A.I.D.S.

o Acquired Immune Deficiency Syndrome

o Considered currently as the deadliest disease in the world

o Universally fatal

o In 2001, there was a total of 3,000,000 deaths from AIDS

o Also considered as the fastest growing disease in the world

o 14,000 of new infections per day (2001)

EPIDEMIOLOGY
Asia :
o overall prevalence is < 1%

o 7.1 M adults as of 2001

o 1.07M in 2001 alone

Philippines: as of Nov., 2002

o 1,785 cases currently

o estimated cases: 10,000-13,000

AIDS is defined as the most severe form of a continuum of illness associated with
Human Immunodeficiency Virus (HIV) infection, resulting in a wide range of clinical
manifestations varying from:
o asymptomatic carrier states; to,

o severely debilitating and fatal disorders related to defective cell-mediated immunity.

HIV has been previously referred to as:

o Human T-Cell Lymphotropic Virus Type III (HTLV III)

o Lymphadenopathy-Associated Virus (LAV)

The HIV belongs to a group of viruses known as RETROVIRUSES. Some retroviruses

are oncogenic, whereas HIV does not appear to cause neoplasms directly. The virus mutates
rapidly making it more difficult for the immune system to “recognize” the invaders.

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 AIDS is characterized by a defect in natural immunity against disease. With loss of the
immune response, the individual is susceptible to a variety of “opportunistic infections” or
“secondary infections” that is usually do not pose a threat to anyone whose immune system
is working normally.

o Immunosuppressed (AIDS) -- (+) opportunistic infections

o Immunocompetent -- (–) opportunistic infections

HIV infects a major subset of T lymphocytes, especially Helper T cells (T4 or CD4). HIV
also infects non-lymphoid cells, such as macrophages, microglia, and various endothelial and
epithelial cells. As a result of HIV infection, the numbers and functions of T cells, B cells,
natural killer cells, and monocytes-macrophages are disturbed. Much of the immunologic
dysfunction in AIDS appears to be explained by loss of the function of Helper T cells, which is
critical to Cell-Mediated Immunity.

Humoral immunity is also affected. Hyperplasia (↑ in number) of B- lymphocytes

(antibody-producing) in lymph nodes causes lymphadenopathy and increased secretion of
antibodies, leading to hyperglobulinemia. Production of antibodies to previously
encountered antigens persists; however, response to NEW antigens is defective and
sometimes absent. Thus, total antibody levels (especially IgG and IgA) may be elevated but
response to immunizations increasingly declines as CD4 counts decline.

CHARACTERISTICS OF HIV
1. HIV is a retrovirus and has a different life cycle from a normal virus.
2. HIV contains a special enzyme called reverse transcriptase.
3. HIV primarily attaches and changes the protein on the surface of the Helper-T cells (also
known as CD4 Lymphocytes or T4)
4. HIV is unique in that it attacks the immune system, which is responsible for us against all
other diseases

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TRANSMISSION OF THE AIDS VIRUS
*AIDS virus does not appear highly contagious

SOURCE:
o Transfer of virus occurs through a transfer of certain body fluids, such as:

o Semen

o Blood

o Breast-milk

o Vaginal cervical secretions

o Body fluids containing infected lymphocytes enter the blood-stream or body cavity to
spread the virus

o The virus exists in:

o Tears

o Saliva

o Urine

o Feces

o spinal fluid

o Sputum

o Pus

o Bone marrow

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 o however epidemiological evidence has not confirmed transmission through those body
fluids; extremely rare, if it occurs

Highest concentrations of HIV are found in:

o Blood

o Semen

o Cerebrospinal fluid

MODE OF TRANSMISSION
1. Having sex with someone who is infected with AIDS virus (Sexual contact)
o other practices, such as fellatio and cunnilingus appear to be relatively, but NOT
absolutely, safe.
2. Receiving blood transfusion or blood products from someone infected with the AIDS
virus.
3. AIDS can be acquired from an infected mother during pregnancy or at birth when
passing through the vaginal canal;
o it can also be transmitted through breast-milk

4. Needle-stick injury or sharing intravenous needles with someone who is infected with
the AIDS virus (small amounts of blood are also shared).
5. Receiving transplants tissues infected with HIV

HIV CANNOT be transmitted through:

o Casual contact such as shaking hands

o Sneezing

o Coughing

o Hugging

o Sharing eating/drinking utensils

o Ordinary household work contact

o Mosquito bites
AIDS – RELATED COMPLEX (ARC)
A person may remain asymptomatic, feel and appear healthy for years even though the
person is infected with HIV. While he or she does not exhibit AIDS, the immune system starts
to be impaired.

