Stages of HIV Infection

Stages of HIV Infection

• Stage I (Acute HIV Infection): Begins with the onset of acute infection responses after initial infection by the virus.
• Most adults develop an acute infection reaction within 4 weeks of being infected, with symptoms similar to those of a viral infection.
• Symptoms of acute HIV infection include fever, sore throat, rash, night sweats, chills, headache, and muscle aches
• High viral numbers in the bloodstream and genital tract occur during this early phase, making sexual transmission possible.
• The time from the beginning of stage I to stage III ranges from months to years, depending on how HIV was acquired.
• Stage II (Chronic HIV Infection): Most adults seek care, are diagnosed, and started on drug therapy.
• Appropriate drug therapy started in this stage suppresses viral reproduction.
• Patients can maintain a level of immunity for protection, with some achieving undetectable virus levels and living well for decades.
• During Stage II, HIV RNA quantification laboratory tests, also known as HIV viral load tests, may be performed
• HIV is still active but reproduces at low levels, with a gradual decline in CD4+ T-cell count.
• Stage III: Untreated individuals progress to this stage when CD4+ T cells become infected and cannot function properly.
• CD4+ T-cell function leads to immunity abnormalities like leukopenia, lymphocytopenia, incomplete antibodies, and abnormal macrophages.
• A diagnosis of stage III requires the adult to be HIV positive and have either a CD4+ T-cell count of less than 200 or certain opportunistic infections.
• AIDS-defining conditions include Candidiasis, Cervical cancer—invasive, Cryptococcosis, Cytomegalovirus, Kaposisarcoma, Interstitial cryptosporidiosis—chronic, Mycobacterium avium complex, Non-Hodgkin lymphoma certain types, Pneumocystis jirovecii pneumonia, and Toxoplasmosis.
• AIDS symptoms include rapid weight loss, recurring fever or night sweats, swollen lymph glands, diarrhea lasting over a week, sores on the mouth, anus, or genitals, memory loss, depression, and neurological disorders.

HIV Prevention Techniques

• Thorough handwashing with antimicrobial soap is crucial, especially before eating or drinking, after touching pets, shaking hands, coming home, and using the toilet.
• Avoid crowds and large gatherings, and wear an N95 or KN95 mask in crowded areas.
• Adherence to prescribed medication is essential.
• Avoid travel to areas with poor sanitation.
• Monitor temperature daily and report any signs of infection to a healthcare provider.
• Indications of infection to report: temperature greater than 100°F (37.8°C), persistent cough, pus or foul-smelling drainage, skin lesions, mouth ulcers, or cloudy/foul-smelling urine.
• Practice personal hygiene: avoid sharing personal items, bathe daily with antimicrobial soap, brush/floss regularly, and replace toothbrushes frequently.
• Visit the dentist every 6 months for cleaning appointments.
• Nutrition precautions include avoiding undercooked foods and properly washing dishes.
• Avoid changing pet litter boxes; if necessary, use gloves and wash hands immediately after performing the task.
• Avoid keeping turtles and reptiles as pets and feeding pets raw or undercooked meat.
• The presence of opportunistic infections (AIDS-defining conditions) can lead to a stage III diagnosis.

Care for Patients with Reduced Immunity

• Place the patient in a private room and limit personnel entering the room.
• Use handwashing techniques or alcohol-based hand rubs before contact and after exiting the room.
• Limit visitors to healthy adults.
• Ensure the patient's room and bathroom are cleaned daily.
• Keep frequently used equipment dedicated to the patient and avoid sharing supplies.
• Use individually wrapped supplies and single-use food utensils when possible.
• Monitor vital signs, including temperature, every 4 hours or more frequently as needed.
• Inspect the mouth, skin, and mucous membranes for fissures and abscesses at least once per shift.
• Inspect open areas such as IV sites every 4 hours for signs of infection.
• Change gauze-containing wound dressings daily.
• Obtain specimens of suspicious areas for culture and promptly notify the primary health care provider.
• Demonstrate and encourage coughing and deep-breathing exercises and use strict aseptic technique for all invasive procedures.
• Monitor daily complete blood count (CBC) with differential, absolute neutrophil count (ANC), inspect the mouth every shift, and assess the lungs every 8 hours for signs of impaired gas exchange.
• Assess urine for odor and cloudiness and ask about any urinary symptoms.
• Assess all skin for loss of tissue integrity and inspect open sores for infection.

Neutropenic Precautions

• Neutropenic precautions are implemented for patients with a low white blood cell count (WBC of 2.5) to protect them from infection.
• Strict hand hygiene, personal protective equipment (masks and gowns), and avoiding fresh flowers or plants in the room are part of neutropenic precautions.
• Patient education on preventing infections is crucial.
• Place the patient on contact/airborne isolation precautions, use single-use oral care supplies, and avoid high-risk procedures like injections.
• Place the patient in a private room whenever possible.
• Clean the patient's room and bathroom at least once each day and monitor the patient's vital signs every 4 hours.
• Encourage activity at an appropriate level for the patient's health status.
• Keep frequently used equipment in the room for the patient's use only.
• Restrict visitors with signs or symptoms of illness.
• Avoid the use of indwelling urinary catheters if possible, and provide perineal hygiene per protocol daily.
• Follow agency policy for the restriction of fresh flowers and potted plants.

