chapter 20

Chapter 20: Nursing Care of Patients With HIV and AIDS

Overview

  • Author: Williams | Hopper, Otmanowski | Nowicki

  • Publisher: F.A. Davis Company, 2023

  • Importance: Understanding nursing care for patients with HIV/AIDS is crucial for providing effective healthcare and implementing prevention strategies.

Learning Objectives

  • Learning objectives for Chapter 20 are available on the Canvas page under the Immune Disorders Module.

Human Immunodeficiency Virus (HIV)

  • Definition: A chronic infection that can be treated but is sometimes a progressive immune disorder. If left untreated, HIV can lead to Acquired Immunodeficiency Syndrome (AIDS) over time.

Acquired Immunodeficiency Syndrome (AIDS)

  • Definition: The final stage of HIV infection where the immune system is severely compromised. There is no cure for AIDS, and it can be fatal.

Epidemiology

  • Incidence in the United States:

    • Approximately 1.2 million people in the U.S. are living with HIV.

    • About 13% of those infected are unaware of their status and require testing.

    • In 2022, an estimated 31,800 new HIV infections occurred in the U.S.

    • New HIV infections dropped by 12% from 36,300 in 2018 to 31,800 in 2022.

    • Diagnoses are not evenly distributed; the South has the highest rates of new diagnoses.

HIV Subtypes

  • HIV-1:

    • The primary type found worldwide.

    • More pathogenic in nature.

  • HIV-2:

    • Primarily found in West Africa.

    • Less pathogenic than HIV-1.

HIV Progression

  • Initial infection: The body experiences a period of immunity before symptoms appear.

  • Clinical latency:

    • A symptom-free period that lasts about 8 to 12 years, during which CD4 T lymphocytes are gradually decreasing.

    • Symptoms of HIV arise as the immune system weakens.

HIV Infection Phases

  • Phases include:

    1. Seroconversion: Initial flu-like illness occurs 1-4 weeks post-infection.

    2. Positive HIV antibody test: Typically occurs around 2 months after exposure.

    3. Asymptomatic latency: Can last for years.

    4. Symptoms develop: Early symptoms and subsequent progression to AIDS if untreated.

HIV Prevention Strategies

Healthy People 2030 Goals

  • Supports the Ending the HIV Epidemic initiative.

  • Key objectives include:

    • Reducing new HIV infections and diagnoses.

    • Increasing knowledge of HIV status among individuals.

    • Enhancing linkage to medical care.

    • Promoting viral suppression in those infected.

    • Reducing perinatal transmission of HIV.

Older Adults and HIV

  • By 2016, 50% of those diagnosed with HIV are over the age of 50.

  • Late diagnosis is common, often with AIDS present.

  • Factors contributing to the rise in infection rates:

    • Less likelihood of being tested for HIV.

    • Lower rates of condom usage.

    • Increased risk due to aging immune systems, particularly in women.

    • Delayed treatment due to misattribution of symptoms to aging.

Modes and Routes of HIV Transmission

  • Modes of Transmission:

    • Transmission primarily occurs through:

    • Blood

    • Breast milk

    • Pre-seminal fluid, semen

    • Vaginal secretions

    • Rectal fluids

    • Not transmitted casually.

  • Routes of Transmission include:

    • Sexual: Highest risk associated with anal sex, with greater risk for women.

    • Parenteral: Injection drug use, contaminated equipment.

    • Perinatal: Transmission from mother to infant during pregnancy and childbirth.

Pre-Exposure Prophylaxis (PrEP)

  • Effectiveness: 99% effective in preventing HIV among high-risk individuals.

  • Drugs Used:

    • Emtricitabine/tenofovir disoproxil (Truvada)

    • Emtricitabine/tenofovir alafenamide (Descovy)

  • Administration: A daily pill taken consistently, combined with other safety precautions.

HIV Counseling and Testing

  • Follow the CDC guidelines for routine testing:

    • Recommended for individuals aged 15 to 65, all pregnant women, and people after sexual assault.

    • Testing options can be confidential or anonymous.

    • Post-test counseling provides:

    • Results explanation

    • Assistance in informing partners

    • Discussion on risk factor reduction

    • Care options support.

Public Health Implications

  • Discussion on public health significance illustrated by policies affecting HIV rates:

    • Example: In 2013, the defunding of needle exchange programs led to a significant HIV outbreak linked to changes in public health policy.

  • Importance of addressing public health strategies to mitigate infection risks in vulnerable populations.

Perinatal Transmission Prevention

  • Routine testing in prenatal care is crucial.

  • Testing is recommended in the third trimester for high-risk women and again during labor if not previously tested.

  • If HIV positive, antiretroviral therapy (ART) should be initiated during pregnancy, labor, and delivery.

Preventive Measures for Healthcare Providers

  • Risk of transmission is rare in healthcare settings; however, recommended practices include:

    • Hand hygiene

    • Standard precautions (PPE)

    • Safe needle handling practices

Postexposure Prophylaxis Guidelines

  • Immediate action after exposure:

    • Wash the exposure site with soap and water.

    • For mucous membranes, flush with water.

    • Seek urgent medical attention, consider risk, test source, and begin treatment for 28 days, ideally starting within hours of exposure.

Stages of HIV Infection and Symptoms

Stage 1: Response After Infection

  • Symptoms develop 2 to 4 weeks after exposure, including:

    • Extreme fatigue

    • Headache

    • Fever

    • Lymphadenopathy

    • Diarrhea

    • Sore throat

Stage 2: Chronic HIV Infection

  • Extended asymptomatic phase with treatment; untreated could extend symptoms to 10-15 years. Symptoms include:

    • Shortness of breath

    • Weight loss

    • Night sweats

    • Persistent diarrhea

    • Oral/vaginal candidiasis

    • Dry skin, skin lesions

    • Peripheral neuropathy

    • Shingles

    • Seizures

    • Dementia

Stage 3: AIDS

  • Defined by:

    • CD4 count less than 200 cells/mm³ or

    • Presence of opportunistic infections or cancers as defined by the CDC.

Diagnosis of HIV

  • Key tests include:

    • HIV antigen/antibody combination immunoassay

    • HIV antibody immunoassay

    • Nucleic acid test (NAT)

    • Complete blood count and lymphocyte count

    • CD4 T-lymphocyte count

    • Viral load testing

    • Genotyping

Therapeutic Interventions

  • Currently no cure for HIV; treatment options include:

    • Initiating antiretroviral therapy (ART).

    • Goals of ART:

    • Suppressing the virus.

    • Preventing or delaying opportunistic diseases, as HIV severely lowers the immune response.

Antiretroviral Therapy (ART)

  • Treatment involves early, aggressive intervention with multiple drugs targeting various stages of the HIV life cycle.

  • Typically involves three drugs across at least two classes to effectively reduce viral load to an undetectable level.

Activity: Cue Recognition Example

Case Study: Travis's Care

  • Scenario: Travis, a 34-year-old HIV positive, has oral ulcerations and is losing weight due to refusal to eat.

  • Recommended Action: Contact healthcare provider to obtain a prescription for a numbing agent to alleviate his oral pain.

  • Rationale: Pain relief from oral lesions is vital for encouraging food intake and preventing further weight loss.

References

  • How Mike Pence Made Indiana's HIV Outbreak Worse - Source: POLITICO