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Acquired immune deficiency syndrome

To understand what AIDS is, lets break it down


A Acquired AIDS is not something you inherit from your parents. You acquire AIDS after birth. I Immuno Your body's immune system includes all the organs and cells that work to fight off infection or disease. D Deficiency You get AIDS when your immune system is "deficient," or isn't working the way it should. S Syndrome A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (OIs). You will be diagnosed with AIDS if you have one or more specific OIs, certain cancers, or a very low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to prevent death.

Cause
HIV causes AIDS. Over time, HIV can destroy so many of your CD4 cells that your body can't fight infections and diseases anymore. When that happens, HIV infection can lead to AIDS. T-cells or CD4 cells. Your body has to have these cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself, and then destroys them.

Pathophysiology

When HIV infection takes place, anti-HIV antibodies are produced but they do not appear immediately. This is called the window effect. In some cases, antibodies to HIV become detectable 4 to 6 weeks after infection. When HIV is in circulation, it invades several types of cells the lymphocytes, macrophages, the Langerhans cells, and neurons within the CNS. HIV attacks the bodys immune system. The organism attaches to a protein molecule called CD4 which is found in the surface of T4 cells. Once the virus enters the T4, it inserts its genetic materials into the T4 cells nucleus taking over the cell to replicate itself. Eventually the T4 cell dies after having been used to replicate HIV. The virus mutates rapidly making it more difficult for the bodys immune system to recognize the invaders.

Signs and symptoms

When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages. Many of the signs and symptoms of AIDS come from opportunistic infections which occur in patients with a damaged immune system.

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.

Common Opportunistic Infections

Diagnostic Examination
Test Normal Result Abnormality with Condition Explanation

Enzyme-linked immunosorbent assay (ELISA) and Western blot


T lymphocyte and B lymphocyte subsets; CD4 counts, CD4 percentages

Negative for HIV antibodies

Positive for HIV antibodies

Positive ELISA test is confirmed by a Western blot


HIV infects cells with the CD4 protein marker

B cells: 654785/mL; CD4 T cells: 4501400/mL; CD4 to CD8 T cell ratio: 1:3.5

B and T cell values decreased. CD4 counts less than 500/mL are generally associated with symptoms; CD4 counts less than 200/mL are associated with severe immune suppression. Any HIVinfected person with a CD4 level less than 200/mL is considered to have AIDS Detects number of copies/mL; test has a lower limit of 400 copies/mL but can reach levels at 30,000 copies/mL and higher; ultrasensitive assay has a lower limit of

Viral load: polymerase chain reaction (PCR)

Negative

Quantitative assay that measures amount of HIV-1 RNA in plasma

PRIMARY NURSING DIAGNOSIS


Risk for infection related to immune deficiency OUTCOMES. Immune status; Respiratory status: Gas exchange; Respiratory status: Ventilation; Thermoregulation INTERVENTIONS. Infection control; Infection protection; Respiratory monitoring; Temperature regulation

Pharmacologic Treatment
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:
Zedovudine (ZDV) Retirvir Zalcitabine Havid Stavudine Zerit Lamivudine Epivir Nevirapine Viramune Didanosine Videx

2. Protease inhibitors. They work by inhibiting the enzyme protease which are needed for the assembly of viral particles. These drugs are:

Saquinavir Invarase Ritonavir Norvir Indinavir Crixivan

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
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. 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.

Practice universal/standard precaution


Prevention

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 puncture-resistant 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


Compliance giving of information and counseling the client which results to the clients successful treatment, prevention and recommendation. Counseling/education

Giving instruction about the treatment Disseminating information about the disease Providing guidance on how to avoid contracting STD again Sharing facts about HIV and AIDS

Contact tracing
Tracing out and providing treatment or partners

Condoms
Promoting the use of condom, giving instructions about its use, and giving away available condoms