But once the patient exhibits signs and symptoms, this will be already known as AIDS-
Related Complex (ARC)
o as symptoms progress, the patient becomes an AIDS patient

It describes the condition of a patient who has one or more illnesses resulting from an
HIV infection who have:
o at least two symptoms indicative of immunodeficiency

o two or more laboratory abnormalities but in whom AIDS itself has not yet been
diagnosed
Major signs
o Rapid weight loss, greater than 10 pounds/month

o Chronic diarrhea for more than one month

o Prolonged fever (sometimes with chills) for one month

Minor signs and symptoms

o Swollen lymph glands usually in neck, armpits and/or groin.

o Severe unexplained fatigue

o Night sweats

o White spits or other unusual blemishes such as yeast infections inside the mouth (Oral
thrush)
o Significant and lasting loss of appetite.

o Persistent cough

o Recurrent Herpes zoster or Herpes simplex

* Symptoms occur because immune system is damaged and cannot effectively fight off
illnesses.
* Symptoms last for weeks or months.

OPPORTUNISTIC INFECTIONS OF AIDS

Pneumocystis Carinii Pneumonia (PCP).
o PCP is a fungal infection of the lungs which affect 85% of AIDS clients.

Kaposi’s sarcoma (KS)

o This is a type of cancer usually occurring on the surface of the skin or in the mouth
caused by HHV-8

Oral Candidiasis/Thrush
o caused by Candida albicans

o is among the earliest and most common manifestations of HIV infection

Tuberculosis
o caused by Mycobacterium tuberculosis

o most important HIV-associated lung infection, which is frequently the first manifestation
of HIV infection especially where TB is heavily endemic

Other opportunistic infections that may occur in patients infected with AIDS include:
o Cryptococcosis (Cryptococcus neoformans)

o Coccidioidomycosis (Coccidioides immitis)

o Histoplasmosis (Histoplasma capsulatum)

o Aspergillosis (Aspergillus fumigatus)

o Toxoplasmosis (Toxoplasma gondii)

POPULATION AT RISK
1. Sexually active heterosexual men/women with multiple partners
2. Sexually active homosexuals with multiple partners
3. Illicit drug users who contact the virus through shared virus-contaminated needles
4. Patients with blood disorders who regularly require blood transfusion

LABORATORY DIAGNOSIS

ENZYME–LINKED IMMUNOSORBENT ASSAY (ELISA)

o Determines the presence of antibodies directed specifically against HIV (Anti-HIV)

o It is NOT a definitive test but it does give information that can be acted on.

o It does NOT establish a diagnosis of AIDS, but rather indicates that the
individual has been exposed to or infected with HIV.

o Person whose blood contains Anti-HIV is said to be SERO-POSITIVE

o when reactive, ELISA should be repeated on the same sample

o It is both highly sensitive and specific, but some false-positive ELISA tests occur

WESTERN BLOT TEST

o A back-up test for ELISA

o It also identifies the presence of HIV antibodies (Anti-HIV)

o Done if ELISA shows (at least two) sero-positive results

o Used to confirm sero-positive patients as identified by the ELISA procedure.

