HIV & AIDS

HIV & AIDS Overview

  • Institution: Green River College

  • Program Focus: Nursing Programs

Learning Objectives

  • Discuss differences between HIV infection, HIV disease, and AIDS.

  • Describe how HIV is transmitted and list signs and symptoms of HIV and AIDS.

  • Discuss laboratory and diagnostic tests related to HIV disease.

  • List opportunistic infections associated with advanced HIV disease (AIDS) and the nurse’s role in assisting with coping, grieving, reducing anxiety, and minimizing social isolation.

  • Develop an educational plan for prevention of an HIV infection.

  • Identify prevention measures used to decrease infection and opportunistic diseases for patients with HIV.

  • Develop an educational plan for a patient with HIV receiving antiretroviral therapy.

  • Assist in planning nursing care for patients with HIV and AIDS related to medications, co-infection prevention, and maintaining nutritional status.

HIV Infection, HIV Disease, and AIDS

  • Human Immunodeficiency Virus (HIV):

    • A chronic infection when treated.

    • HIV can lead to Acquired Immunodeficiency Syndrome (AIDS) over time.

    • Sometimes considered a progressive immune disorder when untreated.

  • Acquired Immunodeficiency Syndrome (AIDS):

    • The final stage of HIV infection.

    • No cure available; can be fatal.

Three Stages of HIV

  • Stage 1: Acute HIV Infection

    • Duration: Occurs 2-4 weeks after infection.

    • Symptoms: Manifests as flu-like symptoms.

    • Infectiousness: Very infectious; elevated numbers of virus in blood and some bodily fluids.

  • Stage 2: Clinical Latency

    • Often asymptomatic.

    • Low levels of virus in the blood.

  • Stage 3: Develops AIDS

    • Most severe stage of infection.

    • Development of opportunistic infections due to decreased immune system function.

    • High viral loads; very contagious.

    • CD4 count drops to less than 200 cells/mm³.

HIV Modes of Transmission

  • Characteristics of HIV:

    • Fragile virus.

  • Transmitted through fluids:

    • Blood

    • Breast milk

    • Pre-seminal fluid, semen

    • Vaginal secretions

    • Rectal fluids

  • Important Notes:

    • HIV is not spread through casual contact.

    • No transmission via air, water, food, or insects.

    • Donated blood and organs are tested for HIV antibodies.

Needlestick Exposure and HIV Risk for Healthcare Workers

  • Risk Assessment:

    • The risk of contracting HIV from a needlestick to a known HIV-positive source is low (0.3%).

    • Some transmission is rare.

  • Prevention Strategies:

    • Hand hygiene and adherence to standard precautions.

    • Use of Personal Protective Equipment (PPE).

  • Needlestick Protocol:

    • No recapping of needles.

    • Use of needleless systems and needle safety devices.

  • Post-Exposure Protocol:

    • Administer antiretroviral medications for post-exposure prophylaxis (PEP) documented according to facility policy.

    • Always follow the facility’s protocol.

HIV Prevention and Education

  • Importance of Education:

    • A key strategy to manage the HIV epidemic.

    • Target audience ranges from older school-age children to older adults.

  • CDC Recommendations:

    • Promote widespread HIV education and awareness.

    • Encourage regular testing and treatment.

  • National Initiative:

    • Ending the HIV Epidemic: A Plan for America.

    • Goal: Reduce new HIV infections by 90% by 2030.

    • Strategies:

      • Diagnose all individuals with HIV as early as possible.

      • Treat rapidly and effectively.

      • Prevent new transmissions.

      • Respond quickly to potential outbreaks.

HIV Prevention: Healthy People 2030

  • Objectives:

    • Reduce new HIV infections and diagnoses.

    • Increase knowledge of HIV status.

    • Improve linkage to medical care.

    • Increase rates of viral suppression.

    • Reduce perinatal (mother-to-child) HIV transmission.

Older Adult and HIV

  • Statistics (2016):

    • 50% of individuals with HIV are over the age of 50.

