History and Description

‡ It is marked by progressive failure of the

immune system.
‡ It affects cell- mediated immunity, humoral
immunity and even autoimmunity.
‡ Patients are predisposed to opportunistic
infections and unusual cancers
‡ Centers for Disease Control and
Prevention 1st described this disease in
1981.
Infectious Process
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HIV
‡ Human immunodeficiency Virus
‡ Retrovirus
‡ Belongs to the genus lentivirus which is
called ³slow virus´
‡ Incubation period is 7-12 years, allows
more opportunities for this MO to be
transmitted to other hosts.
CAUSES
‡ Infection with HIV
- Leads to the destruction of CD4 cells,
other immune cells and neuroglial cells
1.Direct inoculation during intimate sexual
contact (esp. Rectal intercourse)
2. Transfusion of contaminated blood
3. Sharing of contaminated needles
4. Transplacental or postpartum transmission
from infected mother to fetus
Signs and Symptoms

Nonspecific
symptoms

Neurologic
Persistent
generalized
Signs and symptoms
resulting from
adenopathy symptoms HIV
encephalopathy

Opportunistic
infection or
cancer
Persistent generalized adenopathy

‡ A condition in which HIV continues to produce

chronic painless swellings in the lymph nodes
during the latency period.
‡ ›

If they detect something
foreign passing through them, they enlarge.
‡ when two or more lymph node groups are
involved, it is called ›
›
 .
‡ Usually this is in response to a significant
systemic disease and will subside once the
person has recovered.
‡ Sometimes it can persist long-term, even
when no explanation for the lymphadenopathy
can be found. This is then called 


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Nonspecific symptoms

‡ - weight loss
‡ -fatigue
‡ -night sweats
‡ -fever
Neurologic symptoms resulting from HIV
encephalopathy

‡ (often called ARC- Aids related complex)

-memory loss
-sleeping problems
-depression
- altered gait
-fatigability
 Opportunistic infection or cancer
1.BACTERIAL(, Salmonillosis, Mycobacterium Avium
Complex)


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and in some cases
deadly infectious disease caused #u
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in humans.
-a form of gastroenteritis u
‡ Tuberculosis usually attacks caused by the ingestion of
the lungs but can also affect other food contaminated with a -A TB like manifestation that
parts of the body. species of Salmonella usually occur when
patient¶s CD4 is below 50.
 2. VIRAL
‡  , (or
‡ 
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simply ,), commonly ‡   is an
known as (
 and also inflammation of the liver - ,

known as ,
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disease characterized by
characterized by the is a highly
a painful skin rash presence of contagious sexually
with blisters in a limited area inflammatory cells in the transmitted disease caused
on one side of the body, tissue of the organ by some sub-types of human
often in a stripe. papillomavirus(HPV).
Hepatitis
Herpes
Genital Warts

‡ Disease of the skin and

‡ Can cause retinitis, pain on mucous memebranes
swallowing and numbnes chracterized by dome-
on legs shaped papule that usually
‡ Can be transmittes thru occurs on the face, trunk
semen, vaginal secretion, and extremities.
blood and breast milk
Malluscum
Cryptomegalovirius, contagiosum
 3.FUNGAL

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a fungal - disease,"and Caver's
infection (mycosis) of any Cryptococcal menin disease) is
of the u species gitisis a fungal a disease caused by
(all yeasts), of the fungus  ›
which u infection of the
 
›

.
› is the most membranes Symptoms of this
common. covering the brain infection vary greatly,
and spinal cord but the disease
(meninges). primarily affects
the lungs.
 4. PNEUMONIA

Pneucystis carinii Pneumonia

(PCP)
‡ is a form of pneumonia
caused by the yeast-
Bacterial like fungus (which had
previously been erroneously
classified as a
Pneumonia protozoan) 

 
.
‡ 

  is commonly
found in the lungs of healthy
people, but being a source
of opportunistic infection it
can cause a lung infection in
people with a weak immune
system\
5. CANCERS

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- Cancerous lesions
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caused by overgrowth of
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 -a cancerous
blood vessel
-associated with HPV tumor of the
-appears as pink/ purple
painless spot or nodules -women with HIV have lymph nodes-
on the surface of skin/ higher rates for these usually a late
oral cavity types of cancers
-occur internally
manifestation of
(intestines, lymph nodes HIV infection
and lungs
 Î. PARASITIC
 
