Chapter
20:
Acquired
Immunodeficiency
Syndrome
 1




I.
 Acquired
Immunodeficiency
Syndrome

A. Disease
caused
by
infection
with
the
human
immunodeficiency
virus
(HIV)

B. Profound
immunosuppression


1. Opportunistic
infections

2. Malignancies

3. Wasting

4. 
Central
nervous
system
degeneration

C. Pandemic

D. Affects
the
CD4+
T
lymphocytes
(or
T
helper
cells
or
CD4+
T
cells),

macrophages
and
dendritic
cells

1. Recognizes
foreign
antigens
and
helps
activate
antibody‐producing
B

lymphocytes

2. Orchestrate
cell‐mediated
immunity,
in
which
cytotoxic
CD8+
T
cells
and

natural
killer
(NK)
cells
directly
destroy
virus‐infected
cells,
tubercle

bacilli,
and
foreign
antigens

II.
 Transmission
of
HIV

A. HIV
retrovirus


1. Selectively
attacks
the
CD4+
T
lymphocytes

the
immune
cells

responsible
for
orchestrating
and
coordinating
the
immune
response
to

infection

2. Deteriorating
immune
system

susceptible
to
severe
infections
with

ordinarily
harmless
organisms

3. Two
types

a. HIV
infection
worldwide

HIV
type
1
(HIV‐1)

b. West
Africa
endemic

HIV
type
2
(HIV‐2)

B. Transmitted
via
sexual
contact,
blood‐to‐blood
contact,
or
perinatally

1. Infected
blood,
semen,
or
vaginal
secretions
from
one
person
are

deposited
onto
a
mucous
membrane
or
into
the
bloodstream
of
another

person

a. Unprotected
sex,
STDs
of
genital
ulcers

b. Intravenous
drug
use

combination
of
sex,
drugs,
alcohol
alters

perception,
reduces
inhibitions
about
engaging
risky
behaviors

c. Blood
transfusion

since
1985,
all
donations
in
US
have
been

screened

d. Mother
to
infant

in
utero,
labor
and
delivery,
breast
feeding

2. Not
casual
contact,
not
by
mosquitoes
or
insect
vectors

C. HIV‐infected
person
is
infectious
even
when
no
symptoms
are
present

1. Seroconversion

point
at
which
an
infected
person
converts
from

negative
for
the
presence
of
HIV
antibodies
in
the
blood
to
being
positive

a. Occurs
within
1‐3
months

b. Can
take
up
to
6
months

2. Time
after
infection
and
before
seroconversion
(window
period)

HIV

test
will
show
negative

health
history,
identification
of
risky
behaviors

for
risky
HIV
infection
are
important
for
blood
donor
screen



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
 2



3. Infected
individuals
can
transmit
the
virus
to
others
before
their
own

infections
can
be
detected
by
antibody
tests

III.
 Life
Cycle
of
the
HIV‐1

A. Genetic
information
in
RNA
instead
of
DNA

1. Spherical
virion,
contains
electrodense
core
surrounded
by
lipid
envelope

2. Core
contains

a. Major
capsid
protein
p24

most
readily
detected
antigen

target

for
antibodies
used
in
HIV
screening

b. Two
copies
of
genomic
RNA

c. Three
viral
enzymes:
protease,
reverse
transcriptase,
integrase

3. Viral
envelope

2
viral
glycoproteins
gp120,
gp41

critical
for

infection
of
cells

B. Replication
of
HIV

1. Steps
provide
insight
to
methods
for
preventing
or
treating
infection

2. Life
Cycle
of
HIV

a. Attachment
of
HIV
virus
to
CD4+
receptor

b. Internalization
and
uncoating
of
the
virus
with
viral
RNA
and
reverse

transcriptase

c. Reverse
transcription
produces
a
mirror
image
of
the
viral
RNA
and

double‐stranded
DNA
molecule

d. Integration
of
viral
DNA
into
host
DNA
using
the
integrase
enzyme

e. Transcription
of
the
inserted
viral
DNA
to
produce
viral
messenger

RNA

f. Translation
of
viral
messenger
to
create
viral
polyprotein

g. Cleavage
of
viral
polyprotein
into
individual
viral
proteins
that
make

up
the
new
virus

h. Assembly
and
release
of
the
new
virus
from
the
host
cell


i. 



