Chapter 85 HIV and AIDS Copyright 2012 Wolters

Chapter 85 HIV and AIDS Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV and AIDS • HIV: Human immunodeficiency virus • AIDS: Acquired immunodeficiency syndrome • HIV affects the work of the immune system and often leads to AIDS. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

History of HIV/AIDS • HIV-1 is the predominate strain of the virus that causes HIV/AIDS. • An international team of researchers has concluded that HIV-1 was introduced to human populations when hunters became exposed to infected blood from a subspecies of chimpanzees native to west equatorial Africa. • In 1982, AIDS was added to the list of conditions that are formally tracked by the Centers for Disease Control and Prevention (CDC). Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Action of HIV • HIV is an infectious human retrovirus that invades a healthy, normal cell. • The virus overtakes the biosynthesis of existing cells to duplicate and spread HIV within the body. • The retrovirus commonly invades T cells and B cells. • The main cell affected by HIV is the helper T 4 lymphocytes, better known as CD 4 cells. • Also as a direct consequence of the invasion, the individual is vulnerable to many opportunistic infections (OIs). Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Human Immunodeficiency Virus Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

OIs Related to HIV/AIDS • Bacterial infections • Viral infections • Protozoal infections • Fungal infections • Other conditions and complications • Wasting syndrome malignancies (cancers) • Neurologic conditions Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV Medications • Effective after entering a CD 4 cell – Nucleoside reverse transcriptase inhibitors (NRTIs) – Nonnucleoside reverse transcriptase inhibitors (NNRTIs) – Protease inhibitors (PIs) • Prevent HIV from entering CD 4 cells – Entry inhibitors (including fusion inhibitors) – Integrase inhibitors • Antiretroviral therapy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Transmission • HIV is transmitted through infected body fluids. • It can be passed to another through – Unprotected sexual contact – Sharing of infected needles – Accidental exposure to infected blood – Transmission from an infected pregnant woman to her fetus, and breastfeeding. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Nurses must strongly advocate HIV testing for all pregnant women. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True Early detection and treatment of HIV/AIDS as part of maternal prenatal care can prevent HIV infection in the newborn. HIV-infected pregnant women should be treated for HIV because this reduces the risk of infection in the newborn. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diagnostic Tests • Preliminary testing if HIV is suspected: – CD 4 count, viral load – Complete blood count, blood chemistries, urinalysis – Testing for sexually transmitted infections (STIs) – Testing for hepatitis, TB, or toxoplasmosis – Testing for sensitivities or drug resistance to specific HIV medications – HIV antibody testing, HIV antigen testing Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diagnostic Tests (cont’d) • Nursing considerations and HIV testing – An informed consent must be obtained from the client before testing. – Pre- and posttest counseling is required regardless of the test results. – Results cannot be given over the telephone. – Ensure client confidentiality; it is essential. – The laboratory must be approved by the state for HIV testing. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Signs and Symptoms of HIV Infection • Rapid weight loss, lymphadenopathy • Recurring fever, night sweats, diarrhea, anorexia • General malaise, dry cough, oral thrush • White spots on tongue, in mouth, or throat • Herpes zoster infection or shingles, pneumonia • Spots on or under the skin, inside the mouth, nose, or eyelids • Memory loss, lipoatrophy, lipodystrophy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Signs and Symptoms of HIV Infection in Women • HIV infection may be overlooked and attributed to genital ulcer disease, sexually transmitted infections, HPV infections, and pelvic inflammatory disease (PID). • Other common HIV-related signs and symptoms include: – Recurrent vaginal candidiasis – Menstrual abnormalities, including amenorrhea or bleeding between periods – Abnormal Pap tests – Cervical cancer Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Persons with HIV show symptoms immediately, and there may be no need for testing such individuals. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False Persons with HIV can be asymptomatic for many years, and individuals who have not been tested may not know they are infected. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment • The main treatment concept is to use medications specifically designed to combat a part of the retroviral replication cycle of HIV. • Antiretroviral drugs include – Nucleoside/nucleotide reverse transcriptase inhibitors – Nonnucleoside reverse transcriptase inhibitors – Protease inhibitors, entry inhibitors, integrase inhibitors – Immune-based therapies Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS • HIV-positive individuals with a T-cell count below 200/mm 3 belong in the group of individuals who may be considered to have a diagnosis of AIDS. • Persons with HIV and certain OIs or cancers also are considered to have AIDS. • AIDS is ultimately a terminal condition; the emotional, physical, and financial implications can be enormous. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Opportunistic Infections • Candidiasis, cryptococcus, cytomegalovirus (CMV) • Herpes simplex • Histoplasmosis • Mycobacterium avium complex (MAC) • Pneumocystis carinii pneumonia (PCP) • Toxoplasmosis • A variety of other fungal, viral, and bacterial infections may also occur, causing constitutional disease and neurologic disorders. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment • The ideal approach to the management of AIDS involves prophylaxis and the early treatment of such infections when they occur. • The use of antiretroviral medications has resulted in the decline or delay in the number of individuals who progress from HIV to AIDS. • HIV/AIDS medication therapy demands strict adherence to a complicated regimen. The client and the nurse must be aware of the requirements of each medication. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process • Data collection • Planning and implementation – Nursing implications for clients with HIV – Nursing implications for clients with AIDS • Evaluation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? HIV and its treatment can complicate the aging process. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True Healthcare for the older population typically includes heart disease, hypertension, diabetes, cancer, and respiratory problems, which may need pharmaceutical or surgical therapies. Potentially hazardous drug interactions may occur. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV Exposure to Healthcare Workers • Postexposure prophylaxis (PEP) • Postexposure treatment • Counseling, laboratory tests, and follow-up testing • Always use Standard Precautions Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

End of Presentation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins