HIV/AIDS

Human Immunodeficiency Virus (HIV)

targets immune system and weakens people’s defense against many infections and some types of cancer that people with healthy immune systems can fight off.

acquired immunodeficiency syndrome (AIDS)

most advanced stage of HIV infection

can take many years to develop if not treated, depending on the individual

 If HIV is not treated, it can lead to?

AIDS

The ability to transmit HIV continues for?

life

Possible Symptoms (FCRN MSFSM)

Fever

Chills

Rash

Night sweats

Muscle aches

Sore throat

Fatigue

Swollen lymph nodes

Mouth ulcers

some people may not feel sick during acute HIV infection

Acute HIV infection

Stage 1

very contagious

have a large amount of HIV in their blood

some people have flu-like symptoms; body’s natural response to infection

Chronic HIV infection

Stage 2

asymptomatic HIV infection or clinical latency

HIV is still active but reproduces at very low levels

may not have any symptoms or get sick during this phase

can transmit HIV in this phase

Without taking HIV medicine, this period may last a decade or longer, but some may progress faster

At the end of this phase, the amount of HIV in the blood (called viral load) goes up and the CD4 cell count goes down. The person may have symptoms as the virus levels increase in the body, and the person moves into Stage 3

People who take HIV medicine as prescribed may never move into Stage 3

Acquired Immunodeficiency Syndrome (AIDS) now called advance HIV infection

Stage 3

most severe phase

have such badly damaged immune systems that they get an increasing number of severe illnesses, called opportunistic infections

can have a high viral load and be very infectious

When do people with AIDS receive diagnosis?

when their CD4 cell count drops below 200 cells/mm, or if they develop certain opportunistic infections.

Without treatment, people with AIDS typically survive about?

three years

HIV testing

simple blood test that shows if a patient has antibodies to HIV - the virus that causes AIDS

______ tests are the most common way to diagnose HIV

blood

A sample of blood will be taken from the patient’s arm and if the first test (screening) is reactive, another test (confirmatory called ___________) will be done to make sure that the first one is confirmed to be positive.

Western Blot

People exposed to the virus should get tested immediately, although it can take the body anywhere from ____________ to develop antibodies to the virus.

six weeks to a year

Primary tests for diagnosing HIV and AIDS (EHSVW)

ELISA Test

Home Tests

Saliva Tests

Viral Load Tests

Western Blot

ELISA Test (enzyme-linked immunosorbent assay)

used to detect HIV infection

quite sensitive in chronic HIV infection

you may test negative during a window of a few weeks to a few months after being infected since antibodies aren't produced immediately upon infection

Even though your test result may be negative during this window, you may have a high level of the virus and be at risk of transmitting infection

ELISA Test (+) result

the Western blot test is usually administered to confirm the diagnosis

If you get (-) result on ELISA Test when should you be tested again?

1 to 3 months

Home tests

sold in pharmacies

immediate results

Saliva tests

cotton pad is used to obtain saliva from the inside of your cheek

pad is placed in a vial and submitted to a laboratory for testing

Results are available in three days.

Positive results should be confirmed with a blood test

Viral load test

measures the amount of HIV in your blood

used to monitor treatment progress or detect early HIV infection

results may vary between tests

Three technologies that measure HIV viral load in the blood

reverse transcription polymerase chain reaction (RT-PCR)

branched DNA (bDNA)

nucleic acid sequence-based amplification assay (NASBA)

Western blot

very sensitive blood test used to confirm a positive ELISA test result

Following a positive diagnosis, people should be __________ before they are enrolled in treatment and care to rule out any potential testing or reporting error

retested

once a person diagnosed with HIV and has ________ treatment they should not be retested

started

For children less than 18 months of age, serological testing is not sufficient to identify HIV infection – _____________ must be provided as early as birth or at 6 weeks of age

virological testing

HIV Medicine

antiretroviral therapy (ART)

Most people can get the virus under control within _________

six months

Antiretroviral therapy (ART)

usually a combination of three or more medications from several different drug classes.

• This approach has the best chance of lowering the amount of HIV in the blood.

There are many ART options that combine three HIV medications into one pill, taken once daily.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

• turn off a protein needed by HIV to make copies of itself.

  • Efavirenz (Sustiva)

  • Rilpivirine (edurant)

  • Doravirine (Pifeltro)

Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs)

• faulty versions of the building blocks that HIV needs to make copies of itself

  • abacavir (Ziagen)

  • tenofovir (Viread)

  • emtricitabine (Emtriva)

  • lamivudine (Epivir)

  • zidovudine (Retrovir)

• Combination drugs also are available

  • emtricitabine/tenofovir (Truvada)

  • emtricitabine/tenofovir alafenamide (Descovy)

Protease inhibitors (PIs)

• inactivate HIV protease, another protein that HIV needs to make copies of itself.

  • atazanavir (Reyataz)

  • darunavir (Prezista)

  • lopinavir/ritonavir (Kaletra)

Integrase inhibitors

• work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells

  • bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy)

  • raltegravir (Isentress)

  • dolutegravir (Tivicay)

Entry or fusion inhibitors

• block HIV's entry into CD4 T cells

• enfuvirtide (Fuzeon)

• maraviroc (Selzentry)

Nursing considerations for Antiretroviral drugs

Discuss options with health provider to find the best regimen for you. Should order at least 3 different antiretroviral drugs from at least 2 different drug groups

Know the drugs you’re taking and how to take them

Take all of your medications as prescribed. Do not quit taking one drug while continuing the others

Many antiretroviral drugs interact with other drugs, include number of common drugs you can buy without a prescription

Goal of antiretroviral therapy are to decrease the amount of virus in your blood (viral load) and keep CD4 T-cell count high

2 to 4 weeks after you start on drug therapy (or change your therapy), your health provider will test your viral load to find out how the drugs are working

Major problem in treating HIV infection

Resistance to antiretroviral drugs

Goal of antiretroviral therapy

decrease the amount of virus in your blood (viral load) and keep CD4 T-cell count high

Best result of ART

reduces your viral load below detectable levels and keep CD4 T-cell count high

They do routine lab work every__________ whether you are taking antiretroviral agents or not

3 to 6 months

undetectable viral load

means that the amount of virus is extremely low and HIV cannot be found in the blood using current testing technology

• It does not mean that the virus is gone; virus can be in lymph nodes and organs that blood tests cannot detect.

• It does not also mean that you are no longer able to transmit HIV to others

Nursing interventions to HIV associated with Diarrhea

Assess patient’s normal bowel habits

Assess for diarrhea

Obtain stool cultures and administer antimicrobial therapy as prescribed

Initiate measures to reduce hyper-activity of bowel

Maintain food and fluid restrictions as prescribed

BRAT Diet (Bananas, Rice, Apple sauce, Toast)

Discourage Smoking

Offer small frequent meals

Avoid bowel irritants

• Fatty or fried foods

• Raw vegetables and nuts

Maintain fluid intake of at least 3L/day unless contraindicated

Administer anticholinergic antispasmodics and opioids or other medications as prescribed

Nursing Interventions relating to risk of Infection

Monitor for infection

• fever, chills

• diaphoresis

• cough

• shortness of breath

• oral pain

• painful swallowing

• creamy-white patches in oral cavity

• urinary frequency, urgency, or dysuria

• redness, swelling or drainage from wounds

• vesicular lesions on face, lips or perianal area

teach patient or caregiver about need to report possible infection

monitor WBC count and differential

Obtain cultures of wound drainage, skin lesions, urine, stool, sputum, mouth, and blood as prescribed

Administer antimicrobial therapy as prescribed

Instruct patient in ways to prevent infection

• Clean kitchen and bathroom surfaces with disinfectants

• Clean hands thoroughly after exposure to body fluids

• Avoid exposure to others’ body fluids or sharing eating utensils

• Turn, cough, and deep breath, especially when activity is decreased

Medical care

Take your medicine exactly as directed.

• Don’t take any other medicine, including over-the-counter drugs or supplements, unless your healthcare provider says it’s OK.

• Report any side effects to your provider.

See your healthcare provider regularly. Your provider will need to follow you closely for the rest of your life.

Tell all your healthcare providers that you are HIV-positive. This includes dentists and dental hygienists

Help Prevent the spread of HIV

Practice safe sex. Use condoms correctly and use them every time you have sex. Don't risk spreading your illness to noninfected people.

Ask any sexual partners to be tested for HIV. If you are in a stable sexual relationship, your uninfected partner may want to discuss with his or her provider taking PrEP (pre-exposure prophylaxis) to prevent spread of HIV.

Never share needles or other equipment for drug use.

If you get tattoos or have any parts of your body pierced, be sure that the needles are destroyed afterward.

Don't donate blood, plasma, semen, or organs.

If you are a woman, talk with your healthcare provider before getting pregnant.

Talk with your healthcare provider about other very rare ways HIV may be spread

Reduce risk for infection

Take care of your skin.

Wash your hands often.

• Use soap and water and rub your hands together.

• If soap and water is not available, use alcohol-based hand cleaner.

• Make sure you wash your hands before and after taking care of any cuts, scrapes, or wounds.

Use hypoallergenic sunscreen with an SPF of 30 or greater.

Avoid direct sun exposure on your skin.

Use an electric razor for shaving.

Ask your doctor before using cosmetics, contact lenses, tampons, or douches.

Avoid contact with farm, stray, or unknown animals.

• If you do have contact with an animal, wash your hands afterward.

Avoid contact with pet urine or stool. Wear gloves if you might come in contact with pet urine or stool.

Don’t clean litter boxes, cages, or aquariums.

Keep your home clean

Clean floors, carpets, furniture, and countertops regularly.

Be sure your bathroom is clean.

Wash your hands after handling trash.

If you have a pet, talk with your provider about safe pet ownership

Don't eat undercooked, unpasteurized, or unwashed foods.

Don’t smoke or use tobacco products.

Don’t use portable humidifiers or vaporizers.

Avoid contact with anyone who has a cold, the flu, or other contagious condition. This includes measles, chickenpox, herpes, viruses, pinkeye, cough, or sore throat

Follow-up care

Follow up with your healthcare provider, or as advised. Seek immediate medical care if you have any of the following

• Blurred vision or other eye problems

• Trouble concentrating or worsening tiredness

• Wheezing, trouble breathing, or shortness of breath

• Rapid, irregular heartbeat

• Dizziness or lightheadedness

• Rash or hives

• Cut or rash that swells, turns red, feels hot or painful, or begins to ooze

• Fever of 100.4°F (38°C) or higher, or as directed by your provider

• Diarrhea that does not go away after 2 loose stools

• Pain or cramping in your belly (abdomen)