HIV

HIV

• what is it

• targetds

Retrovirus causing immunosuppression → increased susceptibility to infections

Targets: helper T cells (CD4+) and macrophages

transmission

body fluids: blood, semen, vaginal secretion, and breast milk

NOT casual contact

• hugging, dry kissing, hand shaking, utensils, or toilet seats

• not sputum, tears, saliva, urine, emesis, feces, sweat, resp droplets, or enteric waste

perinatal transmission

Can occur during pregnancy, delivery, or breastfeeding

Untreated HIV-positive mother = ~25% risk of infant infection

Treatment during pregnancy/delivery = risk reduced to <2%

• Antiretroviral therapy/ART

HIV patho

Ribonucleic acid virus (retrovirus) → replicates backward: RNA → DNA

Targets: CD4+ T lymphocytes

It binds and fuses with CD4+ T cells

cannot replicate unless inside a living cell

immune problems

• problems begin when

• severe immunodeficiency when

• normal range =

• when abnormal

Problems begin when CD4+ T cells <500/µL

Severe immunodeficiency occurs at <200/µL

Normal CD4+ range: 800–1200/µL

Insufficient immune response → opportunistic infections

• most common cause of disease, disability, and death

acute infection

• describe

• cms (pics)

2-4 weeks after infection

very infections and a high viral load

CD4 falls temporarily and returns to baseline

symptomatic infection

• what is it

• cms

• opportunistic infections

cd4 about 200 

worse symptoms 

HIV advances to active/aggressive infections

AIDS

• dx criteria list all (4)

CD4 < 200 and one or more opportunistic infections

• infections

• malignancies/cancers/dic

• wasting: lose 10% of ideal body mass

• cognitive changes

DX studies

CD4+ T cell count ↓ (normal = ~800 to 1200)

Viral load ↑

All types blood cells will be decreased in these patients

HIV drug therapy goals 6/7

Delay disease progression

Decrease viral load

Maintain or increase CD4+ T cell counts

Prevent HIV-related symptoms and opportunistic infections

Prevent HIV transmission

monitor nutrition and analgesia

Antiretroviral Therapy/ART

slows down HIV progression

combination therapy used = inhibit viral replication

combination because resistance can form from 1 med

drug interactions: herbal and otc

• st. john’s wort, PPIs, etc

opportunistic diseases general

• prevention

• prognosis

• goal for tx

prevent with meds/art, vaccines, etc

usually impossible to completely eradicate after they occur

delay onset and effective mgt

PREP

Reduce risk of sexually-acquired HIV in high-risk adults

Used with other prevention strategies

Tenofovir + Emtricitabine (Truvada)

goals for nursing care

Compliance with drug regimens

Adopting a healthy lifestyle

Maintaining beneficial relationships

Spiritual well-being (regarding life and death)

Coping with the disease and its treatment

EOL care

Promote acceptance of the finite nature of life

Support significant others in coping with loss

Maintain a safe environment

Gerontologic Considerations 3

Increasing rates of HIV among older adults

Antiretroviral therapy (ART) delays disease progression

Reduced death rates from opportunistic infections