HIV & AIDS Nursing Lecture – Key Vocabulary

Concept of Caring & Historical Stigma

• Nursing cornerstone: caring must override fear, judgment, labels (“junkies”, “queers”, etc.).

• 1980-90s HIV/AIDS = “automatic death certificate” ➜ comparable social fear to early COVID-19.

• Influential advocates (e.g., Michael Jackson, Ryan White) + government funding (Pres. Reagan) propelled research.

• Ongoing need for research: practice = Research evidence + Nurse expertise + Patient preference.

Changing Epidemiology & Key Numbers

• ≈ 1{,}000{,}000 people living with HIV in U.S. (book figure; exact year unspecified).

• 14\% of PLWH (People Living With HIV) unaware of status → critical surveillance gap.

• New U.S. diagnosis every 9.5\text{–}10 minutes.

• HIV-1: worldwide, more pathogenic.
  HIV-2: West Africa, less pathogenic.

• Demographic shift: now higher in Black communities & women; previously mostly white MSM (men who have sex with men).

• >50\% of PLWH are \ge 50 years; Viagra/Cialis fuel sexual activity, yet older adults test/use condoms less.

• National goal: 90\% reduction in new infections by 2030 (diagnose – treat – prevent – respond).

Transmission Facts

• Required: virus access to bloodstream (sexual fluids, blood, perinatal).

• Not spread by air, water, insects, casual contact, dishes, or skin-to-skin.

• Highest sexual risk = anal intercourse (tearing of rectal mucosa).

• Screening of donated blood/organs now routine (prevented tainted transfusions like Ryan White case).

Pathophysiology Overview (7 steps – names non-essential for exam)

1. Virus enters host ➜ seeks \text{CD4} T-cell.

2. Fusion of viral & cell membranes.

3. Reverse transcriptase converts viral RNA → DNA.

4. Integrase inserts viral DNA into host DNA ("messes up DNA synthesis").

5. Transcription/translation produce viral proteins.

6. Protease cleaves proteins → mature virions.

7. Budding → release of new viruses ➜ ↑ viral load.

• Key measure: Viral Load (VL) = copies / mL blood.
  – Diagnostic & treatment-monitoring tool.
  – Goal on therapy: “undetectable = untransmittable” (U = U).

Antiretroviral Therapy (ART)

• Cocktail = combo of drug classes to block multiple steps:
  • Fusion/CCR5 inhibitors
  • Reverse-Transcriptase Inhibitors (NRTI, NNRTI)
  • Integrase Strand Transfer Inhibitors (INSTI)
  • Protease Inhibitors (PI)

• Classic drug: AZT / Zidovudine (NRTI); crosses placenta, used perinatally; may suppress WBC ➜ monitor counts.

• Other common agents for PrEP (pre-exposure prophylaxis): Truvada, Descovy; \approx 99\% effective when taken daily + other precautions.

• Therapy always individualized by infectious-disease specialist; nurses ensure adherence, monitor labs, teach S/E.

Disease Progression & Staging

Diagnostic Testing

1. Antibody/antigen screens
   • ELISA (enzyme-linked immunoassay) ×2.
   • Confirm with Western Blot (specific antibodies).
   • New 4th-gen Ag/Ab tests shorten window.

2. Viral Load (PCR) – quantitative RNA copies.
   • Used for initial diagnosis & ongoing monitoring.

3. \text{CD4} T-cell count – immunologic status; <200 ⇒ AIDS.

4. Routine screening recommended ages 15{-}65, all pregnancies, post-sexual-assault, and annually for high-risk groups.

Prevention & Education

• Primary prevention: abstinence, mutually monogamous relationship, consistent condom use, dental dams, latex gloves for contact play.

• Needle-exchange programs, clean equipment, education on safer injection; consider PrEP for high-risk users.

• Perinatal: treat mother with AZT, newborn AZT syrup; C-section if VL high; avoid breastfeeding where safe substitutes exist.

• Goal: suppress VL to undetectable for ≥6 months ➜ non-transmissible.

Post-Exposure Prophylaxis (PEP)

• For healthcare or sexual exposure.

• Steps: immediate washing/flushing; report; baseline labs for both parties; start 3-drug ART ASAP (preferably <2 hrs, max 72 hrs); continue 28 days; follow-up VL & antibody tests.

Workplace Safety (Tier 1 Standard Precautions)

• Hand hygiene, gloves for blood/body fluids, needleless IV systems, engineered sharps protection, never recap needles.

• Exposure protocol = institutional algorithm + consented testing.

Ethical & Legal Points

• Mandatory confidential partner notification by trained counselors for HIV, syphilis, gonorrhea, chlamydia (state laws). Nurses obtain names/contact; patient identity not disclosed.

• Informed consent required for HIV testing (varies by state); post-test counseling mandatory.

• Criminal penalties possible for knowingly transmitting HIV.

Psychosocial & Holistic Care

• HIV affects "mind, body, spirit, soul"; chronic, manageable condition today.

• Address stigma, mental health, social determinants (housing, drug use, sex work, poverty).

• Interdisciplinary team: nurses, physicians, social workers, case managers, PT/OT/ST, chaplains.

• Nursing theorists & Lincoln philosophy: caring, non-judgmental approach, cultural competence.

Common Opportunistic Conditions (selected)

• Infections: PCP/PJP pneumonia, recurrent bacterial pneumonia, TB, CMV, toxoplasmosis, cryptococcal meningitis, candida esophagitis.

• Malignancies: Kaposi’s sarcoma, non-Hodgkin lymphoma, invasive cervical cancer.

• Others: HIV-associated neurocognitive disorder (HAND), AIDS wasting (severe weight loss & diarrhea), shingles, peripheral neuropathy.

Key Acronyms & Terms

• PLWH = People Living With HIV

• ART = Antiretroviral Therapy

• VL = Viral Load

• \text{CD4} / \text{CD8} = T-lymphocyte subsets

• OI = Opportunistic Infection

• PrEP = Pre-Exposure Prophylaxis

• PEP = Post-Exposure Prophylaxis

• U = U = Undetectable VL ⇒ Untransmittable

Quick-Reference Numbers & Targets

• \text{CD4} < 200 cells/mm^3 or <14\% total lymphocytes → AIDS.

• PrEP effectiveness: \approx99\% (with adherence).

• New U.S. HIV diagnosis every 10 minutes.

• 14\% unaware of infection.

• ≥50\% of PLWH now ≥50 years old.

• National reduction goal: 90\% fewer new infections by 2030.

Summary

HIV has evolved from a stigmatized, fatal epidemic to a chronic, highly manageable infection—provided early diagnosis, comprehensive care, strict adherence to ART, and robust prevention strategies. Nurses play a pivotal role in non-judgmental caring, education, advocacy, and vigilant infection monitoring to sustain progress toward ending the epidemic.