Acquired Immune Deficiency Syndrome (AIDS)

Definition

AIDS – It is acquired, which means it is neither hereditary nor inborn. It involves an immune
deficiency. When a person’s immune system breaks down, he or she becomes susceptible to many
infections which eventually lead to death. It is a syndrome, a combination of signs & symptoms
that form a distinct clinical picture of disorder.

HIV – refers to the Human Immunodeficiency Virus which causes AIDS. It is a retrovirus. It
belongs to lentivirus, which is sometimes called “slow virus.” The time between infection and
appearance of symptoms tends to be much longer, allowing more opportunities for these
microorganisms to be transmitted to other hosts. The period between infection and the appearance
of AIDS can make from 7-12 years.

Signs & Symptoms

A person may remain asymptomatic. Feel, and appear healthy for years even though he or she is
infected with HIV. While he or she does not exhibit AIDS, the immune system starts to be
impaired. The person may exhibit neurological symptoms such as:
• Memory loss
• Altered gait
• Depression
• Sleep disorders
• Chronic diarrhea
This set of symptoms is often called AIDS - related complex (ARC) by clinicians. As the
symptoms progress, the patient becomes an AIDS patient.

Minor Signs:

• Persistent cough for 1 month

• Generalized pruritic dermatitis
• Recurrent herpes zoster
• Orophrayngeal candidiasis
• Chronic disseminated herpes simplex
• Generalized lymphadenopathy

Major Signs:

• Loss of weight – 10% of body weight

• Chronic diarrhea fro more than 1 month
• Prolonged fever for 1 month

Common Opportunistic Infections

• Pneumocystis carinii pneumonia

• Oral candidiasis
• Toxoplasmosis of the CNS
• Chronic diarrhea/wasting syndrome
• Pulmonary/extra-pulmonary tuberculosis
• Cancers
a. Kaposi’s sarcoma – affects small blood vessels and internal organs
b. Cervical dysplasia and cancer – researchers found out that women with HIV have higher
rates of this type of cancer. Cervical carcinoma is associated with Human Papilloma
Virus (HPV).
c. Non-Hodgkin’s lymphoma – cancerous tumor of the lymph nodes. This is usually a late
manifestation of HIV infection.

Mode of Transmission:

1. Sexual intercourse
2. Blood transfusion and sharing of infected syringes and needles among intravenous drug users
3. Vertical or perinatal transmission (from a pregnant woman to the fetus during pregnancy,
child delivery, or breast-feeding)

There are several ways of receiving infected blood:

1. Blood transfusion
2. Sharing of unsterilized syringes and needles used for intravenous injections
3. Transmission during pregnancy
a. maybe transplanted
b. there is greater risk of transmission when mother has developed advanced AIDS
4. Organ donation
5. Accidental exposure in hospitals or clinics

Diagnostic Examination:

• EIA or ELISA – Enzyme Link Immunosorbent Assay

• Particle Agglutination (PA) test
• Western Blot Analysis – confirmatory diagnostic test
• Immunofluorescent test
• Radio Immuno-precipitation Assay (RIA)

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 2 groups of anteroviral drugs:

1. Reverse transcriptase 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

Nursing Management

1. Health education
The healthcare worker must:
a. know the patient
b. avoid fear tactics
c. avoid judgmental and moralistic messages
d. be consistent and concise
e. use positive statement
f. give practical advice
2. Practice universal/standard precaution
a. 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.
b. Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap, mask,
gloves, CD gown, face shield/goggles, is very necessary.
3. Prevention
a. Care should be taken to avoid accidental pricks from sharp instruments
contaminated with potentially infectious materials from AIDS patient.
b. Gloves should be worn when handling blood specimens and other body
secretions as well as surfaces, materials, and objects exposed to them.
c. Blood and other specimens should be labeled with special warning “AIDS
Precaution.”
d. Blood spills should be cleaned immediately using common household
disinfectants, like “chlorox.”
e. Needles should not be bent after use, but should be disposed into a puncture-
resistant container.
f. 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.
g. Patients with active AIDS should be isolated.

The Four C’s in the Management of HIV/AIDS

1. Compliance – giving of information and counseling the client which results to the client’s
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 – tracing out and providing treatment to partners
4. Condoms – promoting the use of condoms, giving instructions about its use, and giving
away available condoms.