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
 3



3. Treatment
of
HIV/AIDS
relies
on
the
use
of
agents
that
interrupt
steps
of

the
HIV
replication
process

a. Nucleoside/nucleotide
analog
reverse
transcriptase
inhibitors

(NRTIs/NRTIs)

b. Non‐nucleoside
reverse
transcriptase
inhibitors
(NNRTIs)

c. Protease
inhibitors
that
interrupt
the
cleavage
process

d. Entry
inhibitors
that
prevent
HIV
from
entering
or
fusing
with
the

CD4+
cell

e. Integrase
inhibitors
that
prevent
the
HIV
genome
from
being

integrated
into
the
host's
genome

f. Administration
of
highly
active
antiretroviral
therapy
(HAART),

typically
comprising
a
combination
of
three
to
four
antiviral
agents,

has
become
the
current
standard
of
care

IV.
 Classification
and
Phases
of
HIV
Infection

A. CDC
HIV/AIDS
Classification
System

1. Effective
January
1,
1993

2. Clinical
importance
of
the
CD4+
cell
count
in
the
categorization
of
HIV‐
related
clinical
conditions

B. Three
Categories

correspond
to
CD4+
cell
counts
per
microliter
(µL)
of

blood

1. Category
1:
>500
cells/µL

2. Category
2:
200
to
499
cells/µL

3. Category
3:
<
200
cells/µL

C. Three
Clinical
Categories

1. Clinical
category
A:
asymptomatic
or
have
persistent
generalized

lymphadenopathy
or
symptoms
of
primary
HIV
infection

acute

seroconversation
illness

2. Clinical
category
B:
symptoms
of
immune
deficiency
not
serious
enough

to
be
AIDS
defining

3. Clinical
category
C:
AIDS‐defining
illnesses
that
are
listed
in
the
AIDS

surveillance
case


D. 



