Our Lady of Fatima University

CASE STUDY OF
HIV
(Human immunodeficiency virus)

Submitted by:
Joanna Marie P. Pimentel

Submitted to:
Mrs. Carol San Diego
Introduction

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is not
treated, it can lead to AIDS (acquired immunodeficiency syndrome). There is currently no effective cure. Once
people get HIV, they have it for life. But with proper medical care, HIV can be controlled. People with HIV
who get effective HIV treatment can live long, healthy lives and protect their partners.
HIV infection in humans came from a type of chimpanzee in Central Africa. The chimpanzee version of
the virus (called simian immunodeficiency virus, or SIV) was probably passed to humans when humans hunted
these chimpanzees for meat and came in contact with their infected blood.
Studies show that HIV may have jumped from chimpanzees to humans as far back as the late 1800s.
Over decades, HIV slowly spread across Africa and later into other parts of the world. We know that the virus
has existed in the United States since at least the mid to late 1970s.
Your immune system is your body's defense system. While the immune system can control many
viruses, HIV targets and infects the same immune system cells that protect us from germs and illnesses. These
cells are a type of white blood cell called CD4 cells (sometimes called T cells).
Signs and symptoms:
Some people have flu-like symptoms within 2 to 4 weeks after infection (called acute HIV infection).
These symptoms may last for a few days or several weeks. Possible symptoms include
 Fever,
 Chills,
 Rash,
 Night sweats,
 Muscle aches,
 Sore throat,
 Fatigue,
 Swollen lymph nodes, and
 Mouth ulcers.
But some people may not feel sick during acute HIV infection. These symptoms don’t mean you have HIV.
Other illnesses can cause these same symptoms.

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).

Diagnostic Tests:
The ELISA test, also called the EIA for enzyme immunoassay, is used to detect the HIV antibody. It checks for
certain proteins that the body makes in response to HIV. The blood sample will be added to a cassette that
contains the viral protein, called antigen.
If the blood contains antibodies to HIV, it will bind with the antigen and cause the cassette’s contents to change
color. This very sensitive test was the first one widely used to check for HIV.
The Western blot test was previously used to confirm the result of the ELISA, but it is no longer
recommended, as other tests are now more reliable and enable a faster diagnosis. In the Western blot test, the
blood is taken in the same way, but the sample is separated with an electrical current and transferred onto a
piece of blotting paper. Here, an enzyme is added to cause color changes that signal the presence of HIV
antibodies.
Stages of HIV:
Stage 1: Acute HIV Infection
Acute HIV infection is the earliest stage of HIV infection, and it generally develops within 2 to 4 weeks
after infection with HIV. During this time, some people have flu-like symptoms, such as fever, headache, and
rash. In the acute stage of infection, HIV multiplies rapidly and spreads throughout the body. The virus attacks
and destroys the infection-fighting CD4 cells of the immune system. During the acute HIV infection stage, the
level of HIV in the blood is very high, which greatly increases the risk of HIV transmission. A person may
experience significant health benefits if they start ART during this stage.

Stage 2: Chronic HIV Infection

The second stage of HIV infection is chronic HIV infection (also called asymptomatic HIV infection or
clinical latency). During this stage, HIV continues to multiply in the body but at very low levels. People with
chronic HIV infection may not have any HIV-related symptoms. Without ART, chronic HIV infection usually
advances to AIDS in 10 years or longer, though in some people it may advance faster. People who are taking
ART may be in this stage for several decades. While it is still possible to transmit HIV to others during this
stage, people who take ART exactly as prescribed and maintain an undetectable viral load have effectively no
risk of transmitting HIV to an HIV-negative partner through sex.
Stage 3: AIDS
AIDS is the final, most severe stage of HIV infection. Because HIV has severely damaged the immune
system, the body can’t fight off opportunistic infections. (Opportunistic infections are infections and infection-
related cancers that occur more frequently or are more severe in people with weakened immune systems than in
people with healthy immune systems.) People with HIV are diagnosed with AIDS if they have a CD4 count of
less than 200 cells/mm3 or if they have certain opportunistic infections. Once a person is diagnosed with AIDS,
they can have a high viral load and are able to transmit HIV to others very easily. Without treatment, people
with AIDS typically survive about 3 years.
Anatomy and Physiology:
HIV infects a type of white blood cell in the body’s immune system called a T-helper cell (also called a
CD4 cell). These vital cells keep us healthy by fighting off infections and diseases.
HIV cannot reproduce on its own. Instead, the virus attaches itself to a T-helper cell and fuses with it
(joins together). It then takes control of the cell’s DNA, makes copies of itself inside the cell, and finally
releases more HIV into the blood. HIV will continue to multiply and spread throughout the body – a process
called the HIV lifecycle.
In this way, HIV weakens the body’s natural defences and over time severely damages the immune
system. How quickly the virus develops depends on a person’s general health, how quickly they are diagnosed
and start antiretroviral treatment, and how consistently they take their treatment.
Stages of the HIV lifecycle
Binding and fusion (attachment)
HIV attaches to a T-helper cell. It then fuses to it and releases its genetic information into the cell.
The types of drugs that stop this stage of the lifecycle are called fusion or entry inhibitor drugs – because
they stop HIV from entering the cell.
Reverse transcription (conversion) and integration
Once inside the T-helper cell, HIV converts its genetic material into HIV DNA, a process called reverse
transcription. The new HIV DNA then enters the nucleus of the host cell and takes control of it.
The types of drugs that stop this stage of the lifecycle are called NRTIs (nucleoside reverse transcriptase
inhibitors), NNRTIs (non-nucleoside reverse transcriptase inhibitors) and integrase inhibitor drugs.
Transcription and translation (replication)
The infected T-helper cell then produces HIV proteins that are used to produce more HIV particles
inside the cell.
Assembly, budding and maturation
The new HIV is put together and then released from the T-helper cell into the bloodstream to infect
other cells; and so the process begins again.
The type of drugs that stop this stage of the lifecycle are called protease inhibitor (PI) drugs.
 PATHOPYSIOLOGY
Exposure to infected body fluids

