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I.

DEFINITION
Human Immunodeficiency Syndrome (H I V) A specific type of virus (a retrovirus) HIV invades the helper T cells to replicate itself. Once infected with HIV, a person is referred to as HIV positive. However, this does not necessarily mean that (s)he has symptoms or feels sick. An HIV positive person can feel and look healthy for a long time after first becoming infected. Acquired Immunodeficiency Syndrome HIV is the virus that causes AIDS Disease limits the bodys ability to fight infection A person with AIDS has a very weak immune system the virus kills or impairs more and more cells in the immune system and the body loses the ability to fight off common infections, such as diarrhea or colds. People with AIDS can die from diseases that are usually not dangerous for people with healthy immune systems. There are no cures or vaccines for HIV/AIDS. Currently awareness/education is the only way to prevent infection. AIDS deaths in 2007, Estimate 2.0 million, while the Range is 8-2.3 million. More than 25 million people have died of AIDS since 1981. HIV came from a similar virus found in chimpanzees - SIV. HIV probably entered the United States around 1970 CDC in 1981 noticed unusual clusters of Kaposis sarcoma in gay men in NY and San Francisco, which led to the disease to be called GRID (Gay Related Immune Deficiency). By 1982 the disease was apparent in heterosexuals and was renamed AIDS (Acquired Immune Deficiency). 1984- Scientists(Dr. Luc Montagnier, Dr. Robert Gallo) identify HIV (initially called LAV or HTLV-III) as the cause of AIDS 1987- AZT is the first drug approved for treating AIDS

II. Mode of Transmission


Through Bodily Fluids Blood products Semen Vaginal fluids Breast Milk Through IV Drug Use Sharing Needles Without sterilization Increases the chances of contracting HIV Through Sex Intercourse (penile penetration into the vagina) Oral Anal Digital Sex Mother-To-Baby Before Birth During Birth Postpartum After the birth The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Symptoms: Persistent Cough for one month Generalized pruritic dermatitis Recurrent herpes zoster Oropharyngeal candidiasis

Chronic disseminated herpes simplex Generalized lymphadenopathy Major Signs: Loss of weight 10 percent of body weight Chronic diarrhea for more than one month Prolonged fever for one month Common Opportunistic Infections Pneumocystis carinii pneumonia Oral candidiasis Toxoplasmosis of the CNS Chronic diarrhea/wasting syndrome Pulmonary/extra-pulmonary tuberculosis Cancers Kaposis sarcoma affects small blood vessels and internal organs Cervical dysplasia and cancer. Researchers found out that women with HIV have higher rates of this type of cancer. Cervial carcinoma is associated with Human Papilloma Virus (HPV). Non-Hodgkins lymphoma cancerous tumor of the lymph nodes. This is usually a late manifestation of HIV infection.

III. Diagnostic Examinations


Enzyme-linked immunosorbent assay (ELISA). In an ELISA test, a person's serum is diluted 400-fold and applied to a plate to which HIV antigens have been attached. If antibodies to HIV are present in the serum, they may bind to these HIV antigens. This test is usually the first one used to detect infection with HIV. If antibodies to HIV are present (positive), the test is usually repeated to confirm the diagnosis. If ELISA is negative, other tests are not usually needed. This test has a low chance of having a false result after the first few weeks that a person is infected. Western blot - Like the ELISA procedure, the western blot is an antibody detection test. However, unlike the ELISA method, the viral proteins are separated first and immobilized. In subsequent steps, the binding of serum antibodies to specific HIV proteins is visualized. Rapid or point-of-care tests Rapid antibody tests are qualitative immunoassays intended for use as a point-of-care test to aid in the diagnosis of HIV infection. These tests should be used in conjunction with the clinical status, history, and risk factors of the person being tested. Immunofluorescence is often used to detect the presence and amount of antinuclear antibody (ANA). These are antibodies that the body makes against itself in some autoimmune diseases like SLE. The presence of these antibodies aid in the diagnosis and management of these diseases. Polymerase chain reaction (PCR). This test finds either the RNA of the HIV virus or the HIV DNA in white blood cells infected with the virus. PCR testing is not done as frequently as antibody testing, because it requires technical skill and expensive equipment. This test may be done in the days or weeks after exposure to the virus. Genetic material may be found even if other tests are negative for the virus.

IV. MANAGEMENT
Treatment Modalities: AIDS Drugs are medicines used to treat but not to cure HIV infection. These drugs are sometimes referred to as anteroviral drugs. These work by inhibiting the reproduction of the virus. There are two groups of anteroviral drugs: 1. Reverse trancriptase inhibitors they inhibit the enzyme called reverse transcriptase which is needed to copy information for the virus to replicate. These drugs are: a. Zedovudine (ZDV) Retirvir

b. Zalcitabine Havid c. Stavudine Zerit d. Lamivudine Epivir e. Nevirapine Viramune f. Didanosine Videx 2. Protease inhibitors. They work by inhibiting the enzyme protease which are needed for the assembly of viral particles. These drugs are: a. Saquinavir Invarase b. Ritonavir Norvir c. Indinavir Crixivan 3. Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). 4. Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir). 5. Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). 6. Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.

V. Nursing Management
Health education The healthcare worker must: Know the patient Avoid fear tactics Avoid judgmental and moralistic messages Be consistent and concise Use positive statement Give practical advice Practice universal/standard precaution There is a need for a thorough medical handwashing after every contact with patient and after removing the gown and gloves, and before leaving the room of an AIDS suspect or known AIDS patient. Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap, mask, gloves, CD gown, face shield/goggles are very necessary. Prevention Care should be taken to avoid accidental pricks from sharp instruments contaminated with potentially infectious materials form AIDS patient. Gloves should be worn when handling blood specimens and other body secretions as well as surfaces, materials and objects exposed to them. Blood and other specimens should be labeled with special warning AIDS Precaution. Blood spills should be cleaned immediately using common household disinfectants, like chlorox. Needles should not be bent after use, but should be disposed into a punctureresistant container. Personal articles like razor or razor blades, toothbrush should not be shared with other members of the family. Razor blades may be disposed in the same manner as needles are disposed. Patients with active AIDS should be isolated. The Four Cs in the Management of HIV/AIDS 1. Compliance giving of information and counseling the client which results to the clients successful treatment, prevention and recommendation. 2. Counseling/education a. Giving instruction about the treatment

b. Disseminating information about the disease c. Providing guidance on how to avoid contracting STD again d. Sharing facts about HIV and AIDS 3. Contact tracing a. Tracing out and providing treatment of partners 4. Condoms a. Promoting the use of condom, giving instructions about its use, and giving away available condoms