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
 4



V.
 Phases
of
HIV
Infection

A. Defined
by
3
phases

occur
period
of
8‐12yrs

B. Primary
Infection

1. Acute
mononucleousis‐like
syndrome

2. Increase
in
viral
load,
decrease
in
CD4+
T‐cell
count

3. Signs
and
symptoms
of
primary
HIV
infection
usually
appear
1
to
4
weeks

after
exposure
to
HIV

a. Fever,
fatigue

most
common

b. Myalgias,
sore
throat,
night
sweats,
GI
problems,
lymphadenopathy,

maculopapular
rash,
headache

4. S/S
have
average
duration
of
7
to
10
days

a. Immune
system
controls
viral
replication

reduces
viral
load


remains
for
several
years

b. Opportunity
for
early
treatment
with
antiretroviral
therapy

C. Chronic
asymptomatic
or
latency
phase

1. No
signs
or
symptoms
of
illness

2. Usually
10
years

3. CD4+
T‐cell
count
falls
gradually
from
the
normal
range
of
800
to
1000

cells/µL
to
200
cells/µL
or
lower

depends
on
HIV
RNA
levels

4. Lymphadenopathy
may
develop

at
least
two
locations,
sore
or

externally
visible

D. Overt
AIDS
phase

1. CD4+
cell
count
of
less
than
200
cells/µL
or
AIDS‐defining
illness

2. Without
antiretroviral
therapy

death
within
2‐3yrs

3. Risk
of
opportunistic
infections
increases
significantly
when
CD4+
cell

count
falls
below
200
cells/µL

VI.
 Clinical
Course
of
HIV

A. Typical
progressors:
60‐70%
acquire
AIDS
10‐11yrs
after
infection

B. Rapid
progressors:
10‐20%
progress
rapidly,
acquire
AIDS
in
less
than
5yrs

C. Slow
progressors:
5‐15%
do
not
progress
for
more
than
15yrs

1. Long‐term
nonprogressors:
1%

a. Infected
for
at
least
8
years

b. Antiretroviral
naïve

c. High
CD4+
cell
counts

d. Very
low
viral
loads

2. Elite
controllers

a. Individuals
who
have
spontaneous
and
sustained
virologic

suppression
without
the
use
of
antiretroviral
medications

b. Currently
being
investigated
to
assist
in
determining
the
immunologic

and
virologic
interactions
that
allow
those
individuals
to
maintain

virologic
suppression
of
HIV

VII.
 Consequences
of
CD4+
Death

A. Opportunistic
infections,
malignant
tumors

B. Nervous
system
manifestations

C. Wasting
syndrome,
metabolic
disorders



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
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VIII.
 Opportunistic
Infections
Affecting
AIDS

A. Begin
to
occur
as
the
immune
system
becomes
severely
compromised

B. Involve
common
organisms
that
do
not
produce
infection
unless
there
is

impaired
immune
function

C. Categorized
by
the
type
of
organism

1. Bacterial
and
mycobacterial

pneumonia,
salmonellosis,
bartonellosis,

Mycobacterium
tuberculosis
(TB),
and
Mycobacterium
avium‐
intracellulare
complex
(MAC)

2. Fungal

candidiasis,
coccidioidomycosis,
cryptococcosis,

histoplasmosis,
penicilliosis,
and
pneumocystosis

3. Protozoal

cryptosporidiosis,
microsporidiosis,
isosporiasis,
and

toxoplasmosis

4. Viral

cytomegalovirus
(CMV),
herpes
simplex
and
zoster
viruses,

human
papillomavirus,
JC
virus,
the
causative
agent
of
progressive

multifocal
leukoencephalopathy
(PML)

D. Most
common
opportunistic
infections
in
US


1. Pneumonia

2. Pneumocystis
jiroveci
pneumonia

3. Oropharyngeal
(thrush)
or
esophageal
candidiasis

4. CMV
retinitis

5. Infections
caused
by
MAC

IX.
 Respiratory
Infections
Associated
with
AIDS

A. Most
common:
pneumonia,
P.
jiroveci
pneumonia,
pulmonary
TB

B. Other:
CMV,
MAC,
Toxoplasma
gondii,
and
Cryptococcus
neoformans,

Streptococcus
pneumoniae,
Pseudomonas
aeruginosa,
and
Haemophilus

influenza,
Kaposi
sarcoma

C. P.
jiroveci
(formerly
known
as
Pneumocystis
carinii)
pneumonia
(PCP)

1. Caused
by
P.
jiroveci,
an
organism
that
is
common
in
soil,
houses,
and

many
other
places
in
the
environment

2. Alveoli
become
filled
with
a
foamy,
protein‐rich
fluid
that
impairs
gas

exchange

3. Prophylaxis

trimethoprim‐sulfamethoxazole
or
alternative
if
allergic

4. Best
predictor
of
PCP
is
a
CD4+
cell
count
below
200
cells/µL

5. Symptoms
of
PCP
may
be
acute
or
gradually
progressive

a. Mild
cough,
fever,
shortness
of
breath,
and
weight
loss

b. Fever
and
tachypnea,
and
breath
sounds
may
be
normal

c. Chest
x‐ray
film

interstitial
infiltrates,
but
may
be
reported

negative
in
up
to
30%
of
cases

d. Diagnosis
of
PCP
is
made
on
recognition
of
the
organism
in
pulmonary

secretions

induced
sputum,
bronchoalveolar
lavage,
transbronchial

biopsy,
and,
rarely,
open
lung
biopsy

D. Tuberculosis

leading
cause
of
death
for
people
with
HIV
infection


1. First
manifestation
of
HIV
infection,
positive
PPD

2. Manifestations:
fever,
night
sweats,
cough,
and
weight
loss

3. Tx:
isoniazid,
rifampin

MDR‐TB

extensively
drug‐resistant
(XDR)
TB



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
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X.
 Diseases
of
the
Gastrointestinal
Tract
Associated
with
AIDS

