HIV
As a student, it is crucial to understand the different classes of antiretroviral medications and their mechanisms of action in treating HIV. Nucleoside reverse transcriptase inhibitors (NRTIs) work by blocking HIV replication, while non-nucleoside reverse transcriptase inhibitors (NNRTIs) disable reverse transcriptase. Additionally, protease inhibitors (PIs) target HIV protease, and fusion inhibitors help prevent HIV from entering cells. In terms of nursing care priorities for patients with HIV, it is essential to focus on preventing pathogen exposure and providing both physical and emotional support. Emphasizing hand hygiene and infection control measures can help reduce the risk of transmission. Furthermore, it is crucial to avoid discrimination and stigmatization, treating each patient with empathy and care to ensure they receive the support they need throughout their treatment journey.
HIV/AIDS
Routes of HIV Acquisition
- Body Fluids Transmission:
- Sexual intercourse:
- Anal intercourse has high incidence; rise in heterosexual transmission.
- Mother-to-child transmission:
- Other routes:
- In utero/perinatally
- Breastfeeding
- Contaminated blood, blood products, and organ donations
- Contaminated needles (IV drug misuse, injections, needle stick injuries)
Characteristics of HIV (Human Immunodeficiency Virus)
- Virus Type and Subtypes:
- Belongs to the lentivirus group of the retrovirus family.
- Two types: HIV-1 and HIV-2.
- HIV-1 subtypes: A, B, C, D, E, F, G, H, O; subtype C most prevalent globally.
- HIV-2 progresses slower and is more common in Africa.
- Viral Pathogenesis:
- Uses RNA and host DNA to make viral DNA.
- Utilizes CD4+ cells for replication, leading to their destruction and immunodeficiency.
- Leads to Acquired Immunodeficiency Syndrome (AIDS) when left untreated.
HIV Diagnosis
- Testing Methods:
- EIA (ELISA): Detects HIV antibodies.
- Western blot assay: Confirms seropositivity.
- Viral load tests (PCR): Quantifies HIV DNA/RNA levels in plasma.
- Rapid HIV antibody assays: Provides quick results using various samples.
- IgG antibody to p24: Detects early infection and asymptomatic phase.
- Symptoms & Signs (S&S) of HIV:
- Often asymptomatic in early stages due to sufficient CD4 lymphocytes.
- Early symptoms (2-6 weeks post-infection): Flu-like symptoms.
- Advanced infection symptoms: Lymphadenopathy, night sweats, weight loss, recurrent fever, diarrhea, fatigue, headaches.
Clinical Assessment & Staging
- Baseline Assessment:
- Identifies past/current HIV-related illness.
- Determines co-existing medical conditions influencing treatment.
- Assesses readiness for therapy considering clinical, psychological, social, and cultural factors.
- Encourages partner testing and notification.
- Follow-up Visits:
- Reviews clinical and lab findings.
- Manages acute infections and symptoms.
- Provides multidisciplinary care and counseling.
- Discusses HIV prevention and partner notification.
- Clinical Staging (WHO & CDC):
- Guides treatment decisions in the absence of CD4 testing.
- Classifies severity based on symptoms and conditions.
- Includes asymptomatic HIV, symptomatic HIV, and AIDS-indicator diseases.
Pentamidine:
- Antiprotozoal drug used as an alternative treatment for PCP (Pneumocystis pneumonia) in HIV/AIDS patients.
- Side effects include impaired glucose metabolism, renal damage, and bone marrow suppression.
Dapsone (DDS):
- Leprostatic medication used to treat PCP in HIV/AIDS patients.
Kaposi’s Sarcoma:
- Cancer involving endothelial layer of blood and lymphatic vessels.
- Symptoms: Pinkish-blue macules progressing to reddish-purple or dark lesions.
- Diagnosis: Confirmed by biopsy.
- Treatment: Radiation therapy; recurrence common; chemotherapy options include vinblastine, Adriamycin, bleomycin, or methotrexate.
Cryptosporidium:
- Protozoal infection linked to contaminated water supply.
- Symptoms: Severe watery diarrhea, nausea, vomiting, abdominal cramping, fever, weakness.
- Treatment: Symptomatic relief with antidarrheal medication and intravenous fluid replacement; no effective chemoprophylactic agent available.
HIV Diagnosis:
- Begins with enzyme-linked immunosorbent assay (ELISA) to detect HIV antibodies (6-12 weeks post-exposure).
- Some individuals may not show seroconversion for 6 months or longer.
- Seropositivity: Presence of HIV antibodies in blood.
- False-positive ELISA results possible in certain cases (e.g., multiple births).
Psychosocial Issues:
- HIV infection poses significant psychosocial challenges for both patients and healthcare providers.
- Counseling requires sensitivity; caregivers may need psychiatric training for conditions like HIV encephalopathy.
Western Blot Test:
- More specific than ELISA for confirming HIV antibodies.
Polymerase Chain Reaction (PCR) Test:
- Measures HIV RNA levels (viral load) in plasma.
- Levels decrease post-initial infection due to immune response.
- Early infection produces high viral load; majority of virus produced in first few weeks.
HIV Treatment (HAART):
- Highly active antiretroviral therapy (HAART) prolongs life and delays progression to AIDS.
- Initiate treatment based on viral load (PCR) and CD4 cell count criteria.
- Combination therapy (cocktail) with three or more medications is recommended to suppress viral load effectively.
Antiretroviral Medications:
- Nucleoside reverse transcriptase inhibitors (NRTIs): Block HIV replication.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Disable reverse transcriptase.
- Protease inhibitors (PIs): Disable HIV protease.
- Fusion inhibitors: Prevent HIV entry into cells.
NRTIs and NNRTIs:
NRTIs (Nucleoside Reverse Transcriptase Inhibitors):
Inhibit reverse transcriptase enzyme.
Examples: Zidovudine, Tenofovir.
NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors):
Bind to reverse transcriptase at a different site.
Examples: Efavirenz, Nevirapine.
Nursing Care Priorities:
- Focus on preventing pathogen exposure and providing physical/emotional support.
- Emphasize hand hygiene and infection control measures.
- Avoid discrimination and stigmatization; treat each patient with empathy and care.