Human Immunodeficiency Virus (HIV)

and Acquired Immunodeficiency

Syndrome (AIDS)
• Ina, a nurse phlebotomist, is assigned to an HIV-
positive patient. She was tasked to
withdraw blood from the said patient to be sent to the
laboratory. While Ina is withdrawing blood from the
patient, he suddenly went berserk, and Ina’s needle
plunged deep into her arm. Afraid of being
reprimanded, Ina kept the incident from her colleagues.
A month after, Ina reported fever and skin rash to her
physician. She confessed about the incident of the
needle prick with her physician, so he ordered a series
of tests to confirm Ina’s diagnosis. The laboratory
results showed that Ina is in the primary infection stage
of HIV infection.
 Description
• HIV or human immunodeficiency virus and
acquired immunodeficiency syndrome is a
chronic condition that requires daily
medication.
• HIV- 1 is a retrovirus isolated and recognized
as the etiologic agent of AIDS.
• HIV-2 is a retrovirus identified in 1986 in AIDS
patients in West
 Statistics and Epidemiology
• In 2008, the CDC reported that approximately 56, 300 new HIV
infections occurred in the United States in 2006.
• The figure was roughly 40% higher than their former estimate of 40,
000 HIV infections per year.
• Almost 7000 people still contract HIV infection every day.
• An estimated 33 million people are living with HIV/AIDS; however,
the number of new infections declined from 3 million in 2001 to 2.7
million in 2007.
• The global percentage of women among people with HIV/AIDS
remains at 50%.
• Sub-Saharan Africa continues to be most heavily affected by
HIV/AIDS, with 67% of all people living with the disease.
• In 2007, 72% of deaths from HIV/AIDS occurred in the same region.
 Classification
The stages of HIV disease is based on clinical
history, physical examination, laboratory
evidence of immune dysfunction, signs and
symptoms, and infections and malignancies.
• Primary infection (Acute/Recent HIV
Infection). The period from infection with HIV
to the development of HIV-specific antibodies
is known as primary infection.
• HIV asymptomatic (CDC Category A). After
the viral set point is reached, HIV-positive
people enter into a chronic stage in which the
immune system cannot eliminate the virus
despite its best efforts.
• HIV symptomatic (CDC Category B). Category
B consists of symptomatic conditions in HIV-
infected patients that are not included in the
conditions listed in category C.
• AIDS (CDC Category C). When the CD4+ T-cell
level drops below 200 cells/mm3 of blood,
the person is said to have AIDS.
 Causes
• Sharing infected drug use equipment such as
needles.
• Having sexual relations with infected
individuals (both male and female).
• Blood transmission : Receiving HIV-infected
blood or blood products especially before
blood screening.
• Maternal HIV : Infants born to mothers with
HIV infection.
 Pathophysiology
The virus is present in lymphoid cells ,semen ,
blood,vaginal secrections , saliva ,breast milk ,tears ,
urine ,serum ,CSF etc. of the patient
Infections occurs by :
 Sexual contact with infected person
 Transfusion of blood and blood products
 From mother to child before birth via placenta after
birth through breast milk
 Needle stick injuries and blood splash on open wound
 Sharing of needles in drug addicts
 Virus after entry

Infects CD4 cells ( T helpers cells )

Death of CD4 cells

Reduced number of CD4 cells

Immunity reduced (cell mediated immunity in particular)

Loss of protection

Results

Opportunistic infections Kaposi’s sarcoma

 Clinical Manifestations
AIDS is characterized by :
• Fever
• Malaise
• Weight loss
• Chronic Diarrhea
• Night Sweats
• Cervical Lymphadenopathy
• Persistent cough
• Enlarged lymph nodes in the neck, armpits, and groin
• White Patches on tongue
• Shortness of Breath
• Kaposi’s Sarcoma – a dermal malignancy
• Opportunistic infections caused by bacteria ,fungi ,virus ,parasites etc
 Prevention and Control
• Health education through television,radio,news paper,
etc. regarding the basic concepts of HIV transmission
• Avoidance of sexual contact with unknown person /
multiple sex partners
• Use of physical barriers such as condoms
• Use of same needle and syringe should be avoided
• Screening of blood and blood products
• Change of lifestyle
• Isolation and Treatment of AIDS patient
• Vaccine - no effective vaccine is available – a number
of vaccine preparations are under trial
 Complications
• Opportunistic infections :
Patients who are immunosuppressed are at risk for
opportunistic infections such as pneumocystis pneumonia which
can affect 80% of all people infected with HIV.
• Respiratory failure:
Impaired breathing is a major complication that
increases the patient’s discomfort and anxiety and may lead to
respiratory and cardiac failure.
• Cachexia and wasting :
Wasting syndrome occurs when there is profound
involuntary weight loss exceeding 10% of the baseline body weight
and it is a common complication of HIV infection and AIDS.
 Assessment and Diagnostic Findings
• History Collection
• Physical Examination
• Confirming Diagnosis (patient’s CD4+ T-cell count falls
below 200 cells/mm3 )
• CBC
• PPD
• Serologic
• Western blot test
• Viral load test
• STD screening tests
• Cultures
• Neurological studies : (EEG), (MRI), (CT)
(EMG)
• Chest x-ray
• Pulmonary function tests
• Biopsies
• Bronchoscopy/tracheobronchial washings
• Barium swallow, endoscopy, colonoscopy
 Medical Management
Medical management focuses on elimination of opportunistic infections.

