Infection Notes: HIV Overview and Management

Infection

HIV Overview

• Human Immunodeficiency Virus (HIV): A retrovirus that leads to immunosuppression, increasing susceptibility to infections.
• Current Statistics:
  • Over 1.2 million people living with HIV in the U.S.
  • Approximately 36,400 new infections annually.
• Treatment Impact: Effective treatment has substantially decreased death rates; HIV is now considered a chronic, manageable condition.

Transmission of HIV

• HIV Transmission Modes:
  • Contact with specific body fluids: blood, semen, vaginal secretions, breast milk.
  • Not transmitted through tears, saliva, urine, vomit, feces, sweat, or casual contacts (e.g., hugging, shaking hands).
• High-Risk Activities:
  • Unprotected sexual contact with high viral load individuals; transmission unlikely with undetectable viral load ("U=U").
  • Trauma during sexual activity and presence of other STIs raises the risk.
• Other Transmission Routes:
  • Sharing drug paraphernalia and through blood transfusions (improved safety due to routine screenings).
  • Occupational exposure through needlestick injuries, especially high-risk conditions like deep punctures from visible blood.

Perinatal Transmission

• Risk of transmission during pregnancy, childbirth, or breastfeeding. Without treatment, about 25% risk; can be reduced to <1% with antiretroviral therapy (ART).

Pathophysiology of HIV

• HIV Characteristics:
  • RNA virus (retrovirus); upon entry into host cells, it converts RNA to DNA using reverse transcriptase.
  • Primary target cells: CD4+ T cells (a type of lymphocyte).
  • Causes a progressive loss of CD4+ T cells, leading to immune system compromise.
• Progression:
  • Symptoms emerge as CD4+ T cell counts drop below 500 cells/μL and worsen when below 200 cells/μL.

Clinical Manifestations of HIV Infection

• Acute HIV Infection:
  • Typically occurs 2-4 weeks post-infection, presenting with flu-like symptoms.
  • Often mistaken for other viral infections; has a high viral load, increasing transmissibility.
• Chronic HIV Infection:
  • Asymptomatic phase lasting considerable time; without treatment, AIDS can develop in ~10 years.
  • Symptoms may include fever, night sweats, infections (e.g., oral thrush, shingles).
• AIDS:
  • Marked by significant immune dysfunction, leading to opportunistic infections and various cancers.

Diagnostic Studies

• Testing for HIV:
  • HIV-specific antibody tests; window period of 3 weeks for accurate results.
• Monitoring Disease Progression:
  • CD4 Counts: Normal range is 800-1200 cells/μL; lower counts indicate progressing disease.
  • Viral Load: The goal is to maintain an undetectable level to reduce disease activity.
• Resistance Testing:
  • Genotype and phenotype assays help assess potential drug resistance to ART.

Treatment Approaches

• Antiretroviral Therapy (ART):
  • A combination of antiretroviral medications to control HIV replication.
  • Adherence is crucial for decreasing viral load and preventing symptoms.
• Goals of ART:
  • Maintain or raise CD4 counts, suppress viral load, prevent opportunistic infections.
• Challenges:
  • Side effects, drug interactions requiring consistent patient education and monitoring.

Nursing Management

• Assessment:
  • Thorough health evaluation, including health history and psychosocial factors; identify risk factors and educate on prevention.
• Patient Education:
  • Emphasize adherence to medication, the importance of healthy lifestyle choices, and preventive measures to control transmission.
• Support:
  • Offer support for emotional and social challenges surrounding HIV, including addressing stigma and discrimination.

Prevention Strategies

• Safer Practices:
  • Promote consistent use of condoms and PrEP (pre-exposure prophylaxis).
  • Encourage needle and syringe exchange programs to reduce risk of transmission via shared drug equipment.
• Education:
  • Continuous health education tailored to individual risk behaviors and culturally sensitive materials.

Psychosocial Considerations

• Coping Mechanisms: Address feelings of anxiety, depression, and stigma associated with HIV. Encourage open discussions about mental health and provide access to counseling services.
• Community Support: Advocate for and connect patients to support groups that facilitate shared experiences and coping strategies.

End-of-Life Care

• Complex Challenges: As CD4 counts decline, manage the transition to palliative care, ensuring comfort and addressing emotional and spiritual needs. Support family members through the grieving process and help establish a safe environment for care.