A. Some
of
the
most
frequent
complications
of
HIV
infection
and
AIDS

B. Diarrhea
or
gastroenteritis

Cryptosporidium
parvum

1. Mild
diarrhea
to
severe,
watery
diarrhea
with
a
loss
of
up
to
several
liters

of
water
per
day

2. Severe
form
usually
occurs
in
persons
with
a
CD4+
cell
count
of
less
than

50
cells/µL,
and
also
can
include
malabsorption,
electrolyte
disturbances,

dehydration,
and
weight
loss

3. Identified
by
examination
of
stool
cultures
or
endoscopy

C. Esophagitis
Esophageal
candidiasis,
CMV
infection,
and
herpes
simplex

virus
infection


1. Painful
swallowing
or
retrosternal
pain

2. Range
from
asymptomatic
to
a
complete
inability
to
swallow
and

resulting
dehydration

3. Diagnosis:
Endoscopy
or
barium
esophagography

XI.
 Nervous
System
Manifestations
with
AIDS

A. Late
stages
of
severe
immunocompromise
HIV
infection

nervous
system

vulnerable
to
neurologic
disorders

B. Affect
the
peripheral
nervous
system
or
CNS
and
contribute
to
the
morbidity

and
mortality
of
persons
with
HIV
infection

C. Diagnostic
Criteria
HAND

syndrome
of
cognitive
impairment
with
motor

dysfunction
or
behavioral/psychosocial
symptoms
associated
with
HIV

infection
itself



1. HIV‐associated
asymptomatic
neurocognitive
impairment
(ANI)

2. HIV‐associated
mild
neurocognitive
disorder
(MND)

3. HIV‐associated
dementia
(HAD,
formerly
AIDS
dementia
complex)

a. Late
complication
of
HIV
infection

b. Impairment
of
attention
and
concentration,
slowing
of
mental
speed

and
agility,
slowing
of
motor
speed,
and
apathetic
behavior

c. The
diagnosis
of
HAD
is
one
of
exclusion,
and
all
other
potential

etiologies
need
to
be
excluded

d. Treatment:
HAART
to
decrease
symptoms
and
may
result
in

significant
improvement
of
both
motor
and
cognitive
skills

D. Toxoplasmosis

T.
gondii
parasite

affects
CNS

1. Common
opportunistic
infection
in
persons
with
AIDS

2. Fever,
headaches,
and
neurologic
dysfunction,
including
confusion
and

lethargy,
visual
disturbances,
and
seizure

3. CT
or
MRI

neurologic
lesions

4. Prophylactic
treatment
begins
when
CD4+
cell
count
falls
below
100

cells/µL

trimethoprim‐sulfamethoxazole,
dapsone‐pyrimethamine,
or

atovaquone

E. Progressive
Multifocal
Leukoencephalopathy
(PML)

1. Eemyelinating
disease
of
the
white
matter
of
the
brain
caused
by
the
JC

virus

DNA
papovavirus
that
attacks
the
oligodendrocytes

2. Advances
slowly,
weeks
to
months
before
the
patient
seeks
medical
care



 

Eina
Jane
&
Co.
2009.


 

 Chapter
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Acquired
Immunodeficiency
Syndrome
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3. Progressive
limb
weakness,
sensory
loss,
difficulty
controlling
the
digits,

visual
disturbances,
subtle
alterations
in
mental
status,
hemiparesis,

ataxia,
diplopia,
and
seizure

4. High
mortality
rate

average
survival
time
2‐4
months

5. Diagnosis:
clinical
findings,
MRI,
confirmed
by
presence
of
JC
virus

6. No
cure
for
PML


a. Improvement
with
effective
HAART

b. If
already
on
HAART,
outcome
can
be
worse
secondary
to
immune

reconstitution
syndrome

XII.
 Cancers
and
Malignancies
Associated
with
AIDS

A. Increased
incidence
of
malignancies
probably
is
a
function
of
impaired
cell‐
mediated
immunity

B. Kaposi
sarcoma
(KS)

1. Malignancy
of
the
endothelial
cells
that
line
small
blood
vessels

2. Most
frequent
malignancy
related
to
HIV
infection

3. Herpesvirus
(herpesvirus
8,
also
called
KS‐associated
herpes
virus

[KSHV])

