Nikka Shanna Lingolingo

HIV (human immunodeficiency virus)

What is HIV?

 a sexually transmitted infection (STI). It can also be spread by contact with infected blood or
from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may
take years before HIV weakens your immune system to the point that you have AIDS.
 There's no cure for HIV/AIDS, but medications can dramatically slow the progression of the
disease. These drugs have reduced AIDS deaths in many developed nations.

Differences between AIDS and HIV?

 HIV stands for ‘human immunodeficiency virus’. HIV belongs to a group of viruses called
retroviruses. HIV attacks white blood cells within the immune system. These cells will stay
infected for the rest of their lives. If untreated, HIV will develop into AIDS.
 AIDS stands for ‘acquired immune deficiency syndrome’. (It’s sometimes referred to as ‘late
stage HIV’ or ‘advanced HIV disease’.) It is an umbrella term for the illnesses that occur due
to having untreated HIV infection for several years, by which point the immune system is
severely damaged and unable to fight off infections. The illnesses and symptoms will vary for
each person that has AIDS, but may include life-threatening infections and cancers

 Every person who has AIDS has HIV, but not every person with HIV will develop AIDS.
Because there are now lots of treatment options available for people living with HIV, far
fewer people are developing AIDS. Often, those that do develop AIDS are people who
have not been tested for HIV and have never taken treatment. Once started on HIV
treatment, death due to AIDS can be prevented.

Symptoms

Some people infected by HIV develop a flu-like illness within two to four weeks after the virus enters
the body. This illness, known as primary (acute) HIV infection, may last for a few weeks. Possible
signs and symptoms include:

 Fever

 Headache

 Muscle aches and joint pain

 Rash

 Sore throat and painful mouth sores

 Swollen lymph glands, mainly on the neck

 Diarrhea

 Weight loss

 Cough
 Night sweats

These symptoms can be so mild that you might not even notice them. However, the amount of virus in
your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily
during primary infection than during the next stage.

Clinical latent infection (Chronic HIV)

In this stage of infection, HIV is still present in the body and in white blood cells. However, many
people may not have any symptoms or infections during this time.

This stage can last for many years if you're not receiving antiretroviral therapy (ART). Some people
develop more severe disease much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy your immune cells — the cells in your body that help
fight off germs — you may develop mild infections or chronic signs and symptoms such as:

 Fever

 Fatigue

 Swollen lymph nodes — often one of the first signs of HIV infection

 Diarrhea

 Weight loss

 Oral yeast infection (thrush)

 Shingles (herpes zoster)

 Pneumonia

When AIDS occurs, your immune system has been severely damaged. You'll be more likely to
develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually cause
illness in a person with a healthy immune system.

The signs and symptoms of some of these infections may include:

 Sweats

 Chills

 Recurring fever

 Chronic diarrhea
 Swollen lymph glands

 Persistent white spots or unusual lesions on your tongue or in your mouth

 Persistent, unexplained fatigue

 Weakness

 Weight loss

 Skin rashes or bumps

Causes

HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during
pregnancy, childbirth or breast-feeding.

How does HIV become AIDS?

HIV destroys CD4 T cells — white blood cells that play a large role in helping your body fight disease.
The fewer CD4 T cells you have, the weaker your immune system becomes.

You can have an HIV infection, with few or no symptoms, for years before it turns into AIDS. AIDS is
diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication,
such as a serious infection or cancer.

 CD4 T lymphocytes (CD4 cells) help coordinate the immune response by stimulating

other immune cells, such as macrophages, B lymphocytes (B cells), and CD8
T lymphocytes (CD8 cells), to fight infection. HIV weakens the immune system by
destroying CD4 cells.

How HIV spreads

To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This
can happen in several ways:

 By having sex. You may become infected if you have vaginal, anal or oral sex with an
infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter
your body through mouth sores or small tears that sometimes develop in the rectum or vagina
during sexual activity.

 By sharing needles. Sharing contaminated IV drug paraphernalia (needles and syringes)

puts you at high risk of HIV and other infectious diseases, such as hepatitis.
 From blood transfusions. In some cases, the virus may be transmitted through blood
transfusions. American hospitals and blood banks now screen the blood supply
for HIV antibodies, so this risk is very small.

