HIV
Transmission
1. Blood, semen, vaginal secretions, or breast milk.
2. Sexual transmission is the most common mode of transmission
3. Exposure to HIV infected blood or blood products
4. Perinatal transmission during pregnancy, at delivery or through breastfeeding
5. The partner who receives the semen is at greater risk for infection
Risk of infection after exposure
1. 0.3% to 0.4% after a needle stick exposure
2. 25% of infants born to women with untreated HIV infection are born with HIV
Requirements of transmission
1. Exposure to blood, semen, vaginal fluids, or breast milk
2. A means for HIV to enter the host (open lesions or mucosal tissue)
3. Sufficient levels of HIV virus in infected body fluids
HIV cannot be spread through
1. Hugging, kissing, shaking hands, sharing utensils, using toilet seats
2. Tears, saliva, urine, emesis, sputum, feces, sweat, respiratory droplets
Pathophysiology
1. Virus enters the host
2. CD4 T cells are targeted by HIV virus
3. HIV enters CD4 T cells and replicates and destroys the cell
4. CD4 T cells are a type of lymphocyte (white blood cell) >500 uL is the normal count
5. Low CD4 levels (<500 uL) increase a patient's risk for infection
6. Severe problems develop when CD4 T cell count is < 200 (infections and cancer)
7. HIV destroys about 1 billion CD4 T cells a day
AIDS (acquired immunodeficiency syndrome)
1. CD4 T cell count drops below 200 cell/uL
2. Opportunistic infections
a. Bacterial
b. Fungal
c. Protozoal
d. Viral
3. Opportunistic cancers
a. Burkitt’s lymphoma
b. Immunoblastic lymphoma
c. Invasive cervical cancer
d. Kaposi sarcoma
e. Primary lymphoma
4. Wasting syndrome (cachexia)
a. 10% or more of ideal body mass
5. Diagnosis takes around ten years if left untreated
Clinical Manifestations
1. Acute infection 1 to 3 weeks
2. HIV antibody test becomes positive 3 weeks to 3 months
3. Asymptomatic infection 2 months to 8 years
4. Symptomatic infections 8 to 10 years
5. AIDS 10 years
Acute Infection
1. 1 to 3 weeks after exposure
2. Highest viral load
3. Develop flu like symptoms
a. Fever
b. Fatigue
c. Sore throat
d. Enlarged lymph nodes
e. Headache
f. Muscle and joint pain
g. Diarrhea
h. Rash
Chronic Infection
1. 3 weeks to throughout the patient's lifetime
2. Patients are asymptomatic
3. Patients unknowingly transmit HIV infection through sexual contact
AIDS
1. When the CD4 T cell count is <200 symptoms usually begin
2. Symptoms include
a. Fever
b. Night sweats
c. Chronic diarrhea
d. Severe fatigue
e. Oral candidiasis (thrush)
f. Shingles
g. Oral or genital herpes
h. Kaposi sarcoma
i. Dementia
Diagnosis
1. Rapid antibody screening tests
a. Done in HCP office or at home
b. Finger stick or saliva
c. Results in 20-30 minutes
d. Antibodies appear after 3 weeks to 3 months after infection, may show false negative if
done within this timeframe
e. If positive, must be verified with an antigen/antibody test
2. Antigen/antibody test
a. Done in a lab
b. Detects both antibodies and antigens
c. Antigens are produced earlier than antibodies so diagnosis can be made sooner
Test to Monitor Progression of Disease
1. CD4 T cell count
a. Measures statues of immune cells
b. Normal 800 - 1200 cell/uL
c. Low <500 uL (Immune problems begin)
d. AIDS <200 uL (Severe symptoms)
e. If CD4 T cell count rebounds back to >800, then treatment is effective
2. HIV viral load
a. Measures amount of active HIV in the blood
b. Correlates strongly with stage of disease
c. If viral load is decreasing, then treatment is effective
Goals of Treatment
1. Initiate/monitor ART (Antiretroviral therapy)
2. Monitor HIV progression
a. Increase CD4 T cell count
b. Decrease HIV viral load
3. Prevent symptoms and opportunistic infections/cancer
4. Prevent HIV transmission
5. HIV cannot be cured
ART (Antiretroviral Therapy)
1. Reduces viral load by 90% - 99% by slowing viral replication
2. The goal of ART is to suppress HIV virus to an undetectable level
3. Slows viral replication which leads to a decreased viral load
4. People who take HIV medications as prescribed and keep an undetectable viral load have
effectively no risk of transmitting HIV
5. U=U (Undetectable = Untransmittable)
6. The patient remains HIV positive, even with an undetectable load
7. Adherence to drug regimens is critical to prevent
a. Disease progression
b. Opportunistic disease
c. Viral drug resistance
8. ART therapy requires 3 or more combination drugs as resistance develops rapidly when they are
used alone
9. Has many side effects
10. Is expensive
11. Side effects
a. Depression
b. Diarrhea
c. Peripheral neuropathy
d. Pain
e. Nausea/vomiting
f. Fatigue
PrEP (Pre-exposure Prophylaxis)
1. Combination of two ART meds
2. Taken daily as a preventative measure
3. Not effective when not taken consistently
PEP (Post-exposure Prophylaxis)
1. Taken ART after potential HIV exposure
2. Use in emergency situations - not regular use
3. Does not replace HIV prevention measures
4. Must be taken within 3 days of exposure
5. Taken daily for 28 days
Health Promotion/Disease Prevention
1. Sexual intercourse
a. Abstinence
b. Non-contact safe sex
c. Use of condoms
2. Drug use
a. Don’t use drugs
b. Don’t share needles
c. Don’t have sexual intercourse under the influence of impairing substances
Nursing Care
1. Nutritional support
2. Moderation or elimination of alcohol, tobacco, and drugs
3. Mental health counseling
4. Vaccines - keep up to date
5. Rest, exercise, and stress reduction
6. Avoid exposure to infectious agents
7. Taking antiretroviral medications (ART)