HIV/AIDS What is HIV?

? o Human: Infecting human beings o Immunodeficiency: Decrease or weakness in the bodys ability to fight off infections and illnesses o Virus: A pathogen having the ability to replicate only inside a living cell What is AIDS? o Acquired: To come into possession of something new o Immune Deficiency: Decrease or weakness in the bodys ability to fight off infections and illnesses o Syndrome: A group of signs and symptoms that occur together and characterize a particular abnormality Patho of HIV o HIV is a retrovirusie it replicates backwards o Cannot replicate unless it is inside a living cell o Initial infection results in viremia o How soon after exposure is an individual infectious? o Immune dysfunction in HIV is caused by damage to and destruction of CD4 T cells o Normal CD4 values are 800-1200 o Average life of CD 4 cells is 100 days but for HIV + people it is 2 days o Why is it problematic to have a low CD4 count? Decrease ability to fight infections How you dont catch it

HIV vs. AIDS o HIV is the virus that causes AIDS o Not everyone who is infected with HIV has AIDS o Everyone with AIDS is infected with HIV o AIDS is result of the progression of HIV Infection o Anyone infected with HIV, although healthy, can still transmit the virus to another person HIV Advances AND Prevention o Since 1994 o Development of lab tests to determine viral load o Production of new drugs o Combination drug therapy o Ability to test for antiretroviral drug resistance

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Treatment to decrease risk of vertical transmission Methods to prevent HIV transmission Modifying risky behaviors decreasing risks related to sexual activity Decreasing risks related to drug use Decreasing perinatal transmission Decreasing occupational risks

Transmission of HIV o Individuals are infectious within days after o becoming infected o Modes of transmission o Infectious fluids: o Blood o Semen o Vaginal secretions o Breast milk HIV-Antibody Test Screening Process Diagnosis of HIV o When to test? o How to test Standard HIV antibody testing Rapid HIV antibody testing Confirmatory testing o Pre-test counseling o Post-test counseling Components of HIV Timeline for untreated HIV infection

Acute Intervention o Early diagnosis o Antiretroviral therapy to start When to start Adherence o Delaying disease progression Clinical Manifestations of HIV o Opportunistic infections (OIs) Infections and cancers that occur in immunosupressed patients that can lead to disability, disease or death o What are some examples of OIs?

Collaborative Care o Monitoring HIV progression o Initiating and monitoring ART o Preventing the development of OIs o Detecting and treating OIs o Managing symptoms o Preventing/decreasing complications of treatments o Preventing further transmission of HIV Vaccines for HIV+ Individuals o Hepatitis B o Influenza o Pneumococcal

Pharmacological Treatment of HIV o Goal of treatment is threefold Decrease viral load Maintain or raise CD4 counts Delay the development of HIV related symptoms and opportunistic diseases Antiretroviral Therapy o Treatment regimens are individualized o Individuals who ware HIV + are always considered infectious o HIV medications work at various points of the HIV replication cycle o Risk of drug resistance o Advantages and disadvantages of treatment o Dangers of non-adherence o Potential drug interactions o Side effects that must be reported to HCP Mechanisms of Action of Drugs to Treat HIV Infections

Patient and Caregiver Teaching Guide Strategies to Improve Adherence to Antiretroviral Therapy Pharmacology for Opportunistic Infections (OIs) o Pneumocystis pneumonia (PCP) o Cytomegalovirus (CMV) retinitis o Mycobacterium tuberculosis o Mycobacterium avium complex (MAC) o Toxoplasma encephalitis o Cryptococcal meningitis o Varicella-Zoster virus (VZV) o Herpes Simplex viral (HSV) infection Disease and Drug Side Effects o Anxiety o Fear o Depression

o Diarrhea o Peripheral neuropathy o Pain o n/v o Fatigue o Metabolic disorders Acute Exacerbations and Ongoing Care o Recurring problems of infection, cancer, debility, and psychosocial/economic issues affect ability to cope. o Social stigma o Behaviors may be viewed as immoral, illegal, or uncontrolled by infected person. o Discrimination causes loss of jobs, homes, and insurance. o Most severe for women o Americans with Disabilities Act makes discrimination illegal. Nursing Diagnosis o Identify three nursing diagnosis for a HIV + individual o Identify three nursing diagnosis for and individual with AIDS

Nursing Interventions in HIV Disease Health Promotion o Preventing HIV Infection o Decreasing risks related to sexual intercourse o Decreasing risks related to drug use o Decreasing risks related to peri-natal transmission o Decreasing risks at work o HIV testing o What questions might you ask to help individuals asses their risk factors for HIV? Patient and Caregiver Teaching Guide