4. Lesions
of
KS
can
be
found
on
the
skin
and
in
the
oral
cavity,

gastrointestinal
tract,
and
the
lungs

a. Usually
begins
as
one
or
more
macules,
papules,
or
violet
skin
lesions

that
enlarge
and
become
darker

b. May
enlarge
to
form
raised
plaques
or
tumors

trunk,
neck,
and

head,
especially
the
tip
of
the
nose

c. May
obstruct
organ
function
or
rupture
and
cause
internal
bleeding

d. Progression
of
KS
may
be
slow
or
rapid

5. Diagnosis:
visual,
endoscopy,
bronchoscopy,
biopsy

6. Tx:
HAART,
liquid
nitrogen
or
vinblastine,
chemotherapy,
radiation,
and

interferon
injections

C. Non‐Hodgkin
lymphoma

1. Fever,
night
sweats,
and
weight
loss

generic
symptoms

diagnosis

often
is
difficult

2. Diagnosis:
biopsy
of
the
affected
tissue

3. Tx:
intrathecal
chemotherapy,
HAART

D. Noninvasive
cervical
carcinoma

1. Human
papillomavirus
(HPV)

2. Cervical
dysplasia
is
detected
by
Papanicolaou
smear
and
cervical

colposcopy

3. Routine
screening
for
anal
intraepithelial
neoplasia
should
be
encouraged

in
all
HIV‐positive
patients
regardless
of
history
of
receptive
anal

intercourse

XIII.
 Wasting
Syndrome

A. AIDS‐defining
illness

B. Characterized
by
involuntary
weight
loss
of
at
least
10%
of
baseline
body

weight
in
the
presence
of
diarrhea,
more
than
two
stools
per
day,
or
chronic

weakness
and
a
fever



 

Eina
Jane
&
Co.
2009.


 

 Chapter
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Acquired
Immunodeficiency
Syndrome
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C. Factors
that
contribute
to
wasting


1. Anorexia

2. Metabolic
abnormalities

3. Endocrine
dysfunction

4. Malabsorption

5. Cytokine
dysregulation

D. Treatment

1. Nutritional
interventions

oral
supplements
or
enteral
or
parenteral

nutrition

2. Pharmacologic
agents

appetite
stimulants,
cannabinoids,
and

megestrol
acetate

XIV.
 Metabolic
and
Morphologic
Disorders
Associated
with
HIV

A. Lipodystropy

1. Changes
in
body
composition

increase
in
abdominal
girth,
buffalo

hump
development
(abnormal
distribution
of
fat
in
the
supraclavicular

area),
wasting
of
fat
from
the
face
and
extremities,
and
breast

enlargement
in
men
and
women

2. Metabolic
change

elevated
serum
cholesterol,
low
HDL
cholesterol,

elevated
triglyceride
levels,
and
insulin
resistance

B. Mitochondrial
disorders

1. Cells
revert
to
anaerobic
metabolism
with
generation
of
lactic
acid

2. Lipoatrophy
and
peripheral
neuropathy

3. Nonspecific
gastrointestinal
symptoms,
including
nausea,
vomiting,
and

abdominal
pain

4. Altered
liver
function
and
lactic
acidosis

C. Hypercholesterolemia

D. Hypertriglycerdemia

E. Insulin
resistance

F. Impaired
glucose
tolerance

XV.
 Transmission
of
HIV
and
Prevention

A. Transmission

1. Intravenous
drug
use

2. Risky/unsafe
sexual
behavior

a. Latex
condoms

b. Only
water‐based
lubricants
should
be
used
with
condoms

B. Prevention

1. Personalized
risk
assessment

2. Prevention
plan

3. Education

4. Behavioral
intervention

XVI.
 Diagnostic
Methods
Used
for
HIV

A. Laboratory
methods
to
determine
infection


1. HIV
antibody
test

most
accurate,
inexpensive

a. Enzyme
immunoassay
(EIA)
or
enzyme‐linked
immunosorbent
assay

(ELISA)

