AIDS/HIV

Definition:
 Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system
caused by the Human Immunodeficiency Virus (HIV)
 This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic
infections and tumors.
 The time between infection and the appearance of symptoms tends to be much longer, allowing more opportunities for these
microorganisms to be transmitted to other hosts. The period between infection and the appearance of AIDS can take from 7 to 12 years.
 AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived with the disease worldwide, and it killed an estimated 2.1 million
people, including 330,000 children.

History:
 Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century.
 AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s.

Pathophysiology of HIV/AIDS
1. Human beings produce antibodies against specific infections.
2. When HIV infection takes place, anti-HIV antibodies are produced but they do not appear immediately. This is called the “window effect”.
3. In some cases, antibodies to HIV become detectable 4 to 6 weeks after infection.
4. When HIV is in circulation, it invades several types of cells – the lymphocytes, macrophages, the Langerhans cells, and neurons within the
CNS.
5. HIV attacks the body’s immune system.
6. The organism attaches to a protein molecule called CD 4 which is found in the surface of T4 cells.
7. Once the virus enters the T4, it inserts its genetic materials into the T 4 cell’s nucleus taking over the cell to replicate itself.
8. Eventually the T4 cell dies after having been used to replicate HIV.
9. The virus mutates rapidly making it more difficult for the body’s immune system to ‘recognize” the invaders.
10. HIV infection progresses through several stages.
11. The clinical course of HIV infection begins when a person becomes infected with HIV through:
o sexual contact with infected person
o injection of infected blood or blood products
o Perinatal or vertical transmission.

Signs and Symptoms

 The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems
 Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of
the immune system that HIV damages.
 A person may remain asymptomatic, feel, and appear healthy for even years even though he or she is infected with HIV. While he or she
does not exhibit AIDS, the immune system starts to be impaired.
 The person may exhibit neurological symptoms such as memory loss, altered gait, depression, sleep disorders or chronic diarrhea.
 This set of symptoms is often called AIDS-related Complex (ARC) by clinicians. As the symptom progress, the patient becomes an AIDS
patient.

Minor Signs:
1. Persistent Cough for one month
2. Generalized pruritic dermatitis
3. Recurrent herpes zoster
4. Oropharyngeal candidiasis
5. Chronic disseminated herpes simplex
6. Generalized lymphadenopathy

Major Signs:
1. Loss of weight – 10 percent of body weight
2. Chronic diarrhea for more than one month
3. Prolonged fever for one month
Common Opportunistic Infections
1. Pneumocystis carinii pneumonia
2. Oral candidiasis
3. Toxoplasmosis of the CNS
4. Chronic diarrhea/wasting syndrome
5. Pulmonary/extra-pulmonary tuberculosis
6. Cancers
a. Kaposi’s sarcoma – affects small blood vessels and internal organs
b. Cervical dysplasia and cancer. Researchers found out that women with HIV have higher rates of this type of cancer. Cervial
carcinoma is associated with Human Papilloma Virus (HPV).
c. Non-Hodgkin’s lymphoma – cancerous tumor of the lymph nodes. This is usually a late manifestation of HIV infection.

Mode of Transmission:
1. Sexual intercourse
2. Blood transfusion and sharing of infected syringes and needles among intravenous drug users
3. Vertical or perinatal transmission (from a pregnant woman to the fetus during pregnancy, child delivery or breast-feeding)
There are several ways of receiving infected blood:
1. Blood transfusion
2. Sharing of unsterilized syringes and needles used for intravenous injections
3. Transmission during pregnancy
a. Maybe transplacental
b. There is greater risk of transmission when mother has developed advanced AIDS
 4. Organ donation
5. Accidental exposure in hospitals or clinics

Diagnostic Examination:
1. ELA or ELISA – Enzyme link immunosorbent assay
2. Particle agglutination (PA) test
3. Western blot analysis – confirmatory diagnostic test
4. Immunofluorescent test
5. Radio immuno-precipitation assay (RIPA)
 Many people are unaware that they are infected with HIV.
 HIV tests are usually performed on venous blood.
 Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen.
 The detection of HIV antibody or antigen in a patient previously known to be negative is evidence of HIV infection.
 Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the
results.

Treatment Modalities:
 “AIDS Drugs” are medicines used to treat but not to cure HIV infection.
 These drugs are sometimes referred to as “anteroviral drugs.”
 These work by inhibiting the reproduction of the virus. There are two groups of anteroviral drugs:
1. Reverse trancriptase inhibitors – they inhibit the enzyme called reverse transcriptase which is needed to “copy” information for the
virus to replicate. These drugs are:
a. Zedovudine (ZDV) – Retirvir
b. Zalcitabine – Havid
c. Stavudine – Zerit
d. Lamivudine – Epivir
e. Nevirapine – Viramune
f. Didanosine – Videx
2. Protease inhibitors. They work by inhibiting the enzyme protease which are needed for the assembly of viral particles. These drugs are:
a. Saquinavir – Invarase
b. Ritonavir – Norvir
c. Indinavir – Crixivan

Nursing Management:
1. Health education – The healthcare worker must:
a. Know the patient
b. Avoid fear tactics
c. Avoid judgmental and moralistic messages
d. Be consistent and concise
e. Use positive statement
f. Give practical advice
2. Practice universal/standard precaution
a. There is a need for a thorough medical handwashing after every contact with patient and after removing the gown and gloves,
and before leaving the room of an AIDS suspect or known AIDS patient.
b. Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap, mask, gloves, CD gown, face shield/goggles are very
necessary.
3. Prevention
a. Care should be taken to avoid accidental pricks from sharp instruments contaminated with potentially infectious materials form
AIDS patient.
b. Gloves should be worn when handling blood specimens and other body secretions as well as surfaces, materials and objects
exposed to them.
c. Blood and other specimens should be labeled with special warning “AIDS Precaution”.
d. Blood spills should be cleaned immediately using common household disinfectants, like “chlorox”.
e. Needles should not be bent after use, but should be disposed into a puncture-resistant container.
f. Personal articles like razor or razor blades, toothbrush should not be shared with other members of the family. Razor blades
may be disposed in the same manner as needles are disposed.
g. Patients with active AIDS should be isolated.

The Four Cs in the Management of HIV/AIDS

1. Compliance – giving of information and counseling the client which results to the client’s successful treatment, prevention and
recommendation.
2. Counseling/education
a. Giving instruction about the treatment
b. Disseminating information about the disease
c. Providing guidance on how to avoid contracting STD again
d. Sharing facts about HIV and AIDS
3. Contact tracing
a. Tracing out and providing treatment or partners
4. Condoms
a. Promoting the use of condom, giving instructions about its use, and giving away available condoms
Sources:
Handbook of Common Communicable and Infectious Diseases, 2006 Ed
http://wikipedia.org
http://cdc.gov