Care of Patients Living
with HIV
Mrs. Joice Das (B.Sc. (N)., M.Sc. (N))
INTRODUCTION
• AIDS-1981 (US)- 5 previously healthy homosexual men in Los Angeles.
• Male and female injection drug users.
• Hemophiliacs
• Blood transfusion recipients
• Female sexual partners of men with AIDS
• Infants born to mothers with AIDS.
INCIDENCE
A/T National AIDS control Organization (NACO)-
• PLHIV- Around 24 lakhs.
• Largest number of PLHIV- Southern states
• Top 3- Maharashtra, Andhra Pradesh and Karnataka
• Annual New Infection (ANI)- 62970 in 2021
• AIDS Related Deaths (ARD)- 41970 in 2021
• A decline of 76.5% in ARD- National level from 2010-21.
DEFINITION
• Acquired immunodeficiency syndrome (AIDS) is defined as a Human
immunodeficiency virus (HIV) infection with either a CD4+ count
below 200 cells per µL or the occurrence of specific diseases
associated with HIV infection. Mandell, Bennett, and Dolan (2010).
CAUSATIVE ORGANISM
• 1983- HIV-Isolated from a patient with lymphadenopathy
• 1984-Causative agent of AIDS.
• Human immunodeficiency virus (HIV) is a retrovirus that causes
immunosuppression.
Social Kissing
SEXUAL TRANSMISSION
• Unprotected sexual contact- HIV viral load
• Trauma to local tissues during sex
• Genital lesions from STIs- Herpes or Syphilis, increases the chance of
transmission.
CONTACT WITH BLOOD AND BLOOD
PRODUCTS
• Sharing drug using paraphernalia.
• Contaminated blood transfusions
• Puncture wounds
• Needlestick exposure- 0.3%.
• Risk is higher- High level of circulating HIV, deep puncture wound, a
needle with a hollow bore and visible blood, or a device used for
venous or arterial access.
PERINATAL TRANSMISSION
• Mother to child- Pregnancy, Delivery and/or Breastfeeding.
• Children born to mothers with treated HIV infection - 25% HIV +
• Tested for HIV infection and, if infected, treated with antiretroviral
therapy (ART)- Transmission risk- <1%
PATHOPHYSIOLOGY
Human Immunodeficiency Virus (RNA-based retrovirus) Enters into the
human host to replicate
The virus invades the CD4+ cells and destroys it (ACUTE INFECTION)
10- 15 YEARS
The virus replicates within the CD4+ cells, causing cell death (LATENT STAGE)
Weakened Immunity (SYMPTOMATIC STAGE)
Opportunistic Infection (AIDS)
• 2 to 4 weeks- Acute HIV infection
• Neurologic problems- Aseptic meningitis, peripheral neuropathy,
facial palsy, or Guillain Barré syndrome.
• Chronic HIV Infection- Asymptomatic-8-10 years
• Symptoms- vague and nonspecific for HIV
• They continue their usual activities
• Quality and length of their life is reduced
• Symptomatic stage
• Active stage- CD4 cell count <200 cells/μL and increased viral load
• Persistent fever
• Frequent night sweats
• Chronic diarrhea
• Recurrent headaches
• Severe fatigue
• Oropharyngeal candidiasis (thrush)
• Shingles (varicella-zoster virus)
• Persistent vaginal candidal infections
• Outbreaks of oral or genital herpes
• Kaposi sarcoma (KS) caused by human herpesvirus
• Oral hairy leukoplakia- An Epstein-Barr virus infection
ACQUIRED IMMUNODEFICIENCY SYNDROME
• Diagnosis of Acquired Immunodeficiency Syndrome- Criteria
established by the CDC.
• Severely compromised immune system
• Many infections, a variety of cancers, wasting, and HIV-related
cognitive changes (HAND) can occur in this stage
• Several opportunistic diseases may occur at
the same time.