Infection with HIV retrovirus

HIV invades nucleus of helper T-lymphocytes

(CD4 surface antigen)

HIV replicates

Destruction of T-lymphocytes

Helper T-lymphocytes HIC released from cell

Immune Suppression

Malaise Opportunistic infection

Fatigue Oral-esophageal thrush
Fever Herpes simplex
Weight loss TB, CMV
Neuropsychiatric effects Pneumocystis

AIDS
(Acquired Immunodeficiency Syndrome)
DRUG STUDY
 DRUG ORDER MECHANISM INDICATIONS CONTRAINDICA- ADVERSE NURSING
OF ACTION TIONS EFFECT RESPONSIBI-
LITY
PRECAUTION
GENERIC Used in Treatment of  Contraindicated Headache,  Take drug
NAME: combination HIV infection in with life- weakness, exactly as
Abacavir sulfate with other combination threatening malaise, prescribed;
HIV drugs to with other allergy or fatigue, take missed
BRAND reduce the antiretrovirals. hypersensitivity insomnia. doses as
NAME: viral load as to any Diarrhea, soon as
Ziagen low as component, nausea, possible
possible and moderate to vomiting, and return
CLASSIFICA- decrease the serve hepatic dyspepsia, to normal
TION: chance of impairment. liver schedule;
Antiviral further viral  Used enlargement. do not
mutation. cautiously with double
ROUTE: Though to mild hepatic skipped
Oral cross the impairment, doses; take
blood-brain lactic acidosis, with meals
DOSAGE: barrier and be pregnancy, or a light
300mg effective in lactation. snack if GI
the treatment upset
of HIV- occurs.
related  Do not
dementia. drink
There are no alcohol
long-term while
studies on the taking this
effectiveness drug.
of this drug.  Report
extreme
fatigue,
lethargy,
severe
headache,
severe
nausea,
vomiting,
difficulty of
breathing,
rash, and
fever.
 DRUG STUDY
DRUG ORDER MECHANISM INDICATIONS CONTRAINDICA- ADVERSE NURSING
OF ACTION TIONS EFFECT RESPONSIBI-
LITY
PRECAUTION
GENERIC HIV-1 reserve In  Contraindicated  Headache,  Take this
NAME: transcriptase combination with allergy to asthenia, drug once a
Emtricitabine inhibitor, with other any component insomnia, day with or
competes with antiretroviral of the product, dizziness, without food
BRAND a natural drugs for the lactation (HIV- abnormal and in
NAME: substrate and treatment of infected mother dreams. combination
Emtriva is HIV-1 is discouraged  Nausea, with your
incorporated infection in from breast- diarrhea, other
CLASSIFICA- into the viral adults and feeding). abdominal antiviral
TION: DNA, leading children.  Used cautiously pain. drug.
Anti-HIV drug to chain with  Elevated  This drug
termination. pregnancy; liver may enter
ROUTE: signs of lactic enzymes breastmilk; if
Oral acidosis, risk and you are
factors for bilirubin, nursing a
DOSAGE: lactic acidosis cough, baby, you
200mg daily PO including rhinitis, should find
female gender and rash another
and obesity; method of
infection with feeding the
hepatitis B baby.
virus; impaired  Report sever
renal function. weakness,
muscle pain,
trouble
breathing,
dizziness,
cold feeling
of your arms
and legs,
palpitation,
yellowing of
the eyes or
skin,
darkened
urine or
light-colored
stools.
 NURSING CARE PLAN
ASSESS- DIAGNOSIS SCIENTIFIC PLANNING INTERVEN- RATIONALE INTERVEN-
MENT REASON TION TION
Subjective Imbalanced Biologic, After 2 weeks Independent: After 2 weeks
Data: nutrition psychologic, of nursing  Document  Patients of nursing
“I always
feel weak
less that economic intervention, actual may be intervention,
and tired.” body factors. the patient weight unaware of goal met.
As requirement will be able using their actual Patient was
verbalized s related to to: weighing weight or able to
by the inability to Impair a  Verbalize scale; do not weight loss verbalize
patient.
ingest or person’s d and estimate. due to understanding
Objective digest food ability to demons- estimating and
data: or to absorb ingest food/ trate  Obtain weight. demonstrate
 Weight nutrients absorb selection nutritional  Patient’s selection of
loss because of nutrients. of foods history; perception meals that help
 Poor biologic, in achieving
or meals include of actual
muscle
tone psychologic that will family, intake may weight loss;
 Vital , or Imbalanced achieve a significant differ. and gained at
signs economic nutrition cessation others, or least 10% of
taken factors. (less than of weight caregiver in ideal body
as: body loss. weight.
assessment.
T- 37C
requirements  Have  Determine
P- 59 ) weight etiologic  With proper
bpm within factors for assessment
Rr- 17 10% of reduced you may be
br/min ideal body
BP-
nutritional able to plan
90/60 weight. intake. appropriate
mmHg intervention
 Monitor or s
explore  Many
attitudes psychologic
toward al,
eating and psychosocia
food. l, and
cultural
factors
determine
the type,
amount,
and
appropriate
ness of food
 Encourage consumed.
patient  Determinati
participation on of type,
in recording amount,
food intake and pattern
using a of food or
daily log. fluid intake
 as
facilitated
by accurate
documentat
ion by
patient or
caregiver as
the intake
occurs;
memory is
insufficient.

