transmission of HIV
infection.
• Blood and blood components. People who are HIV positive or who use
injection drugs should be instructed not to donate blood or share drug
equipment with others.
Nursing Management

• Nursing assessment includes identification of potential risk factors, including a history of risky sexual
practices or IV/injection drug use.
• Nutritional status. Nutritional status is assessed by obtaining a diet history and identifying factors that
may affect the oral intake.
• Skin integrity. The skin and mucous membranes are inspected daily for evidence of breakdown,
ulceration, or infection.
• Respiratory status. Respiratory status is assessed by monitoring the patient for cough, sputum
production, shortness of breath, orthopnea, tachypnea, and chest pain.
• Neurologic status. Neurologic status is determined by assessing the level of consciousness;
orientation to person, pace, and time; and memory lapses.
• Fluid and electrolyte balance. F&E status is assessed by examining the skin and mucous
membranes for turgor and dryness.
• Knowledge level. The patient’s level of knowledge about the disease and the modes of disease
transmission is evaluated.
Nursing Interventions

• The plan of care for a patient with AIDS is individualized to meet the needs of the patient.
• Promote skin integrity. Patients are encouraged to avoid scratching; to use nonabrasive, nondrying
soaps and apply nonperfumed moisturizers; to perform regular oral care; and to clean the perianal area after
each bowel movement with nonabrasive soap and water.
• Promote usual bowel patterns. The nurse should monitor for frequency and consistency of stools and the
patient’s reports of abdominal pain or cramping.
• Prevent infection. The patient and the caregivers should monitor for signs of infection and laboratory test
results that indicate infection.
• Improve activity intolerance. Assist the patient in planning daily routines that maintain a balance between
activity and rest.
• Maintain thought processes. Family and support network members are instructed to speak to
the patient in simple, clear language and give the patient sufficient time to respond to questions.
• Improve airway clearance. Coughing, deep breathing, postural drainage, percussion and
vibration is provided for as often as every 2 hours to prevent stasis of secretions and to promote
airway clearance.
• Relieve pain and discomfort. Use of soft cushions and foam pads may increase comfort as
well as administration of NSAIDS and opioids.
• Improve nutritional status. The patient is encouraged to eat foods that are easy to swallow and
to avoid rough, spicy, and sticky food items.
Complications

• Opportunistic infections. Patients who are immunosuppressed are at risk for opportunistic

infections
• Respiratory failure. Impaired breathing
• Cachexia and wasting.