CYTOMEGALOVIRUS
CRYPTOCOCCAL MENINGITIS
ORAL CANDIDIASIS
“THRUSH/ YEAST” TOXOPLASMOSIS
TUBERCULOSIS
HISTOPLASMOSIS
MYCOBACTERIUM AVIUM
COMPLEX
CRYPTOSPORIDIOSIS
SHINGLES
HERPES SIMPLEX (SKIN)
VAGINAL CANDIDIASIS
HUMAN PAPILLOMA VIRUS
GENITAL HERPES SIMPLEX
DIAGNOSTIC STUDY
• HIV antibodies and/or antigens- BLOOD and SALIVA
• Window period- 3 weeks. (False negative result)
• HIV progression- CD4 cell count (below 200 cells/ μL) and viral load.
• The lower the viral load, the less active the disease.
• In HIV, viral loads are reported as real numbers (e.g., 1260 copies/μL)
• Goal of treatment- “undetectable viral load” (< 20-40 copies/ μL)
• Decreased WBC with lymphopenia and neutropenia are common in
HIV infection.
MANAGEMENT- DRUG THERAPY
The goals of ANTI-RETROVIRAL THERAPY are to-
(1) decrease the viral load
(2) maintain or increase CD4 cell counts
(3) prevent HIV-related symptoms and opportunistic diseases
(4) delay disease progression
(5) prevent HIV transmission
MANAGEMENT- DRUG THERAPY
• Attachment Inhibitors- Fostemsavir, Ibalizumab
• Entry Inhibitors- Enfuvirtide, Maraviroc
• Integrase Inhibitors- Bictegravir, Cabotegravir, Dolutegravir,
Elvitegravir, Raltegravir
MANAGEMENT- DRUG THERAPY
• Protease Inhibitors- Atazanavir, Darunavir, Fosamprenavir
• Transcriptase Inhibitors-
• Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) –
Delavirdine, Efavirenz, Etravirine
• Nucleotide Reverse Transcriptase Inhibitor (NtRTI)- Abacavir,
Didanosine, Doravirine
NURSING RESPONSIBILITY
Assessment
• Focus on behaviors that put the person at risk for HIV
(1) Have you ever had a blood transfusion or used clotting factors?
(2) Have you ever shared drug-using equipment with another person?
(3) Unprotected intercourse
(4) Have you ever had an STI?
• A complete history and physical assessment, including an
immunization history and psychosocial and diet evaluations.
Clinical Problems
• Nutritionally compromised
• Difficulty coping
• Deficient knowledge
• Risk for infection
Planning Nursing care can help the patient to
(1) Adhere to ART;
(2) Adopt a healthy lifestyle- Avoiding exposure to other STIs and
blood-borne diseases;
(3) Protect others from HIV;
(4) Have supportive relationships;
(5) Maintain activities and productivity;
(6) Explore spiritual issues;
(7) Come to terms with issues related to disease, disability, and death;
(8) Cope with symptoms caused by HIV and its treatments.
Implementation
• Primary prevention and health promotion
• Behavior change counseling- Culturally sensitive, age specific,
appropriate language
Biomedical Prevention
• Preexposure prophylaxis (PrEP)- Reduce the risk of
acquiring HIV sexually or through IV drug use.
• Other prevention interventions- Condoms, Risk
reduction counseling, and regular HIV testing.
• Two agents are approved for PrEP- Emtricitabine +
Tenofovir disoproxil fumarate.
• Non-occupational postexposure prophylaxis (nPEP)- ART is
given to someone within 72 hours after a potential exposure
to reduce the risk of HIV infection.
• Treatment is typically given for 28 days after the exposure.
• Patients are monitored after the incident with repeat HIV
testing.
Early intervention
• Promotes health and limit disability.
• Early detection of symptoms, opportunistic diseases, and
psychosocial problems.
• Begin teaching about HIV
• Provide teaching about ART
• Group support and individual counseling.
• PERSONALIZED AND INDIVIDUALIZED CARE
EVALUATION
• Develops and implements a personal plan to decrease personal risk
factors.
• Adheres to treatment for HIV AIDS
• Works with the health care team to achieve optimal health
• Prevents transmission of HIV to others
CONCLUSION
Story of Elina (UNICEF)
Assignment
• NACO
• NACP