 During pregnancy or delivery or through breast-feeding. Infected mothers can pass the

virus on to their babies. Mothers who are HIV-positive and get treatment for the infection during
pregnancy can significantly lower the risk to their babies.
How HIV doesn't spread

You can't become infected with HIV through ordinary contact. That means you can't
catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the
infection.

HIV isn't spread through the air, water or insect bites.

Risk factors

Anyone of any age, race, sex or sexual orientation can be infected with HIV/AIDS. However, you're at
greatest risk of HIV/AIDS if you:

 Have unprotected sex. Use a new latex or polyurethane condom every time you have sex.
Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual
partners.

 Have an STIs. Many STIs produce open sores on your genitals. These sores act as

doorways for HIV to enter your body.

 Use IV drugs. People who use IV drugs often share needles and syringes. This exposes
them to droplets of other people's blood.
Complications

HIV infection weakens your immune system, making you much more likely to develop many infections
and certain types of cancers.

Infections common to HIV/AIDS

 Pneumocystis pneumonia (PCP). This fungal infection can cause severe illness. Although
it's declined significantly with current treatments for HIV/AIDS, in the U.S. PCP is still the most
common cause of pneumonia in people infected with HIV.

 Candidiasis (thrush). Candidiasis is a common HIV-related infection. It causes inflammation

and a thick, white coating on your mouth, tongue, esophagus or vagina.
 Tuberculosis (TB). In resource-limited nations, TB is the most common opportunistic
infection associated with HIV. It's a leading cause of death among people with AIDS.

 Cytomegalovirus. This common herpes virus is transmitted in body fluids such as saliva,

blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it
remains dormant in your body. If your immune system weakens, the virus resurfaces — causing
damage to your eyes, digestive tract, lungs or other organs.

 Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid

surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central
nervous system infection associated with HIV, caused by a fungus found in soil.

 Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite

spread primarily by cats. Infected cats pass the parasites in their stools, which may then spread
to other animals and humans. Toxoplasmosis can cause heart disease, and seizures occur when
it spreads to the brain.
Cancers common to HIV/AIDS

 Lymphoma. This cancer starts in the white blood cells. The most common early sign is
painless swelling of the lymph nodes in your neck, armpit or groin.

 Kaposi's sarcoma. A tumor of the blood vessel walls, Kaposi's sarcoma usually appears as
pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may
look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the
digestive tract and lungs.
Other complications

 Wasting syndrome. Untreated HIV/AIDS can cause significant weight loss, often

accompanied by diarrhea, chronic weakness and fever.

 Neurological complications. HIV can cause neurological symptoms such as confusion,

forgetfulness, depression, anxiety and difficulty walking. HIV-associated neurocognitive disorders
(HAND) can range from mild symptoms of behavioral changes and reduced mental functioning to
severe dementia causing weakness and inability to function.

 Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in

your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. It
most often affects black or Hispanic people.

 Liver disease. Liver disease is also a major complication, especially in people who also have
hepatitis B or hepatitis C.
Prevention

There's no vaccine to prevent HIV infection and no cure for AIDS. But you can protect yourself and
others from infection.
To help prevent the spread of HIV:

 Use treatment as prevention (TasP). If you're living with HIV, taking HIV medication can

keep your partner from becoming infected with the virus. If you make sure your viral load stays
undetectable — a blood test doesn't show any virus — you won't transmit the virus to anyone
else. Using TasP means taking your medication exactly as prescribed and getting regular
checkups.

 Use post-exposure prophylaxis (PEP) if you've been exposed to HIV. If you think you've
been exposed through sex, needles or in the workplace, contact your doctor or go to the
emergency department. Taking PEP as soon as possible within the first 72 hours can greatly
reduce your risk of becoming infected with HIV. You will need to take medication for 28 days.

 Use a new condom every time you have sex. Use a new condom every time you have anal
or vaginal sex. Women can use a female condom. If using a lubricant, make sure it's water-
based. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use
a nonlubricated, cut-open condom or a dental dam — a piece of medical-grade latex.

