AIDS(Acquired Immune

Deficiency Syndrome)

by: Policarpio, Anna Marie LoBSN 4-0

A I D S • a chronic infectious disease caused by Human Immuno- defiency Virus (HIV) which destroys helper T-lymphocytes causing loss of the immune response and increased susceptibility to secondary infection and cancer, and eventually lead to death.

• severe form of continuum of illness associated with HIV

• CD4 T-helper lymphocytes are < 200 with increased viral load of more than 100,000

• a NO CURE infection

Causative Agent:

• HIV retrovirus (belongs to lentivirus, which sometimes called “slow virus”

• Human T-cell lymphotropic virus 3 (HTLV-3)

• consist of genetic material in the form of RNA (instead of DNA) surrounded by a lipoprotein envelope.

• HIV type 1 in Europe and America, HIV type 2 in Africa

Mode of Transmission:• sexual contact• blood transfusion• contaminated syringes, needles, nipper,

razor blades• direct contact of open wound/mucous

membrane with contaminated blood, body fluids, semen and vaginal discharges

• vertical or perinatal transmission (mother to fetus, child delivery, breastfeeding)

• organ donations with infected blood

Persons at Risks:

• with polygamous relationships• gay-lesbian relationships• drug addicts• sex workers• organ transplant recipient• receiving blood transfusion • healthworkers

Incubation Period:

• Variable – 1 to 3 months (time of infection to the development of detectable antibodies)

• 1 to 15 years (time from HIV infection to diagnosis of AIDS)

Signs and Symptoms: (AIDS-related Complex) ARC

• a person may remain asymptomatic, feel and appear healthy for years even though he is infected with HIV. The immune system starts to be impaired.

• AIDS is the active stage of infection

• CD4 T-helper lymphocytes are < 200 with increased viral load of more than 100,000

a. Physical

– maculo-papular rashes

– loss of appetite

– weight loss (10% of body weight)

– fever of unknown origin

– body malaise

– chronic diarrhea (more than one month)

– persistent cough for one month

– gaunt-looking, apprehensive (anxious looking)

– generalized lympadenopathy

– recurrent herpes zoster

– tuberculosis (localized and disseminated)

– esophageal/oropharyngeal candidiasis

– Kaposi’s sarcoma ( skin cancer)

– pneumocystis carinii pneumonia

b. Mental • (Early Stage)

–forgetfulness–loss of concentration–loss of libido–apathy (lack of interest or

feeling)–psychomotor-retardation–withdrawal (anti-social)

• (Later Stage)

- confusion

- disorientation

- seizures

- mutism (speechlessness)

- loss of memory

- coma

Top 10 Symptoms of HIV/AIDS:

1. depression2. diarrhea3. thrush4. weight loss5. lipodystrophy (fat redistribution syndrome)6. sinus infection7. fatigue8. nausea and vomiting9. lactic acidosis ( lactic acid build up in the body due

to damage in the mitochondria)10. peripheral neuropathy (burning and tingling of feet

and hands)

Stages in the development of AIDS:

a. Acute HIV (primary infection)• from infection of HIV to

development of antibodies to HIV• “window period” (test negative

with HIV antibody)• viremia stage (flu-like

symptoms)• viral setpoint (balance between

HIV & immune response)• mild symptoms• 0 to 12 months

b. HIV-positive

• asymptomatic (CD4 is >500, feeling well)

• symptomatic (CD4 is 200-499, gradual falling of CD4)

• more antibodies form

• small amount of virus in blood

• 1 to 7 years or more

c. AIDS• active infection• decreasing CD4 count• AIDS indicator

diseases (opportunistic infections, kaposis sarcoma, wasting syndrome, HIV encephalopathy, pneumonia)

• 7 to 12 years or more

Common Opportunistic Infections:

1. Bacterial - Mycobacterium avium complex MAC (TB –like symptoms)

• disseminated disease involving lung, bone marrow, liver; CD4 <= 100/ml

• Tuberculosis

• Salmonillosis

2. Viral

- Herpes

- Hepatitis

- Genital Warts

- Cryptomegalovirus CMV (causes retinitis, pain in swallowing, leg

numbness)

- malluscum contangiosum (dome- shame papule on face, trunk,

extremities)

3. Fungal - Candidiasis (infections of trachea, esophagus, lungs)

- Cyrptococcal meningitis - Histoplasmosis

4. Pneumonias - Bacterial

• Pneucystitis carinii Pneumonia (PCP)

5. Cancers

- Kaposi’s sarcoma (tumors in the skin and linings of the internal

organs)

- Cervical dysplasia and carcinoma

- Non-Hodgkin’s lymphoma (usually late manifestation of HIV infection)

6. Parasitic

- Toxoplasmosis

- Cryptosporidiosis (spreads by contact of feces containing crypto)

Pathophysiology:

HIV Infection:(sexual contact, blood transfusion,mother-to-fetus,

contaminated sharps, organ donation, direct contact with open woundson contaminated fluids & discharges)