• Treatment of opportunistic infections. For Pneumocystis pneumonia, TMP-SMZis

the treatment of choice; for mycobacterium avian
complex, azithromycin or clarithromycin are preferred prophylactic agents; for
cryptococcal meningitis, the current primary treatment is IV amphotericin B.
• Prevention of opportunistic infections. TMP-SMZ is an antibacterial agent used to
treat various organisms causing infection.
• Antidiarrheal therapy. Therapy with octreotide acetate (Sandostatin), a synthetic
analog of somatostatin, has been shown to be effective in managing severe
chronic diarrhea.
• Antidepressant therapy. Treatment for depression in patients with HIV infection
involves psychotherapy integrated with imipramine, desipramine or fluoxetine.
• Nutrition therapy. For all AIDS patients who experience unexplained weight loss,
calorie counts should be obtained, and appetite stimulants and oral supplements
are also appropriate.
 Nursing Management
Nursing Assessment
Nursing assessment includes identification
of potential risk factors, including a history of
risky sexual practices or IV/injection drug use.
• Nutritional status: Nutritional status is assessed
by obtaining a diet history and identifying factors
that may affect the oral intake.
• Skin integrity : The skin and mucous membranes
are inspected daily for evidence of breakdown,
ulceration, or infection.
• Respiratory status : Respiratory status is assessed by
monitoring the patient for cough, sputum production,
shortness of breath, orthopnea, tachypnea, and chest pain.
• Neurologic status: Neurologic status is determined by
assessing the level of consciousness; orientation to person,
pace, and time; and memory lapses.
• Fluid and electrolyte balance : F&E status is assessed by
examining the skin and mucous membranes for turgor and
dryness.
• Knowledge level : The patient’s level of knowledge about
the disease and the modes of disease transmission is
evaluated.
 Diagnosis
• Impaired skin integrity related to cutaneous
manifestations of HIV infection, excoriation, and
diarrhea.
• Diarrhea related to enteric pathogens of HIV
infection.
• Risk for infection related to immunodeficiency.
• Activity intolerance related weakness, fatigue,
malnutrition, impaired F&E balance, and hypoxia
associated with pulmonary infections.
• Disturbed thought processes related to shortened
attention span, impaired memory, confusion, and
disorientation associated with HIV encephalopathy.
• Ineffective airway clearance related to PCP, increased
bronchial secretions, and decreased ability to cough
related to weakness and fatigue.
• Pain related to impaired perianal skin integrity
secondary to diarrhea, KS, and peripheral neuropathy.
• Imbalanced nutrition, less than body
requirements related to decreased oral intake.
 Planning & Goals
• Achievement and maintenance of skin
integrity.
• Resumption of usual bowel pattern.
• Absence of infection.
• Improve activity intolerance.
• Improve thought processes.
• Improve airway clearance.
• Increase comfort.
• Improve nutritional status.
• Increase socialization.
• Absence of complications.
• Prevent/minimize development of new
infections.
• Maintain homeostasis.
• Promote comfort.
• Support psychosocial adjustment.
• Provide information about disease
process/prognosis and treatment needs
 Nursing Interventions
• Promote skin integrity
• Promote usual bowel patterns
• Prevent infection
• Improve activity intolerance
• Maintain thought processes
• Improve airway clearance
• Relieve pain and discomfort
• Improve nutritional status
Discharge and Home Care Guidelines
• Patients and their families or caregivers should
receive instructions about how to prevent disease
transmission, including hand-washing techniques
and methods for safely handling and disposing of
items soiled with body fluids.
• Patients are advised to avoid exposure to others
who are sick or who have been recently
vaccinated.
• Medication administration : Caregivers in the
home are taught how to administer medications,
including IV preparations.
• The patient’s adherence to the therapeutic
regimen is assessed and strategies are suggested
to assist with adherence.
• Infection prevented/resolved.
• Complications prevented/minimized.
• Pain/discomfort alleviated or controlled.
• Patient dealing with current situation realistically.
• Diagnosis, prognosis, and therapeutic regimen
understood.
• Plan in place to meet needs after discharge.
 Bibliography
• Brunner and Suddarth’s ,”Text Book Of
Medical Surgical Nursing”,7th edition, Page no:
• B.S.Nagoba, “Microbiology For Nurses ‘’ 2nd
edition, BI Publication , New Delhi , Page no:
183 to 186
• NURSESLAB : https://nurseslabs.com/hiv-aids/