HIV/AIDS

1. HIV/AIDS Created by: Denise Steele, BSN, RN, CMSRN Date: May 25, 2011

2. HIV/AIDS • Increasing # of heterosexual women; transmission to newborns • Nurses: Largest group of healthcare workers to occupationally acquire HIV • ? Altered form of simian (monkey) immunodeficiency virus (SIV) – consumption of monkey meat caused human infection in Africa Pandemic – infecting massive #’s throughout world Infectious, fatal d/o Weakens immune system HIV causes AIDS HIV – may be well 10+ yrs before developing into AIDS Can infect others HIV ~ 33.2 million worldwide (WHO, 2007) 67% live sub-Saharan Africa, 90% of infected children live here 2007, 2.1 million deaths (decline) 8 x higher among African Americans 2nd leading cause of death African American men 35 to 44 (2003) 3rd for women 35 to 44 (AA) (2003)

3. Structure of HIV, a retrovirus • Subtypes • HIV-1: Mutates easily, frequently, (multiple substrains) • Move prevalent in U.S. & world • HIV-2: less transmittable, HIV to AIDS interval longer • Western Africa primary infection site Requires host for survival, duplication

4. HIV Progression & Development of AIDS

5. Transmission • PREVENTION STRATEGIES • Abstinence • Monogamous sex w/ uninfected partner • Avoid multiple partners • Condoms and spermicide • No IV drug use • Use new syringe/needles • Do not donate blood if high-risk behaviors • Autologous blood (self-donor) or directed donor (relatives & friends) for surgeries • Use Standard Precautions • Report any/all needle sticks Via body fluids (only these 4) 1) blood 2) semen 3) vaginal secretions 4) breast milk HIV present in saliva, tears & conjunctiva secretions but not transmittable HIV not found in urine, stool, vomit, sweat Specific behaviors increase risk - unprotected sexual intercourse - multiple partners - infected semen – sperm bank - organs & tissues for transplantation - blood transfusions -*1984 (testing) if donor recently infected w/ HIV may not show up in screening

6. Cells have proteins on their surface that are called CD4 receptors. • HIV searches for cells that have CD4 surface receptors, because this particular protein enables the virus to bind to the cell • its main target is the T4-lymphocyte (also called the "T-helper cell"), a kind of white blood cell that has lots of CD4 receptors • T4-cell is responsible for warning your immune system that there are invaders in the system. • Once HIV binds to a cell, it hides HIV DNA inside the cell's DNA: this turns the cell into a sort of HIV factory. In order for viruses to reproduce, they must infect a cell In order to make new viruses, they must hi-jack a cell, and use it to make new viruses Viruses hide their own DNA in the DNA of the cell, and then, when the cell tries to make new proteins, it accidentally makes new viruses as well.

7. Rate of progression r/t concentration of virus in blood • Will cause death (opportunistic infections) • Few long-term survivors • HIV weak strain • Strong killer T8 cells • Hindrance of conversion of HIV to AIDS • Effective drug therapy

8. HIV Infection • S&S Acute retroviral syndrome (viremia) • Fever • Swollen, tender lymph nodes • Rash on face, trunk, palms, soles • Muscle, joint pain • Headache • N/V • Diarrhea • Liver/spleen enlargement • Weight loss • Neurologic symptoms • Kaposi’s sarcoma (connective tissue cancer in AIDS pts) • Pneumocystis pneumonia • Gynecological problems

9. Diagnostics • ELISA TEST (X2) – detects presence of HIV antibodies • Western blot test – confirms diagnosis • Strict confidentiality • CD4 (T-cell) count – evaluate & track progression of HIV CD4 main target of HIV – decreased count with progression of HIV • Viral Load – amount of virus; severity of virus

10. Kaposi’s Sarcoma • Pneumocystis Pneumonia

11. MEDICAL MANAGEMENT

12. Treatment • ANTIRETROVIRAL DRUGS • Controversy over initiation • Drug resistance (limits future tx0 • Noncompliance • Mutations • Drug cross resistance • Diminished drug response d/t similar drugs • Initiate if CD4 count < 350 cells/mm3 • Or if AIDS-defining illness • Pregnant women • HIV – associated renal disease • Hep B Tx based on CD4 & viral loads Cost 10K – 30K/yr Medicaid ~ ½ AIDS Drug Assistance Program (government funded) ~ 30% Compliance Side effects Drug interactions Combo tx – 3 antiretroviral drugs 2 interfere w/ virus’s ability to make genetic blueprint 1 inhibits ability of virus particles to leave host cell Some 4 meds Combo tx (drug cocktail); several benefits

13. Drug Resistance Compliance necessary To decrease chance of drug resistance *as prescribed *time* *With/without food *risk of mutations of virus w/ noncompliance Common: AZT Retrovir Sustiva Selzentry Viramune Viread Isentress Invirase Fortase

14. OPPORTUNISTIC INFECTIONS

15. NURSING DIAGNOSIS • AIDS RELATED COMPLICATION MANAGEMENT • Aids Dementia Complex (ADC) • Degeneration of brain • Antiretroviral therapy • Drug therapy (Namenda) slow progression • Distal Sensory Polyneuropathy (DSP) • Abnormal sensations • Side effect – antiretroviral drugs • Vit B12/thiamine (preserve & promote nerve function) • Tx neuropathic pain Risk for Infection Risk for Deficient Fluid Volume Risk for Activity Intolerance, Impaired Physical Mobility, Deficient Self-Care Risk for Impaired Skin Integrity Impaired Oral Mucous Membranes Powerlessness Hopelessness Anticipatory Grieving Interrupted Family Process

16. Client Teaching • No cure – meds may slow progression • Compliance with med regime • East small, frequent, well-balanced meals • Drink plenty of water • Weigh weekly – report wt loss to MD • Avoid people with infections/crowds • Notify MD of any S&S of infection • Wash all food before cooking, no consumption of raw foods • Wash soiled linens separate from others • No smoking • Personal cleanliness • Frequent rest/space activities • Do not share needles/donate blood/inform healthcare workers of HIV