1. Chapter 85 HIV and AIDS

2. HIV and AIDS HIV: Human immunodeficiency virus
AIDS: Acquired immunodeficiency syndrome
HIV affects the work of the immune system and often leads to AIDS.

3. History of HIV/AIDS
HIV-1 is the predominate strain of the virus that causes HIV/AIDS.
An international team of researchers has concluded that HIV-1 was introduced to human populations when hunters became exposed to infected blood from a subspecies of chimpanzees native to west equatorial Africa.
In 1982, AIDS was added to the list of conditions that are formally tracked by the Centers for Disease Control and Prevention (CDC).

4. Action of HIV
HIV is an infectious human retrovirus that invades a healthy, normal cell.
The virus overtakes the biosynthesis of existing cells to duplicate and spread HIV within the body.
The retrovirus commonly invades T cells and B cells.
The main cell affected by HIV is the helper T4 lymphocytes, better known as CD4 cells.
Also as a direct consequence of the invasion, the individual is vulnerable to many opportunistic infections (OIs).

5. Human Immunodeficiency Virus

6. OIs Related to HIV/AIDS
Bacterial infections
Viral infections
Protozoal infections
Fungal infections
Other conditions and complications
Wasting syndrome malignancies (cancers)
Neurologic conditions

7. HIV Medications Effective after entering a CD4 cell
Nucleoside reverse transcriptase inhibitors (NRTIs)
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
Protease inhibitors (PIs)
Prevent HIV from entering CD4 cells
Entry inhibitors (including fusion inhibitors)
Integrase inhibitors
Antiretroviral therapy

8. Transmission HIV is transmitted through infected body fluids.
It can be passed to another through
Unprotected sexual contact
Sharing of infected needles
Accidental exposure to infected blood
Transmission from an infected pregnant woman to her fetus, and breastfeeding.

9. Question Is the following statement true or false?
Nurses must strongly advocate HIV testing for all pregnant women.

10. Answer
True
Early detection and treatment of HIV/AIDS as part of maternal prenatal care can prevent HIV infection in the newborn.
HIV-infected pregnant women should be treated for HIV because this reduces the risk of infection in the newborn.

11. Diagnostic Tests Preliminary testing if HIV is suspected:
CD4 count, viral load
Complete blood count, blood chemistries, urinalysis
Testing for sexually transmitted infections (STIs)
Testing for hepatitis, TB, or toxoplasmosis
Testing for sensitivities or drug resistance to specific HIV medications
HIV antibody testing, HIV antigen testing

12. Diagnostic Tests (cont’d)
Nursing considerations and HIV testing
An informed consent must be obtained from the client before testing.
Pre- and posttest counseling is required regardless of the test results.
Results cannot be given over the telephone.
Ensure client confidentiality; it is essential.
The laboratory must be approved by the state for HIV testing.

13. Signs and Symptoms of HIV Infection
Rapid weight loss, lymphadenopathy
Recurring fever, night sweats, diarrhea, anorexia
General malaise, dry cough, oral thrush
White spots on tongue, in mouth, or throat
Herpes zoster infection or shingles, pneumonia
Spots on or under the skin, inside the mouth, nose, or eyelids
Memory loss, lipoatrophy, lipodystrophy

14. Signs and Symptoms of HIV Infection in Women
HIV infection may be overlooked and attributed to genital ulcer disease, sexually transmitted infections, HPV infections, and pelvic inflammatory disease (PID).
Other common HIV-related signs and symptoms include:
Recurrent vaginal candidiasis
Menstrual abnormalities, including amenorrhea or bleeding between periods
Abnormal Pap tests
Cervical cancer

15. Question Is the following statement true or false?
Persons with HIV show symptoms immediately, and there may be no need for testing such individuals.

16. Answer
False
Persons with HIV can be asymptomatic for many years, and individuals who have not been tested may not know they are infected.

17. Treatment
The main treatment concept is to use medications specifically designed to combat a part of the retroviral replication cycle of HIV.
Antiretroviral drugs include
Nucleoside/nucleotide reverse transcriptase inhibitors
Nonnucleoside reverse transcriptase inhibitors
Protease inhibitors, entry inhibitors, integrase inhibitors
Immune-based therapies

18. AIDS
HIV-positive individuals with a T-cell count below 200/mm3 belong in the group of individuals who may be considered to have a diagnosis of AIDS.
Persons with HIV and certain OIs or cancers also are considered to have AIDS.
AIDS is ultimately a terminal condition; the emotional, physical, and financial implications can be enormous.

19. Opportunistic Infections
Candidiasis, cryptococcus, cytomegalovirus (CMV)
Herpes simplex
Histoplasmosis
Mycobacterium avium complex (MAC)
Pneumocystis carinii pneumonia (PCP)
Toxoplasmosis
A variety of other fungal, viral, and bacterial infections may also occur, causing constitutional disease and neurologic disorders.

20. Treatment
The ideal approach to the management of AIDS involves prophylaxis and the early treatment of such infections when they occur.
The use of antiretroviral medications has resulted in the decline or delay in the number of individuals who progress from HIV to AIDS.
HIV/AIDS medication therapy demands strict adherence to a complicated regimen. The client and the nurse must be aware of the requirements of each medication.

21. Nursing Process Data collection Planning and implementation
Nursing implications for clients with HIV
Nursing implications for clients with AIDS
Evaluation

22. Question Is the following statement true or false?
HIV and its treatment can complicate the aging process.

23. Answer
True
Healthcare for the older population typically includes heart disease, hypertension, diabetes, cancer, and respiratory problems, which may need pharmaceutical or surgical therapies.
Potentially hazardous drug interactions may occur.

24. HIV Exposure to Healthcare Workers
Postexposure prophylaxis (PEP)
Postexposure treatment
Counseling, laboratory tests, and follow-up testing
Always use Standard Precautions

25. End of Presentation