HIV/AIDS-Related Infections

• Candidiasis leads to difficulty swallowing and mouth pain.
• Kaposi sarcoma presents as pink, red, purple, or brown papular lesions with yellow halos on the skin.
• Pneumocystis jirovecii pneumonia causes a dry cough, shortness of breath, and tachypnea, with low-grade persistent fever.
• Toxoplasmosis results in changes in mental status, headache, fever, and neurological deficits.
• Presence of lesions in oral cavity indicates oral and esophageal lesions

HIV/AIDS Medication and Application of CD4 Counts/Viral Load

• Truvada (Emtricitabine) is a combination of antiretroviral medications that inhibit HIV reverse transcriptase and prevent viral replication.
• It is used for the treatment of HIV-1 infection in combination with other antiretroviral drugs and for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV.
• Monitor renal function tests and bone mineral density, and educate patients about hyperpigmentation of the palms and soles.
• Atazanavir (Reyataz) is a protease inhibitor that blocks the HIV protease enzyme, preventing viral replication and is part of highly active antiretroviral therapy (HAART) for HIV infection.
• Monitor glucose, cholesterol, and triglycerides due to associations with hyperglycemia, diabetes, and cholesterol elevations.
• Ritonavir is used for the treatment of HIV infection
• Cabenuva is a long-acting injectable regimen for HIV treatment containing cabotegravir and rilpivirine, designed for use in adults virologically suppressed on a current antiretroviral regimen.
• Use viral load tests to assess the stage of HIV by quantifying the amount of RNA present.
• Viral loads tests are used to measure the prognosis of HIV, disease progression, the effectiveness of therapy.
• A CD4 count is used to assess immune function and decline.

CD4/CD8 Counts

• A healthy adult usually has at least 800-1000 CD4+ T cells per cubic millimeter of blood; this number is greatly reduced as HIV progresses.
• CD4+ T-Cell and CD8+ T-cell counts and percentages are part of an immunity profile. Adults with HIV disease (especially in stage III) have a lower number of CD4+ T cells and a normal number of CD8+ T cells.
• A normal CD4+ Count is 600-1500 cells/mm3 When the CD4+ Count is below 200/mm3, patients are at a high risk for opportunistic infections.
• A measure of the number of CD4+ T cells in the blood
• The measure helps to assess the stage of HIV, guide decisions about starting therapy, monitor the effectiveness of ART, determine the risk of opportunistic infections, and evaluate the need for prophylactic medications.
• Regular monitoring of the CD4 count is essential for managing HIV/AIDS and determining appropriate interventions.
• An uninfected adult has no viral load for HIV, and the laboratory result would show "undetected."
• The higher the viral load, the more likely patients are to develop or progress to stage III, and the less likely they are to survive without a decrease in viral load.
• Testing is recommended every 3-4 months to determine efficacy.
• Undetectable does not mean the patient's blood is without virus, and reinforces that the patient practices safe sex.
• Viral load testingmeasures the amount of HIV RNA present in the blood.

Discharge Care for Patients with HIV/AIDS

• Emphasize following Standard Precautions and practicing good handwashing techniques.
• Use new, clean gloves when cleaning, doing laundry, or disposing of waste.
• Discourage sharing personal items like razors and toothbrushes.
• Direct patients to direct care.
• Wash dishes, silverware, and cookware in hot, soapy water or use a dishwasher.
• Disinfect bathrooms with a bleach solution and clean up body fluids with the disinfectant liquid, clean often
• When sorting laundry; wash and contain soiled garments separately and dispose of wastes by flushing them down the toilet.

Nonpharmacologic therapies for RA

• Includes rest with exercise, joint positioning, heat or cold applications, weight support, and ambulatory aids
• An aquatic exercise is recommended for patients who have knee OA and patients must remain active
• Encourage the patient to maintain a functional position using minimal pillows in order to reduce undo strain
• Topical Capasaicin products are safe for use as OTC drug to reduce feelings of pain through topical means
• The most common surgical process for OA is the total joint surgical arthroplasty where implant surgery is performed

Cautions for Elderly with RA

• Inquire about the occupation, workload, nature, and history of health to provide unique care
• Be aware that many patients over the age of 60 will have to manage pain and other side effects
• For patients who have undergone surgery, encourage the use of abduction pillow for keeping the legs apart and prevent adduction

SLE and RA

• Assess blood pressure, heart rate, and pulse quality, and for presence of jugular-venous distention or lower extremity edema
• Teach patients and families that regular medical drug monitoring and healthy practices can help to prevent flares and that a person with SLE can live a long and healthy life
• Stress proper rest, limited exposure to the sun, and activities that can keep the body flexible while avoiding complications

Medications for RA

• Gold salts, antimalarials, and sulfasalazine
• Glucocorticoids (steroids such as prednisone or dexamethasone
• Patients may only feel pain in a few joints over the rest of them
• Can use drugs like ibuprofen, naproxen, indomethacin, nabu- metone, and celecoxib
• Methotrexate is a DMARD that can slow the process of infection
• Patients with more severe cases are given gold salts like auraniofin that may causes reactions like rashes and bluish discoloration

NonPharmacological SLE Care

• Teach the patient that SLE, also known as the "great imitator" can have symptoms that show up in any range and organ system
• Encourage stress relief activities while being mindful of what activities should be performed and what other can be excluded or done with help
• Ensure the patient avoids UV light exposure or sunlight in any facet
• Teach the patient that a normal life is indeed achievable with regular medical monitoring, drugs, and medical assistance
• Teach the patient that any blood tests may show other conditions like anemia dysfunctions and antibody presence

SLE treatment medications

• The use of antiinflammatory COX1s and COX2s to provide help with joint pain, fever, and serositis for example
• Use glucocorticoids during periods of heightened flares and use DMARD drugs to keep the body from attacking itself