HIV and AIDS

Care of Patients with HIV Disease and Other Immune Deficiencies

Acquired Immune Deficiency Syndrome (AIDS)

  • Definition: HIV can progress to AIDS.

  • Significance: AIDS is the most common immune deficiency disease in the world, constituting a serious worldwide epidemic.

HIV Stigma

  • Definition: HIV stigma refers to negative attitudes and beliefs about individuals with HIV. It encompasses prejudices that label individuals as part of a socially unacceptable group.

  • Examples of Stigma:

    • Believing only certain demographics can contract HIV.

    • Making moral judgments about those engaged in preventative measures for HIV transmission.

    • The belief that individuals deserve to contract HIV due to their decisions.

  • Reasons Behind Stigma:

    • Rooted in fear of HIV and misconceptions prevalent since the 1980s regarding HIV transmission and living with HIV today.

HIV Infectious Process

  • Life Cycle of HIV:

    • CD4+ T-cells are hijacked, transforming them into “HIV factories” producing new viral particles daily.

    • As the infection progresses, the CD4+ T-cell count falls while the viral load increases, leading to a weakened immune system.

    • Important Note: Every individual with AIDS is infected with HIV, but not everyone with HIV has progressed to AIDS.

HIV Classification

  • Clinical Categories:

    • Stage 1 - Case Definition

    • Stage 2 - Case Definition

    • Stage 3 - Case Definition

    • Stage 4 - Case Definition

WHO Classification

  • Stages of Infection (assuming no treatment):

    • Stage 1: Acute infection.

    • Stage 2: Asymptomatic.

    • Stage 3: Symptomatic.

    • Stage 4: AIDS or progression from HIV to AIDS.

CDC Classification

  • Acute Retroviral Syndrome:

    • Characterization: Symptoms resembling mononucleosis, symptoms may appear shortly after infection.

    • Symptomatic Range: Typically mild to severe and self-resolving within 2-3 weeks. Many may be asymptomatic or have mild symptoms.

  • Stage Definitions:

    • Stage 1 (HIV Infection): No AIDS-related conditions; CD4+ count ≥ 500 cells/µL or CD4+ % ≥ 29% of lymphocytes.

    • Stage 2 (HIV Infection): No AIDS-related conditions; CD4+ count between 200-499 or CD4+ % between 14%-28%.

    • Stage 3 (AIDS): CD4+ count < 200, CD4+ % < 14%, or presence of an AIDS-related condition.

HIV Progression Factors

  • Duration: Progression can range from months to years.

  • Influencing Factors:

    • Frequency of re-exposure to HIV.

    • Presence of other sexually transmitted diseases (STDs).

    • Nutritional status.

    • Stress levels.

Health Promotion and Maintenance

  • Common Transmission Modes for HIV:

    • Sexual contact.

    • Parenterally (intravenous drug use).

    • Perinatally (from mother to child).

  • Myths about Transmission:

    • HIV is not transmitted casually (through household items, mosquito bites, etc.).

Safer Sex Practices (CDC Recommendations)

  • ABCs of Safer Sex:

    • A – Abstinence.

    • B – Be faithful (monogamous relationships).

    • C – Condom use.

Transmission Modes Explained

Parenteral Transmission

  • Important Practices: Proper cleaning of needles and syringes; use of harm reduction strategies like needle exchange programs.

Perinatal Transmission

  • Modes of transmission include:

    • Via the placenta during pregnancy.

    • Infant exposure during birth to blood and vaginal secretions.

    • Post-birth via breast milk.

Transmission and Healthcare Worker Safety

  • Risk Exposure:

    • Needle stick injuries.

    • Exposure of non-intact skin/mucous membranes to blood or body fluids.

  • Prevention Methods:

    • Implementing Standard Precautions.

    • Postexposure Prophylaxis (PEP):

    • Must be started within 72 hours post-exposure.

    • Typically a combination regimen of three medications taken over 28 days (e.g., tenofovir and emtricitabine combined, plus a third drug either raltegravir or dolutegravir).

Collaborative Management of HIV

Assessment

  • Components to Assess:

    • History: Comprehensive patient history relevant to HIV.

    • Physical Assessment/Clinical Manifestations:

    • Opportunistic infections (protozoal, fungal, bacterial, viral).

    • Malignancies like Kaposi’s sarcoma (KS), malignant lymphomas, invasive cancers, HPV.

    • Endocrine complications.

    • Psychosocial Assessment to understand emotional, social, and psychological context.

Kaposi’s Sarcoma as an Indicator

  • A key malignancy that often appears in patients with HIV/AIDS, indicative of progression to AIDS.

Laboratory Assessment

  • Includes but not limited to:

    • Lymphocyte counts (CD4+ T-cell and CD8+ T-cell counts).

    • Antibody tests (ELISA, Western blot, home tests like OraQuick In-Home HIV test).

    • Viral load testing.

    • Blood chemistries, Complete Blood Count (CBC), stool tests, biopsies, if necessary.

Priority Patient Problems

  • Common Issues to Address:

    • Potential for infection.

    • Inadequate oxygenation.

    • Pain management.

    • Nutritional inadequacies.

    • Diarrhea management.

    • Maintaining skin integrity.

    • Addressing confusion and psychological distress.

    • Reducing social contact or support needs.

HAART (Highly Active Antiretroviral Therapy)

  • Definition: A treatment regimen involving the combination of three or more antiretroviral drugs.

  • Also Known As: Antiretroviral therapy (ART) or combination antiretroviral therapy (cART).

  • Goals:

    • Reduce morbidity and mortality (for both AIDS and non-AIDS related causes).

    • Enhance quality of life.

    • Lower plasma viral RNA load.

    • Prevent HIV transmission (to sexual partners, in needle sharing, and from mother to child).

    • Prevent development of drug resistance.

    • Improve immune function.

Preventing Infection

  • Drug Therapy:

    • Use of multiple antiretroviral drugs juxtaposed (HAART).

    • Types of drugs include NRTIs, NNRTIs, Protease Inhibitors, Integrase inhibitors, Fusion inhibitors, and Entry inhibitors.

PrEP (Pre-Exposure Prophylaxis)

  • Approved Medications:

    • Truvada: For all individuals at risk via sex or drug use.

    • Descovy: For individuals at risk through sex, excluding those assigned female at birth at risk from vaginal sex.

  • Side Effects: Generally safe but may include diarrhea, nausea, headache, fatigue, and abdominal pain, which usually diminish over time.

Supportive Care for Patients

Enhancing Oxygenation

  • Methods include drug therapy, respiratory support, and adjustments to rest/activity.

Managing Pain

  • Approaches involve comfort measures, drug therapy, and complementary alternative therapies.

Enhancing Nutrition

  • Emphasis on drug therapy, nutrition therapy, and maintaining oral health/care.

Tissue Integrity Maintenance

  • Strategies to minimize diarrhea (antidiarrheals), maintaining cleanliness of perineal area, and restoring skin integrity.

Mental Health Support

  • Techniques to minimize confusion include reorientation, drug therapy, and supportive environments.

  • Strategies to support self-esteem include fostering an accepting atmosphere, encouraging trust and expression of feelings, and promoting independence.

Community-Based Care

  • Focus on home care management, patient self-management education, psychological preparation, and access to healthcare resources.

Therapy-Induced Immune Deficiencies

  • Potentially caused by drug-induced or radiation-induced factors affecting immunity.