-infection due to the parasite
Toxoplasma gondii
-he infection is most commonly
acquired from contact with cats
and their feces or with raw or
undercooked meat.
Cryptosporidiosis
- Caused by the parasite
cryptoporidium or ³crypto´
-if CD4 is below 200, crypto may
give sx for a long time
-if CD4 is above 20, sx may
appear for 1-3 weeks
-spreads by having contact with
feces containing crypto
 SIGNS AND SYMPTOMS

1.Persistent cough for one Loss of weight (10 % of

month body weight)
2.Generalized pruritic Chronic diarrhea for more
dermatitis than a month
3.Recurrent herpes zoster Prolonged fever for one
4.Oropharyngeal month.
candidiasis
5.Chronic disseminated
herpes simplex
Î.Generalized
lymphadenopathy
 Lipod stroph (fat
Depression distribution Sinus infection
s ndrome)

Weight loss ausea and vomiting Lactic acidosis

eripheral
europath
fatigue
/0
- urning and tingling
of feet and hands
%1%2
/3 4%
diarrhea thrush
PATHOPHYSIOLOGY
 Predisposing Factors: Precipitating factors:
>Age: Young adults >Sexual intercourse:
>Gender: bothe male and (oral, anal) with the
female, male homosexuals,
infected person
>Race: African America,
>Multiple Sex partners
Native American, Middle
East Asia >IV drug administrations
>Transplacental >Blood transfusion and
Transmission organ donation
>Sharing of needle

Exposure to HIV virsu

HIV infection

Will become
detectable 4-
Window Anti-HIV antibodies are produced Î weeks
effect but they don¶t appear immediately after
infection
 HIV circulates in the system

Invade several types of cells; lymphocytes,

macrophages, langerhans cells and neurons

HIV attacks the immune system

The organism attaches to the protein

molecule called CD4 whihc is found in the
surface of T4 cells

HIV enters the T4

Inserts its genetic materials inot the T4 cell¶s
nucleus taking over the cell tp replicate itself

T4 cells die after having been used ti replicate

HIV

Virus matures rapidly making ti more difficult

for the body¶s immune system to recognize
the invaders

Progresses through several stages

 DIAGNOSIS
1. CD4 COUNT the faster the CD4 T-cells
† N CD4 count: 500- 1500 are killed by HIV
† Determines whether the
client is HIV positive or if
the illness is already
categorized as AIDS

2. VIRAL LOAD
† <10 000 viral load is low
† >10 000 viral load is high
† The higher the viral load,
 ELISA
Enzyme- linked
immunosorbent
assay isa biochemical te
chnique used mainly in
immunology to detect
the presence of
an antigen
Western blot test

‡ confirmatory diagnostic test

‡ A method in molecular biology used to
detect a certain protein in a sample by
using antibody specific to that protein. It
also gives info about the size of the
protein.
IMMUNOFLUORESCENT TEST
‡ is a technique used
for light microscopy with a fluorescence
microscope and is used primarily
on biological samples.
‡ This technique uses the specificity
of antibodies to their antigen to
target fluorescent dyes to
specific biomolecule targets within a cell,
and therefore allows visualization of the
distribution of the target molecule through
the sample.
‡ If the sample contains the antigen of
interest, it will emit light.
Tonsillar epithelium infected with HIV
Radio- Immuno- precipitation
assay
‡ Sensitive assay using radiolabeled
Anitgens to detect specific antibodies in
serum.
‡ The antigens are allowed to react with the
serum and then precipitated using a
special reagent such as PROTEIN A
sepharose beads.
‡ Commonly analyzed by gel
electrophpresis
‡ Sometimes used as a confirmatory test for
detecting the presence of HIV antibodies
HIV Antibody tests

