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Management of Patients with HIV and AIDS

Human Immunodeficiency Virus . Infectious agentRequires human host RNA-based retrovirusDestroys Helper T-cells (CD4 ) Causes:HIV encephalopathy Wasting syndromeBlood abnormalities . Acquired Immunodeficiency Syndrome (AIDS). Group of disorders caused by the progressive immune system destruct

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Management of Patients with HIV and AIDS

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    1. Management of Patients with HIV and AIDS

    2. Human Immunodeficiency Virus Infectious agent Requires human host RNA-based retrovirus Destroys Helper T-cells (CD4+) Causes: HIV encephalopathy Wasting syndrome Blood abnormalities

    3. Acquired Immunodeficiency Syndrome (AIDS) Group of disorders caused by the progressive immune system destruction associated with HIV infection Characterized by opportunistic diseases and neoplasias

    4. HIV: Modes of Transmission Contact with infected blood/blood products Contact with infected body fluids Across placental barrier from infected mother to fetus, or through cervical or blood contact at time of delivery or through breast milk What factor increases exposure risk?

    5. HIV/AIDS: Important Aspects of Care Prevention Safer Sex Practices Harm Reduction Strategies Reproductive education Early detection Enzyme immunoassay testing Ongoing treatment Managed as a chronic disease Outpatient care setting

    6. Healthcare Provider Transmission Prevention Strategies Describe Standard Precautions What entity developed recommendations for post-exposure? Discuss recommendations for Post-exposure Prophylaxis.

    8. HIV Lifecycle HIV GP120 and GP41 attach to uninfected CD4+ cell surface (receptor) and fuse with cellular membrane Viral core contents empty into host cell (uncoating) HIV enzyme reverse transcriptase copies viral gentic material from RNA into the double-stranded DNA Double-stranded DNA is spliced into cellular DNA by action of integrase

    9. HIV Lifecycle (continued) Using provirus (integrated DNA) as a blueprint, the cell makes new viral proteins and viral RNA HIV protease cleaves the new proteins (polyproteins) New proteins join the viral RNA into new viral particles New viral particles bud from the cell and start the process over.

    10. Stages of HIV Disease Based on: Clinical history, physical exam, lab evidence of immune dysfunction, signs/symptoms, and presence of infections and malignancies Include: Primary infection (part of CDC Category A) HIV Symptomatic (CDC Category A) HIV Symptomatic (CDC Category B) AIDS (CDC Category C)

    11. Nursing Responsibilities Related To Antibody Testing Pre-test Explanation of meaning of test and possible test results; informed consent Confidentiality Education and Counseling Post-test Positive: ongoing counseling, referrals to social, financial, medical and psychological support services

    12. HIV Testing Enzyme immunoassay testing (EIA) Western blot Viral load CD4+/CD8+ ratio What is the “window period” and what is its significance?

    13. HIV Infection: Treatment What is the most concerning detail regarding HIV/AIDS treatment? Treatment decisions must be individualized. What classification of drugs will be used to treat HIV/AIDS? What are the goals of drug therapy? What test is used to evaluate results of therapy?

    14. HIV Drug Therapy HAART (highly active antiretroviral therapy) Classes of Antiretrovirals Non-nucleoside reverse transcriptase inhibitors Nucleoside reverse transcriptase inhibitors Protease inhibitors Fusion inhibitors What other drug classes would you anticipate using in the treatment of AIDS?

    15. HIV Drug Resistance Results from spontaneous genetic mutation of the pathogen or in response to medication exposure Factors associated with development: Serial monotherapy Inadequate suppression of viral replication with suboptimal treatment regimens Difficulty adhering to complex and toxic regimens Initiating therapy late in course of illness

    16. Clinical Manifestations Respiratory Gastrointestinal Oncologic Neurologic Depressive Integumentary Endocrine Gynecologic

    17. Medical Management Treatment of Infections Antidiarrheal Therapy Chemotherapy Antidepressant Therapy Nutrition Therapy Complimentary and Alternative Modalities Supportive Care

    18. Nursing Interventions Promote skin integrity Promote usual bowel patterns Prevent infections Improve activity tolerance Maintain thought processes Improve airway clearance Relieve pain and discomfort Improve nutritional status Decrease sense of isolation Increase coping ability

    20. Nursing Interventions Monitor and manage potential complications Opportunistic infections Respiratory failure Cachexia and wasting Side effects of medications

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