Dr. Jayesh V. Patidarwww.drjayeshpatidar.blogspot.com

NURSING CARE OF

THE CLIENT: HIV AND

AIDS

HIV and AIDS

The human immunodeficiency virus

(HIV), first reported in the U.S. in 1981, is

a retrovirus that causes acquired

immunodeficiency syndrome (AIDS), a

progressively fatal disease that destroys

the immune system and the body’s ability

to fight infection.

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HIV/AIDS Statistics

By the end of 1998, an estimated 33.4

million people in the world were living with

HIV/AIDS.

In the U.S., 688,200 cases of AIDS

reported by the end of 1998, with as many

as 900,000 infected with HIV.

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Continuum of HIV Disease

Advanced HIV disease (AIDS)

Early HIV disease (Symptomatic infection)Persistent, unexplained fever, night sweats, diarrhea, weight loss, fatigue, and lymphadenopathy;

signs and symptoms may not occur until 10 years or more after initial exposure

Asymptomatic HIV Infection (HIV Seropositivity)Infectious but no evidence of illness except positive HIV antibody test

Primary HIV infection (acute infection)Flu-like s ymptoms; develop antibodies to HIV in 1 to 6 months

Initial Exposure

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AIDS-Defining Conditions

Most AIDS-defining conditions are

opportunistic infections (infections in

persons with a defective immune system

that rarely cause harm in healthy

individuals).

Pneumocytis carinii pneumonia is the

most frequent AIDS-defining condition in

the U.S. and Europe.

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AIDS Testing

The enzyme-linked immunosorbent assay (ELISA) is the basic screening test to detect antibodies of HIV.

A confirmatory test, the Western blot, is always employed when the ELISA is positive.

The two taken together have an extremely high accuracy rate.

Obtaining a signed informed consent for testing is often a nursing responsibility.

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Demographics of AIDS in the

United States

Age (AIDS affects mainly people during

the most productive years of their life).

Gender (More men from women, though

women’s rates are increasing).

Race (The HIV/AIDS epidemic is growing

most rapidly among some minority

populations and is a leading cause of

death of African American males).

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Modes of Transmission

The virus may be found in blood, semen,

vaginal secretions, and breast milk of

infected individuals.

No evidence that HIV is spread through

sweat, tears, urine, or feces. Risk of

infection from “deep kissing” or oral sex is

unknown.

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Medical-Surgical Management

MEDICAL

Goal is to keep

disease from

progressing as

long as possible.

Patient monitored

by viral load test.

PHARMACOLOGICAL

Goal of anti-HIV treatment is to keep viral load as low as possible for as long as possible.

Use of protease inhibitors.

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Common Diagnostic Tests for

HIV and AIDS

CD4-T-cells

ELISA

Polymerase chain reaction (PCR)

Western blot

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Pulmonary Opportunistic

Infections

Pneumocystis Carinii Pneumonia.

Histoplasmosis.

Tuberculosis.

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Pneumocystis Carinii

Pneumonia

The most common opportunistic infection associated with advanced HIV disease.

Found primarily in the lungs, but also reported in the adrenal glands, bone marrow, skin, thyroid, kidneys, and spleen.

Clinical signs include fever, shortness of breath, nonproductive cough, and crackles.

Initial diagnosis made by chest x-ray.7/14/2014 12www.drjayeshpatidar.blogspot.in

Histoplasmosis

An infection caused by the fungus

Histoplasma capsulatum. The fungus has

been isolated in bird droppings, dirt from

chicken coops, and caves.

Histoplasmosis should be suspected if the

person presents with fever of uncertain

origin, cough, and malaise.

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Gastrointestinal Opportunistic

Infections

Mycobacterium avium complex.

Cytomegalovirus.

Cryptosporidiosis.

Hepatitis.

HIV-wasting syndrome.

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Mycobacterium avium complex

In persons with AIDS, involvement of the

bowel is usually extensive. The

microorganism can fill the bone marrow

and lymph nodes.

Most common symptoms are chronic

fever, malaise, anemia, weight loss,

diarrhea, and abdominal pain.

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Cytomegalovirus (CMV)

Belongs to the herpes virus group.

Causes disease by destroying the brain,

lung, retina, and liver.

Signs and symptoms include weight loss,

fever, diarrhea, and malaise.

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Cryptosporidosis

Caused by a protozoan that usually infects the epithelial cells that line the digestive tract.

Clinical signs include profuse water diarrhea, up to 20 liters a day. Abdominal pain, serious weight loss, abdominal cramping, anorexia, low-grade fever, dehydration, electrolyte imbalance and malaise may also be present.

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Hepatitis

Hepatitis B virus, C virus, and D virus are

commonly seen with HIV infection.

Signs and symptoms include malaise,

weakness, anorexia, nausea, vomiting,

and right upper quadrant pain.

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HIV-Wasting Syndrome

Defined as unexplained weight loss of more than 10% of body weight accompanied by weakness, chronic diarrhea, and fever in those affected with HIV.

Signs and symptoms include anorexia, diarrhea, nausea, vomiting, changes in taste and smell, aphthous ulcers of mouth and esophagus, and abdominal pain.

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Oral Opportunistic Infections

Oral candidiasis (thrush), a fungal infection, is seen in more than 90% of AIDS clients. Symptoms include unpleasant taste, mouth dryness, and creamy, white oral plaques.

Oral Hairy Leukoplakia (OHL) usually appears as a white patch on the lateral borders of the tongue. OHL is not usually bothersome to the client and may regress spontaneously.

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Gynecological Opportunistic

Infections

Vaginal Candidiasis is the most common

initial infection occurring in HIV-infected

women.

Cervical Intraepithelial Neoplasia (CIN) is

of a much higher incidence in women

affected with HIV.

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Central Nervous System

Opportunistic Infections

AIDS dementia complex.

Toxoplasmosis.

Cryptococcosis.

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AIDS Dementia Complex

The most common central nervous

system complication in persons with

AIDS.

This disorder is chronic and progressive

with cognitive, motor, and behavioral

dysfunction.

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Toxoplasmosis

Caused by the protozoan Toxoplasma

gondii, found in cats and other animals.

Clinical signs may be vague and

nonspecific, ranging from mild headache,

fever, and lethargy to poor coordination,

seizures, and coma.

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Cryptococcosis

A fungal infection caused by

Cryptococcus neoformans.

The most life-threatening fungal infection

associated with AIDS.

Clinical symptoms include fever,

headache, nausea, vomiting, dizziness,

photophobia, mental status changes,

seizures, and stiff neck.

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Opportunistic Malignancies:

Kaposi’s Sarcoma

A vascular malignancy that can occur any

place in the body, including the internal

organs.

First lesions often appear subtly on the

face or in the oral cavity.

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Opportunistic Malignancies:

Non-Hodgkin’s Lymphoma

Clinical manifestations include fever,

night sweats, and weight loss.

Treatment of NHL in clients with

advanced HIV disease is often withheld,

because it is not tolerated well and may

even lead to earlier death.

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Thank you

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