  • Issues:

    • Often diagnosed late in the course of the disease with AIDS present.

    • Less likely to be tested for HIV or use condoms.

    • Increased risk due to an aging immune system.

    • Older women at increased risk due to biological factors.

    • Symptoms may be mistakenly attributed to aging issues, delaying treatment.

HIV: Signs and Symptoms (Stage 2)

  • Many individuals may live for years with HIV before developing symptoms, including:

    • Night sweats

    • Weight loss

    • Diarrhea

    • Unexplainable fevers

    • Fatigue

    • Shortness of breath

    • Persistent diarrhea

    • Oral/vaginal candidiasis

Diagnostic Tests

  • HIV Antigen/Antibody Combination Immunoassay:

    • Detects both HIV antibodies and the p24 antigen to identify early infection.

  • HIV Antibody Immunoassay:

    • Confirms the presence of HIV antibodies in the blood.

  • Nucleic Acid Test (NAT):

    • Detects HIV RNA; used for early detection or recent exposure assessment.

  • CD4 T-Lymphocyte Count:

    • Measures immune system strength; lower counts indicate a higher risk of illness.

  • Viral Load Testing:

    • Determines how much HIV is in the blood; used to monitor treatment effectiveness.

  • Genotyping (Drug Resistance Testing):

    • Identifies mutations in HIV that may resist specific medications.

  • Complete Blood Count (CBC) / Lymphocyte Count:

    • Assesses red/white blood cells and overall immune status.

Opportunistic Infections

  • Common opportunistic infections associated with AIDS include:

    • Cystoisosporiasis

    • Cytomegalovirus retinitis

    • Candidiasis

    • Toxoplasmosis

    • Microsporidiosis

    • Coccidioidomycosis

    • Tuberculosis (TB)

    • Cryptosporidiosis

    • Salmonellosis

    • Histoplasmosis

    • Mycobacterium avium complex

    • Pneumonia

  • Implications:

    • AIDS is the final stage of HIV; characterized by severe immune compromise leading to these infections and potential cancers.

Complications of AIDS

  • AIDS Wasting Syndrome:

    • Defined as weight loss greater than 10% over more than 30 days, often accompanied by chronic weakness, fever, or chronic diarrhea.

  • AIDS Dementia Complex:

    • Can cause memory impairment, personality changes, hallucinations, loss of balance, and slow responses.

    • Safety is crucial in caring for affected individuals.

  • Common Opportunistic Infections with AIDS:

    • Candida albicans

    • Cytomegalovirus

    • Pneumocystis pneumonia

    • Tuberculosis

    • Other cancers, including Kaposi sarcoma (which is rarely seen with effective therapy).

Caring for a Patient with HIV Disease

  • Caring Practices:

    • Treat all patients with empathy and without judgment.

    • Provide compassionate care regardless of the patient's sexual practices or history of drug use.

    • Prevent personal attitudes, values, or beliefs from interfering with patient care.

  • Nursing Interventions:

    • Promote adherence to antiretroviral therapy (ART).

    • Provide palliative care.

    • Address psychosocial issues: coping, grieving, anxiety, and social isolation.

Nurse’s Role in the Prevention and Education of HIV Infection

  • Prevention Options:

    • Educate on early HIV testing and counseling.

    • Understand the risk of HIV transmission.

    • Early antiretroviral therapy (ART) can reduce transmission to uninfected partners by 96%.

    • Achieving an undetectable viral load for 6 months means the individual is untransmittable.

  • Nutritional Options:

    • Suggest small, frequent meals for better dietary management.

  • Health Promotion:

    • Promote overall wellness and preventive strategies.

Educational Teaching and Preventive Care for Clients with HIV

  • Overview of HIV:

    • HIV infects CD4+ (helper T) cells, weakening the immune system, making individuals more vulnerable to opportunistic infections, particularly when CD4+ counts are low.

  • Key Prevention Strategies:

    • Vaccinations:

    • Receive routine inactivated vaccines (e.g., influenza, DTaP).

