Exam 19 - HIV

Introduction to HIV

• Early cases date back to 1959, but the disease may have existed earlier.
• The virus is estimated to have spread from its source around the 1930s.
• It was recognized as a clinical syndrome in the early 1980s.
• In 1987, the CDC reported cases of occupationally acquired HIV in healthcare providers, leading to standard precautions for blood and body fluids.

Early Observations

• Pneumocystis jiroveci pneumonia (PCP) was observed in increasing numbers.
• Patients also developed Kaposi's sarcoma, mainly in men of Mediterranean descent.
• Initially, the disease mainly affected homosexual men with failing immune systems, but it also affected people who used injection drugs, patients with hemophilia, and later heterosexual men and women.

Stages of HIV

Stage 1: Acute HIV Infection

• Occurs within 2 to 4 weeks of transmission.
• Symptoms resemble influenza.
• Patients are highly infectious due to elevated viral loads in blood and bodily fluids.

Stage 2: Clinical Latency

• Patients are often asymptomatic.
• Low levels of the virus are present in the blood.

Stage 3: AIDS (Acquired Immunodeficiency Syndrome)

• The most severe stage of the infection.
• Patients develop opportunistic infections due to damaged immune systems.
• Viral loads are elevated, making patients very contagious.
• CD4 count drops to less than 200 cells/mm³.
• Symptoms include fever, chills, sweating, swollen lymph nodes, weight loss, and weakness.

Types of HIV

HIV-1

• Found worldwide and the most prevalent.
• More virulent than HIV-2.
• Typically leads to profound immunodeficiency and high viral loads.

HIV-2

• Mostly confined to West Africa.
• Develops more slowly than HIV-1.
• Has a lower transmission rate than HIV-1.
• Resistant to some HIV-1 medications.

Significance of the Problem

• Approximately 50,000 new HIV cases are diagnosed each year in the US.
• More than 1.1 million people in the U.S. are living with HIV.
• The epidemic affects various racial, ethnic, geographic, and demographic populations, including nonwhite people, women, heterosexuals, and people who use injection drugs.
• People with HIV are living longer due to advancements in treatment.
• The progression from HIV to AIDS has slowed due to treatment advancements.
• In some countries, HIV infection remains a leading cause of death.

Transmission of HIV

• HIV requires a host organism to survive and cannot live long outside the human body.
• Transmitted through infected blood, semen, rectal secretions, cervicovaginal secretions, and breast milk.
• Also found in pericardial, synovial, cerebrospinal, peritoneal, and amniotic fluids.

Pathophysiology

• HIV is a lentivirus or "slow" retrovirus.
• Requires host cells for replication.
• The virus takes over the host cell to reproduce viral copies of itself.
• Acute Retroviral Syndrome: viral replication during acute infection, viral load peaks, decline in virus before detectable antibodies.
• Seroconversion: development of antibodies (5 days to 3 months after exposure).

Laboratory Tests for HIV

• Blood is tested for the presence of antibodies to HIV. (ELISA and Western blot).
• Confirmation of antibodies does not necessarily mean AIDS, as seroconversion may not have occurred.
• CD4+ cell monitoring: tracks progression of HIV disease, lower CD4+ means more severe immunosuppression, helpful in treatment decision-making.
• Viral load monitoring: Quantitative assays (NASBA, RT-PCR, and bDNA) measure viral load levels.

Treatment

• Focuses on monitoring HIV disease progression and immune function.
• Preventing the development of opportunistic diseases.
• Initiating and monitoring antiretroviral therapy (ART).
• Detecting and treating opportunistic diseases.
• Managing symptoms and complications.

Psychosocial Considerations

• People with HIV may deny infection, neglect health, and continue risky behaviors.
• Interventions must be sustained; the emotional impact of an HIV diagnosis can overshadow initial education.

Prevention

• Nurses should discuss sexual activity and substance use in a non-judgmental and empathetic way.