ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

DEFINITION
AIDS is acquired, which means it is neither hereditary nor inborn. It involves an
immune deficiency. When a persons immune system breaks down, he or she becomes
susceptible to many infections, which eventually lead to death. It is a syndrome, a
combination of signs and symptoms that form a distinct clinical picture of disorder.
HIV refers to the human immunodeficiency which causes AIDS. It is a retro virus
belonging to the family of lentiviruses, which are sometimes called slow viruses. They
are described as such because the time between infection and the appearance of
symptoms tends to be much longer, allowing greater opportunity for these
microorganisms to be transmitted to other hosts. The period between infection and the
appearance of AIDS can take from 7 to 12 years.
PATHOPHYSIOLOGY
Human beings produce antibodies against specific infections. When HIV infection
takes place, anti-HIV antibodies are produced but they do not become detectable
immediately. This is called the window effect. In some cases, however, antibodies to
HIV become detectable 4 to 6 weeks after infection.
When HIV is in circulation, it invades several types of cells the lymphocytes,
macrophages, the Langerhans cells, and neurons within the CNS.
HIV attacks the bodys immune system. The organism attaches to a protein
molecule called CD4, which is found on the surface of T4 cells. Once the virus enters
the T4, it inserts its genetic materials into the T4 cells nucleus, taking over the cell to
replicate itself. Eventually, the T4 cell dies after having been used to replicate HIV.
The virus mutates rapidly, making it more difficult for the bodys immune system
to recognize the invaders. HIV infection progresses through several stages. The
clinical course of HIV infection begins when a person becomes infected with HIV
through:
1. Sexual contact with an infected person
2. Injection of infected blood or blood products, and
3. Perinatal or vertical transmission


MODIFIED CLASSIFICATION (STAGES) OF HIV INFECTION (U.S. CDC)
CLINICAL STAGE 1: ASYMPTOMATIC
Asymptomatic/acute HIV infection characterize by genera lymphadenopathy
CLINICAL STAGE 2: EARLY (MILD)
Weight loss greater than 10% of body weight
Minor mucocutaneous manefistation, like;
a. Seborrhic dermatitis
b. Fungal nail infection
c. Recurrent oral ulceration
d. Angular cheilitis
e. Recurrent respiratory infection (rhinitis, tonsilopharyngitis)
CLINICAL STAGE 3: INTERMEDIATE (MODERATE)
Weight loss greater than 10%
Chronic unexplained diarrhea for more than one month
Oral candidiasis (thrush)
Oral hairy leukoplakia
Severe bacterial infection, like pneumonia
CLINICAL STAGE 4: LATE (SEVERE) AIDS
HIV wasting syndrome
Pneumocystis carinii pneumonia
Toxoplasmosis of the brain
Cryptosporidiosis with diarrhea for more than one month
Herpes simplex virus infection
Progressive multifocal leukoencephalopathy
Disseminated endemic myocosis


HIV infection


Acute illness
(fever, rash, joint and muscle pain, sore throat)


Chronic illness
Opportunistic infections
Weight loss, diarrhea
Lympadenopathy, fatigue