WHAT TEST RESULTS REALLY MEAN:

o If both ELISA and the Western Blot have turned up “POSITIVE”, these two things are
certain:
o the patient is exposed to HIV and has been infected; or,

o the patient is infectious and consequently capable of infecting others

o A “NEGATIVE” test is better news but does not necessarily indicate that you are safe,
especially to those who are at a higher risk in acquiring AIDS.
o Several conclusions may be drawn from a negative result:

o Seroconversion or “Window period” of the HIV

 time between the infection and the appearance of detectable antibodies

 Anti-HIV are only detectable 4 to 6 weeks after the infection
o False negative

o Patient is not infected with HIV

TREATMENT MODALITIES
“AIDS drugs” are medicines used to treat but NOT to cure HIV infection.
o works by inhibiting reproduction of HIV

types:
o Reverse Transcriptase Inhibitors

o inhibits reverse transcriptase which is needed to copy information for the virus
to replicate
o e.g. Zidovudine (AZT) and Lamivudine

o Protease Inhibitors

o inhibits protease which is needed for assembly of viral particles

o e.g. Saquinavir

PREVENTION
At present, the only practical means of control is by MINIMIZING TRANSMISSION. This
will require Educational Programs that:
o promote the use of condoms

o discourage sexual promiscuity

o prevent the use of contaminated needles

Since there is no known cure yet for AIDS, dissemination of information regarding
precautionary measure will be of great importance

Precautionary measures appropriate in caring for people with AIDS

o Extraordinary care must be taken to avoid accidental wounds from sharp instruments
contaminated with potential infected material and to avoid contact of open skin lesions with
material from people with AIDS.
o Gloves should be worn when handling blood specimens, blood-soiled items, body fluids,
excretions and secretions as well as surface, materials and objects exposed to them.

o Gowns should be worn when clothing may be soiled with body fluids, blood, secretion or
excretions.

o Hands should be washed after removing gowns and gloves and before leaving the rooms
of known or suspected AIDS victims and should also be washed thoroughly and
immediately if they become contaminated with blood.

o Blood and other specimens should be labeled prominently with a special warning such as
“Blood Precautions” or “AIDS Precautions”.

o Needless should NOT be bent after use but should be promptly placed in a puncture –
resistant container used solely for such disposal.
o needles should not be reinserted into their original sheaths before being discarded into the
container, because this a common cause of needle injury.

o Disposable syringes and needles are preferred.

o Only needle-locking syringes or one-piece syringe units should be used to

aspirate fluids, so that collected fluid can be safely discharged through the
needle, if desired.

o If reusable syringes care employed, they should be decontaminated before reprocessing.

o A private room (or isolation room) is indicated for those who are too ill to observe good
hygiene, such as those with profuse diarrhea, fecal incontinence or altered behavior
secondary to central nervous system infections.

o To minimize the need for mouth-to-mouth resuscitation, mouthpieces, resuscitation bags or

other ventilation devices should be located strategically and available for use in areas
where the need for resuscitation is predictable.

o Health care workers who are pregnant are not known to be of greater risk of contracting
HIV infection than those who are not pregnant; however, if a health care worker contracted
HIV infection during pregnancy, the infant is at increased risk of infection resulting from
 perinatal transmission. Because of this, pregnant health care workers should be especially
careful and maintain proper precautions.

o In the home setting, blood and body fluids may be flushed down the toilet.

Educational messages to provide to individuals known to have antibodies to HIV:

Individuals who have been found with a positive HIV antibody test should be informed
that they could pass the disease on to others, as a result, they should be counseled to:
o refrain from donating blood, plasma, body organs, other tissues or semen.

o Take precautions against exchanging body fluids during sexual activity.

o the effectiveness of condoms in preventing infection is NOT yet proven but their
consistent use may reduce the risk of transmission.

o Recognize the risk of infecting others by sexual intercourse or sharing of needles.

o Refrain from sharing toothbrushes, razor or other implements that could be

contaminated with blood.

4 Cs in the management of HIV/AIDS (DOH)

1. Compliance
2. Counseling/Education
3. Contact tracing
4. Condoms

“ It takes strength to conquer,

It takes courage to surrender ”

Prepared originally by:

Israel H. Gaddi, Jr., R.N., M.A.N.

Reviewed and revised by:

Nathaniel Gaddi, RN, MD

Leonardo Saenz Angeles, Jr., RN, MAN