 Consider preexposure prophylaxis (PrEP). The combination drugs emtricitabine plus

tenofovir (Truvada) and emtricitabine plus tenofovir alafenamide (Descovy) can reduce the risk of
sexually transmitted HIV infection in people at very high risk. PrEP can reduce your risk of
getting HIV from sex by more than 90% and from injection drug use by more than 70%,
according to the Centers for Disease Control and Prevention. Descovy hasn't been studied in
people who have receptive vaginal sex.

Your doctor will prescribe these drugs for HIV prevention only if you don't already
have HIV infection. You will need an HIV test before you start taking PrEP and then
every three months as long as you're taking it. Your doctor will also test your kidney
function before prescribing Truvada and continue to test it every six months.
You need to take the drugs every day. They don't prevent other STDs, so you'll still need
to practice safe sex. If you have hepatitis B, you should be evaluated by an infectious
disease or liver specialist before beginning therapy.

 Tell your sexual partners if you have HIV. It's important to tell all your current and past
sexual partners that you're HIV-positive. They'll need to be tested.

 Use a clean needle. If you use a needle to inject drugs, make sure it's sterile and don't share
it. Take advantage of needle-exchange programs in your community. Consider seeking help for
your drug use.

 If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the
infection to your baby. But if you receive treatment during pregnancy, you can significantly cut
your baby's risk.
 Consider male circumcision. There's evidence that male circumcision can help reduce the
risk of getting HIV infection.

Diagnosis

HIV can be diagnosed through blood or saliva testing. Available tests include:

 Antigen/antibody tests. These tests usually involve drawing blood from a vein. Antigens are
substances on the HIV virus itself and are usually detectable — a positive test — in the blood
within a few weeks after exposure to HIV.

Antibodies are produced by your immune system when it's exposed to HIV. It can take weeks to
months for antibodies to become detectable. The combination antigen/antibody tests can take
two to six weeks after exposure to become positive.

 Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most
rapid HIV tests, including self-tests done at home, are antibody tests. Antibody tests can take
three to 12 weeks after you're exposed to become positive.

 Nucleic acid tests (NATs). These tests look for the actual virus in your blood (viral load).
They also involve blood drawn from a vein. If you might have been exposed to HIV within the
past few weeks, your doctor may recommend NAT. NAT will be the first test to become positive
after exposure to HIV.

Talk to your doctor about which HIV test is right for you. If any of these tests are negative, you may
still need a follow-up test weeks to months later to confirm the results.

Tests to stage disease and treatment

If you've been diagnosed with HIV, it's important to find a specialist trained in diagnosing and
treating HIV to help you:

 Determine whether you need additional testing

 Determine which HIV antiretroviral therapy (ART) will be best for you

 Monitor your progress and work with you to manage your health

If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of your
disease and the best treatment, including:

 CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and
destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your
CD4 T cell count dips below 200.
 Viral load (HIV RNA). This test measures the amount of virus in your blood. After
starting HIV treatment the goal is to have an undetectable viral load. This significantly reduces
your chances of opportunistic infection and other HIV-related complications.

 Drug resistance. Some strains of HIV are resistant to medications. This test helps your
doctor determine if your specific form of the virus has resistance and guides treatment decisions.
Tests for complications

Your doctor might also order lab tests to check for other infections or complications, including:

 Tuberculosis

 Hepatitis B or hepatitis C virus infection

 STIs

 Liver or kidney damage

 Urinary tract infection

 Cervical and anal cancer

 Cytomegalovirus

 Toxoplasmosis

Treatment

Currently, there's no cure for HIV/AIDS. Once you have the infection, your body can't get rid of it.
However, there are many medications that can control HIV and prevent complications. These
medications are called antiretroviral therapy (ART). Everyone diagnosed with HIV should be started
on ART, regardless of their stage of infection or complications.

ART is usually a combination of three or more medications from several different drug classes. This
approach has the best chance of lowering the amount of HIV in the blood. There are
many ART options that combine three HIV medications into one pill, taken once daily.

Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from
different classes to:

 Account for individual drug resistance (viral genotype)

 Avoid creating new drug-resistant strains of HIV

 Maximize suppression of virus in the blood

Two drugs from one class, plus a third drug from a second class, are typically used.
The classes of anti-HIV drugs include:

 Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed

by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant) and
doravirine (Pifeltro).

 Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of

the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen),
tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir).
Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and
emtricitabine/tenofovir alafenamide (Descovy).

 Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make

copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and
lopinavir/ritonavir (Kaletra).

 Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its

genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir
alafenamide fumar (Biktarvy), raltegravir (Isentress) and dolutegravir (Tivicay).

 Entry or fusion inhibitors block HIV's entry into CD4 T cells. Examples include enfuvirtide
(Fuzeon) and maraviroc (Selzentry).

Nursing Assessment
Nursing assessment includes identification of potential risk factors, including a history of risky sexual
practices or IV/injection drug use.

 Nutritional status. Nutritional status is assessed by obtaining a diet history and identifying

factors that may affect the oral intake.
 Skin integrity. The skin and mucous membranes are inspected daily for evidence of
breakdown, ulceration, or infection.
 Respiratory status. Respiratory status is assessed by monitoring the patient for cough,
sputum production, shortness of breath, orthopnea, tachypnea, and chest pain.
 Neurologic status. Neurologic status is determined by assessing the level of consciousness;
orientation to person, place, and time; and memory lapses.
 Fluid and electrolyte balance. F&E status is assessed by examining the skin and mucous
membranes for turgor and dryness.
 Knowledge level. The patient’s level of knowledge about the disease and the modes of
disease transmission is evaluated.

Diagnosis
The list of potential nursing diagnoses is extensive because of the complex nature of the disease.

 Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation,

and diarrhea.
 Diarrhea related to enteric pathogens of HIV infection.
  Risk for infection related to immunodeficiency.
 Activity intolerance related weakness, fatigue, malnutrition, impaired F&E balance, and
hypoxia associated with pulmonary infections.
 Disturbed thought processes related to shortened attention span, impaired
memory, confusion, and disorientation associated with HIV encephalopathy.
 Ineffective airway clearance related to PCP (Pneumocystis pneumonia) increased bronchial
secretions, and decreased ability to cough related to weakness and fatigue.
 Pain related to impaired skin integrity secondary to diarrhea, and peripheral neuropathy. (a
result of damage to the nerves outside of the brain and spinal cord (peripheral nerves),
often causes weakness, numbness and pain, usually in your hands and feet. It can also
affect other areas of your body.)
 Imbalanced nutrition, less than body requirements related to decreased oral intake.

Planning & Goals

Goals for a patient with HIV/AIDS may include:

 Achievement and maintenance of skin integrity.

 Resumption of usual bowel pattern.
 Absence of infection.
 Improve activity intolerance.
 Improve thought processes.
 Improve airway clearance.
 Increase comfort.
 Improve nutritional status.
 Increase socialization.
 Absence of complications.
 Prevent/minimize development of new infections.
 Maintain homeostasis.
 Promote comfort.
 Support psychosocial adjustment.
 Provide information about disease process/prognosis and treatment needs.

Nursing Interventions

 Promote skin integrity. Patients are encouraged to avoid scratching; to use nonabrasive,

nondrying soaps and apply nonperfumed moisturizers; to perform regular oral care; and to
clean the perianal area after each bowel movement with nonabrasive soap and water.
 Promote usual bowel patterns. The nurse should monitor for frequency and consistency of
stools and the patient’s reports of abdominal pain or cramping.
 Prevent infection. The patient and the caregivers should monitor for signs of infection and
laboratory test results that indicate infection.
 Improve activity intolerance. Assist the patient in planning daily routines that maintain a
balance between activity and rest.
  Maintain thought processes. Family and support network members are instructed to speak
to the patient in simple, clear language and give the patient sufficient time to respond to
questions.
 Improve airway clearance. Coughing, deep breathing, postural drainage, percussion and
vibration is provided for as often as every 2 hours to prevent stasis of secretions and to
promote airway clearance.
 Relieve pain and discomfort. Use of soft cushions and foam pads may increase comfort as
well as administration of NSAIDS and opioids.
 Improve nutritional status. The patient is encouraged to eat foods that are easy to swallow
and to avoid rough, spicy, and sticky food items.

Evaluation
Expected patient outcomes may include:

 Achieved and maintained of skin integrity.

 Resumption of usual bowel pattern.
 Absence of infection.
 Improved activity intolerance.
 Improved thought processes.
 Improved airway clearance.
 Increased comfort.
 Improved nutritional status.
 Increased socialization.
 Absence of complications.