AIDS
Kaposis sarcoma
Pneumocystis carinii
Pneumonia
Cryptococcal meningitis








SIGNS AND SYMPTOMS
A person may remain asymptomatic, feeling and appearing healthy for years even
though he or she is infected with HIV. While he or she does not exhibit AIDS, the
immune system starts to be impaired. The person may exhibit neurological symptoms
such as memory loss, altered gait, depression, sleep disorders, and gastrointestinal
symptoms such as chronic diarrhea. This set of symptoms is often called AIDS- related
complex (ARC) by clinicians. As the symptoms progress, the patient becomes an AIDS
patient.
Normal CD4 count ranges from 500-1500. The CD4 count is a criterion that determines
whether the client is HIV positive or whether the illness is already categorized as AIDS.
A viral load of less than 10,000 is considered low, and a viral load of more than 10,000
is high. The higher the viral load, the faster the CD4. T-cells are killed by HIV. Thus, a
CD4 count of 230 viral load of 350,000 would be considered of a serious risk for disease
progression to AIDS and HIV and treatment is absolutely indicated.
MINOR SIGNS
1. Persistent cough for 1month
2. Generalized pruritic dermatitis
3. Recurrent herpes zoster infection
4. Oropharyngeal candidiasis
5. Chronic disseminated herpes simplex infectin
6. Generalized lymphadenopathy
MAJOR SIGNS
1. Loss of weight 10% of body weight
2. Chronic diarrhea for more than one month
3. Prolonged fever for one month
TOP 10 SYMPTOMS OF HIV/AIDS
1. Depression
2. Diarrhea
3. Thrush
4. Weight loss
5. Lipodystrophy (fat redistribution syndrome)
6. Sinus infection
7. Fatigue
8. Nausea and vomiting
9. Lactic acidosis lactic acid builds up in the clients body due to damage in the
mitochondria, the power house of the cell
10. Burning and tingling of the feet and hands ( peripheral neuropathy )
COMMON OPPOTUNISTIC INFECTIONS
1. Bacterial
a. MAC mycobacterium avium complex, a TB-like manifestation tha usually
occurs when the patients CD4 count is below 50
b. Tuberculosis
c. Salmonillosis
2. Viral
a. Herpes
b. Hepatitis
c. Genital warts
d. CMV(cryptomegalovirus) can cause retinitis, pain on swallowing and
numbness of the legs. This can be transmitted through semen, vaginal
secretions, blood and breast milk.
e. Molluscum contagiosum a disease of the skin and mucous membranes
characterized by dome-shape papules that usually occur on the face,
trunk and extremities.

3. Fungal
a. Candidiasis
b. Cryptococcal meningitis
c. Histoplasmosis- small lesions that appear on the skin usually transmitted
by direct contact; it is autoinoculable. The organism is resistant to
treatment. When the CD4 count falls below 200, lesions tend to proliferate
and start to spread. Other symptoms are fever, adenopathy, cough,
shortness of breath, and weight loss.
4. Pneumonias
a. Bacterial
b. Pneucystis carinii pneumonia(PCP) an atypical type of pneumonia
5. Cancers
a. Kaposis sarcoma- a cancerous lesion caused by overgrowth of blood
vessels. KS typically appears as painless pink or purple spots or nodules
on the surface of the skin or oral cavity. It can also occur internally,
especially on the intestine, lymph nodes, and lungs. The cancer can
spread and can also attack the eyes.
b. Cervical dysplasia and cancer researchers found out that women with
HIV have higher rates of this type of cancer. Cervical carcinoma is
associated with Human Papilloma Virus (HPV).
c. Non-Hodgkins lymphoma cancerous tumor of the lymph nodes. This is
usually a late manifestation of the HIV infection.
6. Parasitic
a. Toxoplasmosis Parasitic disease that causes neurologic symptoms
b. Cryptosporidiosis is cause by the microscopic parasite cryptosporidium,
commonly known as crypto. It can cause severe illness in people with
HIV. If the CD4 count is below 200, crypto may cause symptoms for a long
time. If the CD4 count is above 200, symptoms may appear only for one to
three weeks. Cryptosporidiosis spreads by having contact with feces
containing crypto. It is not transmitted by contact with blood. There is no
drug cure for crypto. However, anti-retroviral medicines decrease or get rid
of symptoms.
SIGNS AND SYMPTOMS
Watery diarrhea
Abdominal cramps
Low-grade fever
Weight loss due to persistent diarrhea
PREVENTIVE MEASURES AGAINST CRYPTO
1. Wash hands thoroughly after contact with feces
2. Practice safe sex
3. Be careful not to swallow water when swimming
4. Wash and/or cook food properly
5. Drink safe water
MODE OF TRANSMISSION
1. Sexual intercourse
2. Blood transfusion and sharing of infected syringes and needles among
intravenous drug users
3. Vertical or perinatal transmission ( from a pregnant woman to the fetus during
pregnancy, child delivery, or breast feeding)
There are several ways of receiving infected blood:
1. Blood transfusion
2. Sharing of unsterilized syringes and needles used for intravenous injection
3. Transmission during pregnancy
a. May be transplacental
b. There is greater risk of transmission when the mother has develop
advanced AIDS
4. Organ donation
5. Accidental exposure in hospitals or clinics
DIAGNOSTIC EXAMINATION
1. EIA or ELISA enzyme linked immunosorbent assay
2. Particle agglutination (PA) test
3. Western blot analysis confirmatory diagnostic test
4. Immunofluorescent test
5. Radio immune-precipitation (RIPA)
6. HIV antibody test
When HIV antibodies are not detectable at the time of examination, it is
considered a negative antibody test.
When HIV antibodies are present in the blood in the positive antibody
test the person is considered HIV-positive
TREATMENT MODALITIES
AIDS drugs are medicines used to treat but not cure HIV infection. These drugs are
sometimes referred to as anti-retroviral/anteroviral Drugs. These work by inhibiting the
reproduction of the virus. There are two groups of anteroviral drugs-reverse
transcriptase inhibitors and protease inhibitors:
1. Reverse transcriptase inhibitors they inhibit the enzyme called reverse
transcriptase, which is needed to copy information for the virus to replicate
these drugs are:
a. Zedovudine (ZDV) Retirvir
b. Zalitabine Havid
c. Stavudine Zerit
d. Lamivudine Epivir
e. Nevirapine viramune
f. Didanosine Videx
2. Protease inhibitors. They work by inhibiting the enzyme which are neede of viral
particles. These drugs are:
a. Saquinavir invarase
b. Ritonavir norvir
c. Indinavir crixivan

