HIV & AIDS Summary

HIV & AIDS

Pathophysiology & Prevention

  • HIV attacks CD4 T-cells, weakening the immune system.

  • AIDS is the final stage of HIV; medication adherence can prevent progression.

  • HIV replicates by transcribing RNA into DNA using reverse transcriptase.

  • Prevention: Avoid sharing needles, use condoms, offer HIV testing during prenatal care, and follow standard precautions.

  • HIV spreads through contact with infectious bodily fluids (blood, semen, vaginal secretions, breast milk) and not through casual contact.

Transmission & Prevention

  • Sharing needles poses the highest risk.

  • Unprotected sex increases risk.

  • Preventative measures include safe sex practices and barrier methods.

  • Pre-exposure prophylaxis (PrEP) is recommended for high-risk clients before potential exposure.

  • Post-exposure prophylaxis (PEP) should be provided within 72 hours of exposure.

Safe Sex Practices

  • Use condoms during intercourse.

  • Use a latex barrier during oral sex.

  • Apply water-based lubricant with condoms to reduce friction.

Diagnosis & Monitoring

  • Initial diagnosis may yield false negatives within 3 weeks of exposure; retesting is recommended.

  • HIV antibody or antigen testing detects HIV.

  • Monitor CD4 count and viral load to assess HIV progression and treatment effectiveness.

  • Normal CD4 count: 800-1,200 cells/mm3.

  • Treatment goal: Undetectable viral load.

  • New diagnoses must be reported.

  • AIDS is diagnosed when CD4 count is <200 cells/mm3 or with opportunistic infections like candidiasis, Kaposi sarcoma, Pneumocystis pneumonia (PCP), tuberculosis, or toxoplasmosis.

HIV Progression Stages

  • Stage 1 (acute): High viral load, flu-like symptoms.

  • Stage 2 (chronic): Asymptomatic phase.

  • Stage 3 (AIDS): End-stage HIV with significant immunocompromise.

Interventions

  • Priorities: ART adherence, preventing HIV transmission and opportunistic infections, and providing psychosocial support.

Promoting ART Adherence

  • ART requires a daily combination of drugs to interrupt HIV replication.

  • Adherence is crucial to delay disease progression.

  • Goal of ART: Decrease viral load to undetectable levels and increase CD4 count.

  • U=U: Undetectable = Untransmittable through sexual contact.

  • Never skip doses to avoid drug resistance.

  • Use reminders or pill organizers.

  • Report unmanageable side effects but do not stop medications without consulting HCP.

Preventing HIV Transmission

  • Promote ART adherence to decrease viral load.

  • Administer ART during pregnancy, childbirth, and breastfeeding.

  • Practice safe sex.

  • Follow HIV prevention measures and avoid sharing personal items.

Preventing & Monitoring Opportunistic Infections

  • Infection prevention is a high priority because opportunistic infections are a leading cause of death in clients with HIV and immunosuppression.

  • Promote ART adherence to increase CD4 count.

  • Provide infection control teaching.

  • Administer prophylactic antibiotics as prescribed.

  • Report signs of infection immediately.

  • Routine tuberculosis (TB) testing is essential.

  • Monitor for reddish-brown lesions (Kaposi sarcoma).

  • Assess respiratory status frequently.

Infection Control Teaching

  • Perform frequent hand hygiene and skin/oral care.

  • Get recommended vaccines.

  • Avoid crowds and pathogen exposure.

  • Monitor temperature.

  • Cook food thoroughly.

  • Avoid traveling to areas with poor sanitation.

  • Encourage proper nutrition and rest.

Providing Psychosocial Support

  • Address depression, anxiety, and social isolation.

  • Consult mental health services.

  • Refer to HIV support groups.

  • Ensure advance directives are in place.

Medications: Antiretroviral Therapy (ART)

  • ART delays disease progression and prevents transmission but does not cure HIV.

  • Hepatotoxicity: Monitoring liver enzymes is a priority.

  • Entry inhibitors: block HIV from entering CD4 cells.

  • Nucleoside/Non-nucleoside reverse transcriptase inhibitors (NRTIs/NNRTIs): inhibit reverse transcriptase to prevent HIV replication.

  • Integrase inhibitors: block integrase enzymes, preventing HIV DNA from inserting into CD4 DNA.

  • Protease inhibitors (PIs): block protease, preventing replicated HIV from maturing.