    • Avoid live vaccines (e.g., MMR, varicella) if CD4+ counts are less than 200/mm³.

    • Food Safety:

    • Avoid cat feces (e.g., litter boxes).

    • Do not consume raw or undercooked foods (e.g., raw fish, undercooked meats, unpasteurized dairy).

    • Water Safety:

    • Avoid drinking from untreated sources (e.g., rivers, wells).

    • Use bottled or purified water for all consumption and dental hygiene.

    • Soil Exposure:

    • Avoid contact with soil (e.g., gardening, houseplants) to prevent infections like Cryptococcus.

More Educational Teaching and Preventive Care for Clients with HIV

  • Sexual Activity:

    • Unprotected sexual intercourse significantly increases the risk of transmitting HIV and other sexually transmitted infections (STIs).

    • Protection is essential, even when both partners are HIV positive.

    • Utilize latex or synthetic condoms and dental dams during any sexual activity involving exposure to bodily fluids.

    • Avoid natural barrier methods like lambskin, which are porous and may allow the transmission of the virus.

  • Personal Hygiene:

    • Do not share personal items exposed to blood (e.g., toothbrushes, razors) to prevent HIV transmission.

  • Substance Use:

    • Understand that cessation of recreational drug use may not be immediate.

    • Needle exchange programs (NEPs) provide sterile supplies and proper disposal of needles to reduce the risk of blood-borne infections in IV drug users.

HIV Prevention Teaching for All Clients

  • General Prevention Measures:

    • Avoid exchanging semen or vaginal fluids.

    • Use nonporous condoms (e.g., latex).

    • Do not reuse condoms.

    • Avoid sharing blood-contaminated items (e.g., razors, toothbrushes, sex toys).

    • Use needle exchange programs when necessary.

    • Consider pre-exposure prophylaxis (PrEP) for high-risk individuals:

    • Truvada (emtricitabine/tenofovir disoproxil)

    • Descovy (emtricitabine/tenofovir alafenamide)

    • Dosage: Take daily and consistently for effective protection.

HIV Prevention Teaching for Clients with HIV

  • Adherence to ART:

    • Take antiretroviral therapy (ART) as prescribed to maintain viral suppression and reduce the risk of transmission.

  • Notification of Exposure:

    • Inform all individuals who may have been exposed to HIV.

  • Sexual Practices:

    • Avoid unprotected sex, even if the partner is also HIV positive.

    • Do not donate blood, plasma, organs, or sperm.

Resources

  • Financial Support

  • Support Groups

    • Meals on Wheels

    • Respite care services

    • Community mental health services

Case Study: HIV

  • Subject: Travis, 34 years old, is HIV positive; presents with four oral ulcerations due to candidiasis, currently treated with nystatin.

  • Symptoms: He has lost 2 pounds this week and is refusing food.

  • Action Required: Assess and address food refusal, managing symptomatic care, and nutritional support.

Case Study: Communication to Healthcare Provider

  • SBAR Format:

    • S - Situation:

    • Nurse caring for Travis, a 34-year-old male with a known HIV diagnosis and concerns about nutritional and mucosal health.

    • B - Background:

    • Travis is HIV positive, treated for oral candidiasis with nystatin; developed four oral ulcerations, lost 2 pounds, and is refusing food.

    • A - Assessment:

    • Travis shows discomfort and pain while eating, likely due to oral ulcerations.

    • Ongoing refusal to eat exacerbates weight loss and poses a risk to nutritional status.

    • R - Recommendation:

    • Evaluate Travis for:

      • Alternative pain management prior to meals

      • Nutritional supplementation (e.g., high-calorie shakes)

      • Consult with a dietitian, and possibly infectious disease or palliative care for ongoing symptom management

      • Assessment for IV fluids or enteral support if oral intake does not improve

References

  • Williams: Davis Advantage for Understanding Medical-Surgical Nursing (7th ed.). Philadelphia, PA: F.A. Davis

  • Watkins: Pharmacology Clear and Simple (4th ed.) Philadelphia, PA: F.A. Davis