NURSING MANAGEMENT
1. Health Education. The health care worker must:
a. Give practical advise
b. Inform the client of the disease process and the mode of transmission
c. Emphasize the AIDS awareness program
d. Avoid judgemental and moralistic messages
e. Be consistent and concise in giving instructions, especially those about taking
medications
f. Use positive statement
g. Encourage client to trace or identify previous contacts for proper management
2. Practice universal/standard precaution
a. There is a need for a thorough medical handwashing after every contact with
each patient and after removing the gown and gloves, and before leaving the
rooms of an AIDS suspect or known AIDS patient.
b. Use universal barriers or personal protective equipment (PPE) e.g., cap,
mask, gloves, CD gown, face shield/ googles, is very necessary.
3. Prevention
a. Care should be taken to avoid accidental pricks from sharp instruments
contaminated with potentially infectious materials from an AIDS patient.
b. Gloves should be worn when handling blood specimens and other body
secretions, as well as surfaces, material, and objects exposed to them.
c. Blood and the other specimens should be labelled with a special warning
such as AIDS Precautions
d. Blood spills should be cleaned immediately using common household
disinfectants, such as chlorox
e. Needles should not be bent after use, but should be disposed into a puncture
resistant container.
f. Personal articles, like razor or razor blades and toothbrushes, should not be
shared with other members of the family. Razor blades may be disposed in
the same manner as needles.
g. Patients with active AIDS should be isolated.
h. Clients considered at risk HIV should not be allowed to donate blood or any
organ of the body.
i. Encourage monogamous relationships
j. HIV-infected pregnant women should go into regular prenatal, interpartal, and
postpartal care.
k. Speak openly with partners about safer sex techniques and HIV status.


COMMON NURSING DIAGNOSIS
Knowledge deficit
Social isolation
Risk for infection
Anxiety
Self-esteem disturbance
Altered role performance
THE FOUR Cs IN THE MANAGEMENT OF HIV/AIDS (DOH 2000, P. 296)
1. Compliance- making sure the client sticks with the program.
2. Counseling/education
a. Giving instructions about the treatment
b. Disseminating information about the disease
c. Providing guidance on how to avoid contracting STD again
d. Sharing facts about HIV and AIDS
3. Contact tracing tracing and providing treatment to partners
4. Condoms promoting the use of condoms by giving away samples and providing
information on their proper use.