HIV particles attaches to receptors on Helper-T4 lymphocyte

(CD4) cell surfaces

Viral RNA and reverse transcriptase enzymeenter Helper-T4 cell

enzyme converts Viral RNA to Viral DNA

Drug AZT blocks transcription

Viral DNA joins Helper-T4 cell DNA

Replication of HIV Helper-T4 cell producesviral components

Anti-HIV protease inhibitor drugs block

Assemble new virus particles

infected Helper-T4cells shed many HIV particles to

invadeother Helper-T4 cells & lymphoid tissue (VIREMIA)

infected Helper-T4 cells are destroyed

Phase 1: initial infection usually in 3-6 weeks with mild, non-specific “flu-like” symptoms self-limiting – initially the immune response limits infection antibodies from in 2-10 wks. (blood test)

TEST HIV POSITIVE

Phase 2: LATENT – may last years-asymptomatic or lymphadenopathy may be present

Helper-T4 cell count decreases & weaker immune response

gradually move into active infection

Phase 3: ACUTE – AIDS IMMUNODEFICIENCY very low T4 cell count

multiple severe opportunistic infections, cancers, wasting syndrome, CNS involvement

Diagnosis:

• Physical Exam

– evaluate for oral candidiasis, "cottage cheese and ketchup" appearance of retina, adenopathy, skin abnormalities, respiratory symptoms, abdominal tenderness, and signs of dementia

• Chest X ray

– for pneumonia, tuberculosis. Brain imaging if neurological symptoms are present.

•Laboratory Tests:

1. ELISA (Enzyme link immunosorbent assay)– screening test/presumptive test– produces false positive results in people who have

been exposed to parasitic diseases such as malaria

2. Western Blot analysis– confirmatory test/positive result– to confirm reactive seropositive results obtained by

ELISA test

3. Polymerase Chain Reaction test (PCR)- screen for viral RNA and therefore allow detection of the virus after very recent exposure- viral load (measures HIV RNA in the plasma)- better predictor of risk of HIV progression than CD4 count)

4. CD4 count (CD4-CD8 Ratio)- significant lowering of CD4 over CD8

5. Radio immuno-precipitation assay (RIPA)

6. Immunofluorescent test

7. Particle Agglutination test

8. HIV Antibody tests

- negative test (HIVantibodies not detectable in the blood at the time of test)

- positive test (HIV antibodies are present in blood, person is considered HIV positive)

Treatment:

• AIDS drugs are medicines used to treat but not cure HIV infection.

• These drugs are sometimes referred to as “anteroviral drugs”, work by reducing the replication of the virus.

There are 2 groups of anteroviral drugs:

• Reverse transcriptase inhibitors

- inhibits the enzyme “reverse transcriptase” which is needed to “copy” information for the virus to replicate.

– Zidovudine (ZDV) / Azidothymidine - Retirvir (best known drug)

– Zalcitabine - Havid

– Stavudine - Zerit

– Lamivudine - Epivir

– Nevirapine - Viramune

– Didanosine - Videx

• Protease inhibitors – inhibits the enzyme protease which are needed for the assembly of viral particles.

- Saquinavir - Invarase

- Ratinovir - Norvir

- Indinavir - Crixivan

• “Cocktail drugs” (combination of three to five drugs) – are used to prolong the latent phase

- as well as reduce the viral load during the final phase

• HARRT (Highly Active Anti-Retrovirus Therapy) - very effective at controlling the virus by reducing the viral load in the blood and returning CD4 cell counts to near normal levels

PRIMARY FOCUS:

- minimize the effects of complications such as infections or malignancy by prophylactic medications and immediate treatment.

Nursing Management:

1. Health Education.

– inform client of the disease process and mode of transmission

– emphasize “AIDS awareness Program”– give practical advice– avoid judgemental and moralistic messages– be consistent & concise in giving instructions

especially in taking medication– use positive statement– encourage client to trace or identify previous

contact for proper management

2. Practice universal/standard precautions.

– thorough medical handwashing after every contact with patient and after removing the gown & gloves, and before leaving the room of an AIDS suspect or known AIDS patient.

– use of universal barrier or personal protective equipment is very necessary

3. Prevention.– avoid accidental pricks from sharp instruments

contaminated with potentially infectious materials from AIDS patient

– gloves should be worn when handling blood specimens & other body secretions as well as surfaces, materials and objects exposed to them

– blood and other specimens should be labeled with special warning “AIDS Precaution”

– blood spills should be cleaned immediately, like using chlorox

– needles should not be bent after use, but are disposed to sharps-container

– personal articles like toothbrush and razors should not be shared with other family members

– patients with active AIDS should be isolated

– clients considered at risk should not be allowed to donate blood or any organ of the body

– encourage monogamous relationship

– HIV-infected pregnant women should go into regular prenatal, interpartal, postpartal care

– speak openly with partners about safer sex techniques and HIV status

4 C’s in HIV/AIDS Management:

– Compliance

– Counseling/Education

– Contact tracing

– Condoms

Nursing Diagnosis:

• Knowledge deficit• Strict isolation• Risk for infection• Anxiety• Self-esteem disturbance• Altered role performance

Prognosis:

• at present, persons living with HIV/AIDS infection are living longer with improved drug treatment...

References:• Public Health Nursing (DOH Book) , 2nd Edition• Contemporary Medical-Surgical Nursing, J. Tazbir• Handbook of Common Communicable & Infectious

Diseases, D. Navales• Pathophysiology for the Health Professions, B.

Gould• E-Encyclopedia Britannica 2007