‡ Reveals HIV antibodies

‡ whenHIV antibodies are not detectable in the
blood, it is considered as Negative antibody
test
‡ when HIV antibodies are present in the
positive antibody test, the person is
considered ³HIV positive´
‡ Disadvantage:
- May be unreliable at times because of the
³window effect´
-the body takes variable amount of time to
produce detectable antibodies, a window
varying from few weeks and yeven up to 35
months allows an HIV infected person to test
for negative HIV antibodies.
TREATMENT
AIDS DRUGS
‡ medicines used to treat but not cure HIV
infection.
‡ ³ANTEROVIRAL´ drugs
‡ Inhibits reproduction of the virus
‡ Has 3 groups:
1. protease inhibitors
2. nucleoside reverse transriptase inhibitors
3. non nucleoside reverse transcriptade
inhibitors (NNRTIs)
 ANTEROVIRAL DRUGS
protease inhibitors (PIs)
-inhibits the enzyme protease
which are needed for the
assembly of viral particles
‡ zedovudine (Retivir)
‡ zalcitabine (Havid)
‡ Stavudine (Zerit)
‡ Lamivudine (Epivir)
‡ Nevirapine (Videx)

nucleoside reverse transriptase ‡ Saquinavir (Invarase)

inhibitors (NRTIs) ‡ Ritonavir (Norvir)
-inhibits the enxyme nucleoside ‡ Indinavir (Crixivan)
reverse transcriptase which is
needed to copy info for the virus
to replicate

‡ Efavirenz (Sustiva)
‡ Nevirapine (Viramune)
non nucleoside reverse ‡ Delavirdine (Rescriptor)
transcriptade inhibitors (NNRTIs)
.
‡ Immunommodulatory agents
-designed to boost the weakned immune system

‡ Anti- infective and anti neoplastic agents

-to combat infections and associated cancers

‡ Combination therapy
- Combining 2 or more agents in an effort to gain the
maximum benefit with the fewest adverse reactions
-Helps inhibit the production of resistant, mutant strains
-1 PI + 2 NRTIs, 1 NNRTI + 2 NRTI, 3 NNRTI
NURSING MANAGEMENT
1. Health education

- give practical advise

-inform client of the disease process and
mode of transmission
- emphasize AIDS Awareness Program
- avoid judgemental and moralistic messages
- be consistent and concise in giving
instruction esp. In taking meds
- use positive statement
- encourage client to trace or identify
precious contact for proper mgt.
Practice universal/ standard
precaution

‡ Thorough medical handwashing after

every contact with patient and after
removing gown and gloves, and before
leaving the room of an AIDS suspect
‡ Use of universal barrier or Personal
Protective Equipment (PPE)= cap, gloves,
mask, CD gown, face shield/ goggles.
 Prevention
-care should be taken to avoid accidental pricks from sharp
instruments contaminated with potentailly infectious
materials from AIDS pt.
-gloves should be worn when handling blood specimens
and other body secretions
-blood and other specimens must be labeled with special
warning ³AIDS precaution´
- personal articles such as razor, toothbrush should not be
shared with other family members.
‡ Blood spills should be cleaned
immediately using commone household
disinfectants like chlorox
‡ Needles should not be bent after use, it
should be disposed off into a puncture-
resistant container.
‡ -AIDS patients should be isolated
-clients considered at risk for HIV should not
be allowed to donate blood or organs
-encourage monogamous relationship.
-HIV infected pregnant women should go into
regular prenatal, interpartal and postpartal
care.
-speak openly with partners about safe sex
techniques and HIV status.
The Four Cs in the Management
of HIV/ Aids
1. Compliance
-giving info and counseling to the ct. Which
result to the client¶s successful tx,
prevention and recommendation.
2.Counseling and education
a.Treatment
b. Disease
c. Avoiding STD
d. Facts about HIV and AIDS
3.Contact tracing
-tracing out and providing tx to partners

4.condoms
-promotion of the use of condom
-instructions on how to use
-giving away available condoms.
SPECIAL CONSIDERATIONS
‡ Be sure to use precautions in all situations that risk
exposure to blood, body fuids and secretions.
‡ Combination antiretroviral therapy aims to maximally
suppress HIV replication, thereby improving survival.
Stress to patients that medications must be followed
closely and may be required for many years, if not
throughout life.
‡ Immunosuppression caused by HIV
disease maked patients vulnerable to
additional infections and complications.
Patients should undergo periodoic
screening tests for complications
‡ Recognize that a diagnosis of AIDS is
profoundly distressing because of the
disease¶s social impact and the
discouraging prognosis. Provide emotional
support to the patient and family.