Burgess Nursing Care of Patients with HIV and AIDS

Nursing Care of Patients with HIV and AIDS

• Focuses on the care of individuals with HIV and AIDS, including their history, pathophysiology, treatment, and prevention.

History of HIV

• Epidemic first reported in June 1981.
• First antiretroviral drug (ARV) introduced in 1987.
• Highly active antiretroviral therapy (HAART) introduced in 1996, also known as antiretroviral therapy (ART).
• Combination of at least two ARVs with different mechanisms of action.
• At the end of 2018, there were 1.2 million infected individuals and 39,968 new cases reported.

HIV

• Human immunodeficiency virus.
• Two strains: HIV-1 (most common, global) and HIV-2 (found in specific areas of West Africa).
• Retrovirus with RNA makeup, attracts to CD4 receptors on lymphocytes and macrophages, destroying them.
• CD4 T lymphocytes crucial for immune function.
• Destruction of CD4 T lymphocytes leads to a weakened immune response.

7 Steps of the HIV Life Cycle

• Binding: HIV attaches to the CD4 receptor of the host cell.
• Fusion: HIV envelope fuses with the host cell membrane.
• Reverse Transcription: HIV releases reverse transcriptase to convert RNA into DNA in the host cell.
• Integration: HIV integrase incorporates the viral DNA into the host's DNA.
• Replication: HIV uses host cell machinery to replicate long chains of HIV proteins.
• Assembly: HIV RNA and proteins assemble into new viral particles.
• Budding: Immature non-infectious HIV buds from the host cell, and protease releases chains into shorter functional forms, creating mature infectious HIV.

Pathophysiology (continued)

• HIV can persist in a latent (inactive) state for years.
• Can lie dormant in small cells called viral reservoirs.
• Currently, no cure exists, however lifelong antiviral treatment controls the virus.
• Ongoing research for a cure and possible vaccine development.

Antiretroviral Medications

• Stop HIV at different stages of its life cycle.
• Binding: Cellular chemokine receptor type 5 (CCR5) antagonists block HIV attachment.
• Fusion: Fusion inhibitor drugs.
• Reverse Transcription: Nonnucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs).
• Integration: Integrase inhibitors.
• Budding: Protease inhibitors.

Progression of HIV Infection

• Initial infection involves a symptom-free period (clinical latency stage).
• CD4 counts decrease.
• Symptomatic stage varies in onset (average 8-12 years).
• Early symptoms point to a weakened immune system.
• Diagnosis of AIDS occurs when CD4 counts drop below 200, leading to opportunistic infections or cancers.

AIDS

• Acquired immunodeficiency syndrome.
• Final stage of HIV infection.
• Can develop at any point during HIV infection.
• Most people with early diagnosis and treatment do not progress to AIDS.
• HIV positive does not equal AIDS.

Transmission

• Person-to-person transmission through specific bodily fluids.
• Fluids include blood, semen, pre-seminal fluid, vaginal secretions, rectal fluids, and breast milk.
• Transmissible within 2-4 weeks of initial infection.
• Transmission occurs via bodily fluids through tears in mucous membranes, nonintact skin, needle injection, and sexual contact.
• Transmission is not via air, water, food, or insects (household transmission is rare).
• Does not survive long outside of the human body.

Prevention

• Education on transmission modes.
• Pre-exposure prophylaxis (PrEP) with an ARV drug for those at high risk of contracting HIV (99% effective).
• Routine testing knowing one's status is crucial, especially for ages 15-65, pregnant women, and victims of sexual assault.
• Post-test counseling for positive individuals (education and treatment).
• Undetectable viral load for more than 6 months indicates that the virus is practically undetectable and cannot be transmitted.
• Education about safe sex like abstinence, limiting partners, and using condoms.
• Legal requirement for individuals to disclose their HIV infection status to sexual partners.