3wks

6wks

3mo

6mo



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
 9



b. Western
blot
assay

used
to
confirm
if
EIA
is
positive

c. Orasure
test

cotton
swab

2
min

EIA
+
Western
Blot

d. Home
HIV
testing
kit

finger
stick
sent
to
lab

EIA
+
Wester
Blot

e. Ora
Quick
Rapid
HIV‐A
Antibody
Test

f. Polymerase
chain
reacion
(PCR)

technique
for
detecting
HIV
DNA


i. Detects
the
presence
of
the
virus
rather
than
the
antibody
to
the

virus

ii. Useful
in
diagnosing
HIV
infection
in
infants
born
to
infected

mothers
because
these
infants
have
their
mothers'
HIV
antibody

regardless
of
whether
the
children
are
infected

iii. Method
for
amplifying
the
viral
DNA
up
to
1
million
times
or
more

to
increase
the
probability
of
detection

2. Sensitivity
and
confidentiality
must
be
maintained
whenever
testing
is

implemented

3. Counseling
before
and
after
testing
to
allay
fears

a. Provide
accurate
information,

b. Ensure
appropriate
follow‐up
testing

c. Provide
referral
to
needed
medical
and
psychosocial
services


B. Clinical
methods
to
evaluate
the
progression
of
disease

XVII.
 Treatment
for
HIV
Following
Diagnosis

A. Baseline
evaluation

B. Complete
history

C. Physical
examination

D. Baseline
laboratory
tests

E. Routine
follow‐up
care

1. CD4+
cell
count
and
viral
load
testing
every
3‐4mo

2. Persons
who
are
symptomatic
may
need
to
be
seen
more
frequently

XVIII.
 Criteria
for
Therapeutic
Interventions
for
HIV

A. Determined
by
level
of
disease
activity
based
on

1. Viral
load

2. Degree
of
immunodeficiency
based
on
the
CD4+
cell
count

3. Appearance
of
specific
opportunistic
infections

B. U.S.
Department
of
Health
and
Human
Services
(DHHS)
recommend
the

initiation
of
antiretroviral
therapy
based
on
symptomatic
disease
and
CD4+

cell
counts

1. All
symptomatic
patients
should
be
treated
with
antiretroviral
therapy

2. CD4+
cell
count
greater
than
350/µL

antiretroviral
therapy
is

generally
not
recommended

3. CD4+
cell
count
is
200
to
350/µL

antiretroviral
therapy
should
be

considered
and
a
decision
individualized
to
the
patient
should
be
made

C. Early
intervention
delays
life‐threatening
symptoms
and
progression
of

disease

XIX.
 HIV
Antiretroviral
Medications

A. No
cure
for
HIV



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
 10



B. Medications
currently
available
decrease
amount
of
virus
in
the
body

do

not
eradicate
HIV


1. Nucleoside
reverse
transcriptase
inhibitors

block
the
elongation
of
the

DNA
chain
by
stopping
more
nucleosides
from
being
added

2. Nucleotide
analog
reverse
transcriptase
inhibitors

block
the

elongation
of
the
DNA
chain
by
stopping
more
nucleosides
from
being

added

3. Non‐nucleoside
reverse
transcriptase
inhibitors

binding
to
the
reverse

transcriptase
enzyme
so
it
cannot
copy
the
virus's
RNA
into
DNA

4. Protease
inhibitors

bind
to
the
protease
enzyme
and
inhibit
its
action


a. Prevents
the
cleavage
of
the
polyprotein
chain
into
individual

proteins,
which
would
be
used
to
construct
the
new
virus

b. Because
the
information
inside
the
nucleus
is
not
put
together

properly,
the
new
viruses
that
are
released
into
the
body
are

immature
and
noninfectious

5. Fusion
inhibitors

C. Immunizations

1. Immunization
is
important
because
persons
infected
with
HIV
are
at
risk

for
contracting
other
infectious
diseases


2. Persons
with
asymptomatic
HIV
infection
and
CD4+
cell
counts
greater

than
200
cells/µL
should
be
vaccinated
against
measles,
mumps,
and

