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Understanding HIV: Transmission, Symptoms, Diagnosis, and Nursing Care Strategies

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  1. HIV & AIDS Megan McClintock, MS, RN Fall 2011

  2. “HIV has no cure, continues for life, causes increasing physical disability, contributes to impaired health and ultimately ends in death.”

  3. Transmission of HIV • Sexual intercourse • Exposure to infected blood • Drug-using equipment • Blood products • Needle stick • Perinatal transmission during pregnancy, delivery, or breastfeeding

  4. Transmission Through Sexual Intercourse • Safe sex – masturbation, insertive sex only if neither person infected or at risk of being infected • Barriers – condoms, dental dams, plastic food wrap

  5. Transmission Through Infected Blood • No alcohol or tobacco • Don’t share drug equipment • Utilize needle/syringe exchange programs • Clean equipment (least effective) • If exposed through a needle stick at work, get post-exposure prophylaxis with ART

  6. Perinatal Transmission • Prevent HIV in women • Treat HIV during pregnancy with ART • Offer HIV testing to all women

  7. Disease Progression

  8. Signs & Symptoms • Acute Infection • Occurs within 2-4 weeks of infection and lasts 1-2 weeks (often mistaken for the flu) • Mono-like symptoms • Neuro symptoms • High viral load, decreased CD4+ T cells • Chronic Early Infection • Generally asymptomatic but spreading the disease b/c they don’t know they are infected • May have night sweats, fatigue, headache, low grade temp, lymphadenopathy • Low viral load, CD4+ T cells fairly normal (>500)

  9. Signs & Symptoms (cont.) • Chronic Intermediate Infection • Symptoms worsen – localized infections, nervous system symptoms • Thrush is common, also shingles, vaginal candida, oral/genital herpes, bacterial infection, Kaposi’s sarcoma, oral hairy leukoplakia • Increased viral load, CD4+ T cells 200-500

  10. Signs & Symptoms (cont.) • Late Chronic Infection – AIDS • Can only make this diagnosis when specific criteria is met (pg 245, Table 15-9) • Opportunistic disease (pg 245, Table 15-10), wasting, dementia, malignancies • High viral load • Low CD4+ T cells (<200)

  11. Diagnosis of HIV Infection • HIV antibodies and/or antigens in the blood • May not appear for 2 months after infxn, but can still transmit the virus during this time (window period) • Rapid HIV test (EIA) – looks for antibodies • Western blot test of IFA must be done to confirm diagnosis • CD4+ Tcell counts (measure of immune function) – normal 800-1200 • Viral load (measure of disease progression) – can be undetectable (but still have the virus and can transmit it) •  WBC, neutropenia, thrombocytopenia, anemia, liver function abnormalities, can also test for ART drug resistance, Hep B, Hep C

  12. Treatment • No cure, just decreased disease progression • Goals – decrease viral load, increase CD4+ T cell count, delay onset of opportunistic disease • Must use at least 3 drugs from 2 different drug classes • Critical for the patient to adhere to the drug regimen • Drugs interact with many other drugs and herbs • Vaccinations are important

  13. When to Treat

  14. Nursing Care • Assess for risky behaviors • Blood transfusion before 1985 • Sharing drug-using equipment • Any sexual experience (yes, this covers lots of folks) • STDs • CDC recommends HIV testing for everyone ages 13-64

  15. Nursing Care (cont.) • Drug therapy • Must take right dose at right time every day • Encourage use of electronic reminders, calendars, timers, group support • Promote a healthy immune system • Good nutrition to keep lean body mass • Decrease alcohol/tobacco/drug use • Vaccinate for infectious diseases • Good rest and exercise • Decrease stress • Avoid exposure to illnesses • Mental health counseling and support groups

  16. Complications • Metabolic disorders that cause fat deposits in abdomen, upper back, breasts and fat loss in arms, legs, face (lipodystrophy) • Hyperlipidemia • Insulin resistance • Hyperglycemia • Bone disease • CV disease

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