Prevention (continued)

• Parenteral transmission via injection:
  • Avoiding injecting drugs, using clean supplies, and having safe injection techniques.
  • Not sharing or reusing needles.
  • Pharmacies participating in syringe exchange programs.
• Parenteral transmission via transfusion
  • Rigorous testing and screening of blood products before transfusion to minimize risk of infection.
  • Low chance of infection if blood has not had sufficient time to develop detectable antibodies.

Prevention – Health Care Workers

• Occupational transmission is rare.
• Standard precautions must be followed.
• Hand hygiene is crucial.
• Safety devices on needles (never recapping).
• If exposed, seek immediate emergency care and prophylactic treatment with ARVs.

HIV Signs and Symptoms

• Initial infection can be asymptomatic.
• Stage 1 (Acute retroviral syndrome): fatigue, headache, fever, enlarged lymph nodes, diarrhea, and sore throat.
• Stage 2 (Chronic HIV infection): asymptomatic or mild symptoms with treatment
• Stage 3 (AIDS): opportunistic infections or cancers, increased weakness, pain, weight loss, and wasting.

Complications

• Fewer complications are seen due to advances in treatment.
• AIDS wasting syndrome: unintentional weight loss, weakness, fever, or diarrhea lasting more than 30 days.
• Malnutrition needs attention.
• HIV-associated neurocognitive disorder: infection in the brain and central nervous system, leading to memory problems, personality changes, hallucinations, leg weakness, balance loss, and slow responses.
• Cancer: weakened immune system permits uncontrolled cell growth.
• Opportunistic infections: fungi, viruses, bacteria utilize weakened immune system, like Candida albicans, Pneumocystis jirovecii pneumonia, Cytomegalovirus (CMV), Mycobacterium avium complex (MAC), and Tuberculosis (TB)

Diagnosis

• Finger stick, oral swab, or serum tests are methods used for diagnosis.
• Urine tests (rare).
• Health care and home test kits detect antigens within 2 weeks of exposure and antibodies within a range of 3 weeks to 3 months.

Lab Testing

• Antigen and antibody testing.
• CD4 T lymphocyte counts (332-1642 cells/mm³).
• Viral load testing (quantitative RNA assay) to measure HIV RNA in plasma.
• Goal of treatment is to achieve an undetectable viral load.
• Genotyping for resistance to available ARV medications.
• Screening for concurrent STIs or hepatitis.
• Enzyme-linked immunosorbent assay (EIA) and Western blot assay for confirmation of HIV diagnosis.

Treatment

• All patients should be treated with antiretroviral therapy (ART) regardless of CD4 count.
• Prophylactic treatment for opportunistic infections.
• ART inhibits viral reproduction, but does not kill the virus.
• Combination therapy using various medications that act on different phases of the HIV life cycle.
• Achieve undetectable viral load within 6 months of treatment.
• "Undetectable = untransmissible"

Medication Adherence

• Medication resistance can occur if drugs are not taken as prescribed.
• Resistant strains can be transmitted.
• Promoting adherence through patient education is crucial.
• If not taken correctly, HIV can reemerge and become detectable again.
• Encourage reporting side effects for regimen adjustments and improved adherence.

Nursing Implications

• Non-judgmental approach, empathy, and psychosocial support.
• Maintain confidentiality (HIPAA).
• Infection prevention (table 20.5).
• Education about transmission, prevention, safety, and treatment.
• Maintaining nutrition and weight.

Patient Education

• Wash dishes in hot soapy water to destroy bacteria and soak cleaning sponges in bleach.
• Clean spills with bleach solutions.
• Avoid items that carry toxoplasmosis risk (changing litter boxes).
• Daily use of antimicrobial cleansers.
• Monitor body temperature to identify fever or infections early.

This quiz explores the nursing care required for patients with HIV and AIDS, covering essential topics such as the disease's history, pathophysiology, treatment options, and prevention strategies. Focus on understanding the life cycle of HIV and its impact on the immune system to provide effective care and support.