HIV/ AIDS

Acquired Immune Deficiency Syndrome: AIDS

• The most common secondary immune deficiency disease in the world

  • Identified in 1981

  • Probably from monkeys

  • Estimated to have crossed species = 1930

• Serious worldwide epidemic

• HIV 1 vs. HIV 2

Human Immunodeficiency Virus (HIV)

• A virus that attacks the immune system

• Retrovirus:

  • Intracellular parasite that never dies

• Selectively infects & destroys CD4 T-cells

• Immune response fails, opportunistic infections &/or cancers arise

HIV Mechanism of Infection

• CD4 lymphocytes stimulate B lymphocytes

• B lymphocytes produce antibodies to HIV

  • Increased antibody production leads to incomplete/non-functional antibodies

  • Become incapable of responding to invading organisms/ immunizations

• HIV weakens the immune system by destroying CD4 cells

Effects of HIV infection

• Everyone w/ AIDS has HIV infection

• Not everyone w/ HIV has AIDS

• Distinction based on # of CD4 cells & opportunistic infections

• HIV is infectious & transmittable at all stage especially in a recently infected person w/ a high viral load

HIV Risk Categories

• Male-to-male sexual conduct contact (MSM)

• Injecting drug users (IDUs)

• MSM who inject drugs

• High-risk heterosexual contact

• Blood transfusion

• Hemophilia/ coagulation disorders

• Perinatal transmission

HIV Transmission

3 conditions must be present for HIV transmission

1. There must be an HIV source

2. There must be a sufficient dose of virus

3. There must be access to the bloodstream of another person

Most cases are transmitted through sexual contact &/or sharing needles

HIV Stages

• Stage 1: Acute HIV Infection

• Stage 2: Chronic HIV Infection

• Stage 3: AIDS

HIV Stage 1: Acute HIV infection

• Flu-like Sx or no Sx at all

• High viral load & highly infectious but HIV test may be negative due to lack of antibodies

HIV Stage 2: Chronic HIV Infection

• Alteration in immune system

• CD4 200-499

• Often present w/ diarrhea, fever, enlarged glands, oral infections, skin problems

HIV Stage 3: AIDS

• CD4 levels < 200 +

• Presence of one or more AIDS defining conditions

Acute HIV Infection (Stage 1)

• 1-4 weeks after exposure

  • High viral load = highly infectious

• Will test negative but still be highly infectious

• 1st Sx = Acute Retroviral Syndrome:

  • Fever, chills, night sweats, headache, muscle aches, rash, sore throat

  • Lasts 5-7 days

  • Can have severe Sx (Encephalitis, seizures)

Chronic HIV Infection (Stage 2)

• Durability of the immune system determines how long the patient will be able to respond successfully to the virus

• Average time varies due to therapies

• CD4 cell count grbeibreiukjvre

• Progress decline in the immune system

AIDS Defining Conditions (Stage 3)

• Bacterial infection, multiple or recurrent

• Candidiasis of bronchi, trachea, or lungs

• Cytomegalovirus

• herpes Simplex: Chronic ulcers > 1 month

• Kaposi sarcoma

• Mycobacterium avium complex

• Mycobacterium tuberculosis

• Pneumonia: recurrent

• Wasting syndrome

Transmission & HCW

• Risk from non-intact skin & mucous membranes contact w/ infected blood & body fluids

  • HIV+ HCW should not provide direct patient care when they have any open lesions

• Post-exposure prophylaxis for HCW exposed to blood of HIV+ or unknown status:

  • Started within 72 hrs

  • Best if within 2 hrs

  • Taken for 28 days

  • Pretesting & post testing included

HIV Screening

• Recommendations include one-time screening for individuals 15-65 years of age

• Annual screening for high-risk individuals

• Routine prenatal screening

• Frequent testing for repeated high-risk exposures

• Testing:

  • Interpretation

  • Counseling

  • Confidentiality

HIV Laboratory Assessment

• Serologic & virologic testing to detect infection

• Antibodies

  • May take weeks to months to show up

• Antibody/antigen

  • May detect 5 days earlier than just antibody testing

• “Point of Service” testing

  • Results within 1 hr

• “Window” or “Seroconversion window”

  • Time from infection to antibody formation

• Nucleic Acids Tests (NAT) “Viral load tests”

  • More expensive usually for monitoring treatment

HIV Less common Lab Assessment

• Oral mucosal transudate (OMT) test

  • Result in 20 mins

  • Swab gums & gumline (not saliva)

  • Need blood test confirmation

• Home blood (Finger stick) HIV test available

• Spot urine testing

HIV Standard Diagnostic Tests

• HIV & syphilis serology

• Viral load testing (HIV RNA quantification testing)

• CD4 count

• CBC

• Papanicolaou (Pap) testing:

  • Cervical or anal

• Hepatitis serology & liver chemistry panel

• PPD skin test

HIV Lab Assessments

• Decreased lymphocyte counts

  • Leukopenia

• Decreased CD4 T-cells

  • Normal CD4 count: 800-1000 cells/mm3

  • CD4 count < 500 cells → Increased infection risk

• CD4 T-cell & CD8 T-cell %

Nursing Considerations (Meds)

• Monitor lab results

  • CBC, WBC, LFT, amylase, lipase

  • Antiretroviral meds may increase ALT, AST, bilirubin, HDLs, total cholesterol, & triglycerides

• Patient education

  • Side effects & ways to decrease the severity

  • Adherence & tolerability is the key!!!

  • Need to take medications on a regular schedule & to not miss doses

• HIV virus can replicate & lead to drug resistance

HIV Monitoring Response to Therapy

• Increasing CD4 count

• Viral load testing to determine response to therapy

  • Goal = undetectable viral load

• Don’t do within 2 weeks of vaccinations or illness

• Usually 2 tests before deciding to change therapy

Doxy PrEP & PEP

• Doxycycline (200mg) PEP within 24 hrs of condomless sex to reduce syphilis, chlamydia & gonorrhea

• “Morning after pill” for STIS

• PrEP: Ongoing treatment before & after exposure to prevent transmission

• Can be taken with HIV PrEP

Autoimmune Deficiency Syndrome (AIDS)

• AIDS = last & most serious stage of HIV infection

• a diagnosis of AIDS requires:

  • Confirmed HIV+ status & CD4 cell count <200 cells/mm3

  • Or AIDS-related opportunistic infection