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective Anxiety/fear After 8 -Monitor vital -To identify After 8 hours
data: related to hours of signs physical of nursing
“Natatakot ako threat to self- nursing responses intervention
na layuan nila concept, threat interventions associated with the patient
ako.” As of death, the patient both medical appeared
verbalized by change in will appear and emotional relaxed and
the patient. health/ relaxed and conditions. the level of
socioeconomic the level of anxiety is
Objective status, and anxiety will -Use presence, -Being reduced to a
data: role be reduced touch, supportive and manageable
 Restlessnes functioning. to a verbalization or approachable level.
s manageable demeanor to encourages
 Narrowed level. remind client communicatio
 Facial and to n
flushing encourage
 Sweating expressions or
 Difficulty in clarification of
sleeping needs,
concerns,
unknowns and
questions.

-Accept client’s
defenses, do not -If defenses are
confront, and not threated,
argue and the client may
debate feel safe
enough to look
at the behavior
 -Allow and
reinforce clients -Taking or
personal otherwise
reaction expressing
towards the feeling reduces
threatens to anxiety
wellbeing

-Explain
everything -To educate
necessary the patient
regarding the regarding the
disease disease to
reduce anxiety.

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATION
N
Subjective Fatigue may After 8 hours Independent: -Multiple After 8 hours
Data: be related to or nursing -Assess sleep factors can of nursing
“I always decrease in intervention patterns and cause and interventions,
feel tired and metabolic the patient other factors aggravate the patient
lately I’m energy will: that may be fatigue, was able to:
prone to production, -report aggravating including -Report
infections.” increased improved fatigue. sleep improved
As energy sense of deprivation, sense of
verbalized by requirements. energy emotional energy
the patient -Participate distress, side -Participate in
in desired effects of desired
Objective activities at drugs, and activities at
Data: level of developing level of
-Lack of ability and central ability; and
energy -identify nervous -Identify
-Inability to individual system individual
maintain areas of disease. areas of
usual control and -Encourage -Fatigue is control and;
routines -Engage in timely present in -Engage in
-Decreased energy evaluation of variable energy
performance conservation fatigue if new degrees as part conservation
techniques. medications of HIV techniques.
T- 36.5C have been infection
P- 65 added to the process but is
R- 16 regimen. often
BP- 100/80 aggravated by
nutritional
 deficiencies
and side
effects of
certain
medications.
-Discuss reality -Helpful in
of patient’s planning
feelings of activities
exhaustion and within
identify tolerance
limitations levels.
imposed by
fatigue state.
-Assist patient -Patient may
to set realistic need to alter
goals, priorities and
determining delegate some
individual responsibilities
priorities and to manage
responsibilities. fatigue and
optimize
performance.
 HEALTH TEACHING

 Use condoms correctly every time you have sex.

 Talk to your partner about taking PrEP
 If you inject drugs, don’t share your needles, syringes, or other drug equipment with your partner.
 Follow a good diet and stay at a healthy weight.
 Exercise for endurance and to boost your immune system and your mental health.
 Don’t donate blood, plasma, semen, or organs.
 Never share needles or other equipment for drug use.