rubella


3. Pneumococcal
vaccine
should
be
given
once,
as
soon
as
possible
after
HIV

infection
is
diagnosed,
and
then
every
10
years,
and
influenza
vaccine

should
be
given
yearly

4. Live‐virus
vaccines
should
not
be
given
to
persons
with
HIV
infection;

however,
there
is
much
interest
in
the
possibility
of
vaccinating
those

HIV‐infected
persons
with
varicella‐zoster
virus
(VZV)
vaccine
to

decrease
the
risk
of
VZV
disease
recurrences,
or
shingles


XX.
 Psychosocial
Issues
Associated
with
HIV/AIDS

A. Dramatic
impact
of
this
illness
is
compounded
by
complex
reactions
on
the

part
of
the
person
with
HIV
or
AIDS;
his
or
her
partner,
friends,
and
family;

members
of
the
health
care
team;
and
the
community

1. Hidden
lifestyle
impact
on
support
persons

2. Depression

3. Anxiety
disorders

4. Alcohol

5. Drug
problems

B. To
deal
with
these
complex
issues,
the
health
care
team
must
recognize
and

accept
their
own
fears,
prejudices,
and
emotions
concerning
those
with
HIV

infection
or
AIDS

1. Personal
feelings
must
not
prevent
caregivers
from
acknowledging
the

intrinsic
human
worth
of
all
persons
and
their
right
to
be
treated
with

dignity
and
respect



 

Eina
Jane
&
Co.
2009.


 

 Chapter
20:
Acquired
Immunodeficiency
Syndrome
 11



2. Members
of
the
health
care
team
should
have
adequate
support
for
their

own
emotional
needs
generated
from
working
with
persons
with
HIV

infection

XXI.
 HIV
Infection
During
Pregnancy
and
in
Infants
and
Children

A. HIV
can
be
passed
from
mother
to
infant

1. During
labor
and
delivery

2. Through
breast
feeding

B. Prophylactic
treatment
during
pregnancy

C. Course
of
HIV
infection
is
different
for
children
than
for
adults

1. Two
positive
PCR
tests
for
HIV
DNA
are
needed
to
diagnose
a
child
with

HIV
infection

2. Children
born
to
mothers
with
HIV
infection
are
considered
uninfected
if

they
become
HIV
antibody
negative
after
6
months
of
age,
have
no
other

laboratory
evidence
of
HIV
infection,
and
have
not
met
the
surveillance

case
definition
criteria
for
AIDS
in
children

D. Recommendations
also
stress
that
women
who
test
positive
for
HIV

antibodies
should
be
informed
of
the
perinatal
prevention
benefits
of

zidovudine
therapy

1. Perinatal
transmission
could
be
lowered
by
two
thirds,
from
26%
to
8%,

by
administering
zidovudine
to
the
mother
during
pregnancy
and
labor

and
delivery
and
to
the
infant
when
it
is
born

2. Cannot
be
used
during
the
first
trimester
because
it
is
a
teratogen


neural
tube
defects

3. Women
receiving
antiretroviral
therapy
who
also
have
a
viral
load
less

than
1000
copies/mL
have
very
low
rates
of
perinatal
transmission

E. Benefits
of
voluntary
HIV
testing
for
mothers
and
newborns

1. Reduced
morbidity
because
of
intensive
treatment
and
supportive
health

care

2. Opportunity
for
early
antiretroviral
therapy
for
mother
and
child

3. Information
regarding
the
risk
of
transmission
from
breast
milk

F. Different
clinical
presentation
of
HIV
infection
than
adults

1. Failure
to
thrive,
CNS
abnormalities,
and
developmental
delays
are
the

most
prominent
primary
manifestations
of
HIV
infection
in
children

2. Usually
weigh
less
and
are
shorter
than
noninfected
infants

3. PCP

transmitted
vertically
from
mother

a. Peak
age
of
onset
at
3
to
6
months

b. Prophylaxis
with
trimethoprim‐sulfamethoxazole
is
started
by
4
to
6

weeks
for
all
infants
born
to
HIV‐infected
mothers,
regardless
of
their

CD4+
cell
count
or
infection
status





 

Eina
Jane
&
Co.
2009.