Management of Patients with HIV and AIDS

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Management of Patients with HIV and AIDS
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Human Immunodeficiency Virus

• Infectious agent
• Requires human host
• RNA-based retrovirus
• Destroys Helper T-cells (CD4)
• Causes
• HIV encephalopathy
• Wasting syndrome
• Blood abnormalities

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Acquired Immunodeficiency Syndrome (AIDS)

• Group of disorders caused by the progressive
  immune system destruction associated with HIV
  infection
• Characterized by opportunistic diseases and
  neoplasias

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HIV Modes of Transmission

• Contact with infected blood/blood products
• Contact with infected body fluids
• Across placental barrier from infected mother to
  fetus, or through cervical or blood contact at
  time of delivery or through breast milk
• What factor increases exposure risk?

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HIV/AIDS Important Aspects of Care

• Prevention
• Safer Sex Practices
• Harm Reduction Strategies
• Reproductive education
• Early detection
• Enzyme immunoassay testing
• Ongoing treatment
• Managed as a chronic disease
• Outpatient care setting

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Healthcare Provider Transmission Prevention
Strategies

• Describe Standard Precautions
• What entity developed recommendations for
  post-exposure?
• Discuss recommendations for Post-exposure
  Prophylaxis.

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HIV Lifecycle

• HIV GP120 and GP41 attach to uninfected CD4 cell
  surface (receptor) and fuse with cellular
  membrane
• Viral core contents empty into host cell
  (uncoating)
• HIV enzyme reverse transcriptase copies viral
  gentic material from RNA into the double-stranded
  DNA
• Double-stranded DNA is spliced into cellular DNA
  by action of integrase

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HIV Lifecycle (continued)

• Using provirus (integrated DNA) as a blueprint,
  the cell makes new viral proteins and viral RNA
• HIV protease cleaves the new proteins
  (polyproteins)
• New proteins join the viral RNA into new viral
  particles
• New viral particles bud from the cell and start
  the process over.

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Stages of HIV Disease

• Based on
• Clinical history, physical exam, lab evidence of
  immune dysfunction, signs/symptoms, and presence
  of infections and malignancies
• Include
• Primary infection (part of CDC Category A)
• HIV Symptomatic (CDC Category A)
• HIV Symptomatic (CDC Category B)
• AIDS (CDC Category C)

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Nursing Responsibilities Related To Antibody
Testing

• Pre-test
• Explanation of meaning of test and possible test
  results informed consent
• Confidentiality
• Education and Counseling
• Post-test
• Positive ongoing counseling, referrals to
  social, financial, medical and psychological
  support services

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HIV Testing

• Enzyme immunoassay testing (EIA)
• Western blot
• Viral load
• CD4/CD8 ratio
• What is the window period and what is its
  significance?

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HIV Infection Treatment

• What is the most concerning detail regarding
  HIV/AIDS treatment?
• Treatment decisions must be individualized.
• What classification of drugs will be used to
  treat HIV/AIDS?
• What are the goals of drug therapy?
• What test is used to evaluate results of therapy?

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HIV Drug Therapy

• HAART (highly active antiretroviral therapy)
• Classes of Antiretrovirals
• Non-nucleoside reverse transcriptase inhibitors
• Nucleoside reverse transcriptase inhibitors
• Protease inhibitors
• Fusion inhibitors
• What other drug classes would you anticipate
  using in the treatment of AIDS?

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HIV Drug Resistance

• Results from spontaneous genetic mutation of the
  pathogen or in response to medication exposure
• Factors associated with development
• Serial monotherapy
• Inadequate suppression of viral replication with
  suboptimal treatment regimens
• Difficulty adhering to complex and toxic regimens
• Initiating therapy late in course of illness

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Clinical Manifestations

• Respiratory
• Gastrointestinal
• Oncologic
• Neurologic
• Depressive
• Integumentary
• Endocrine
• Gynecologic

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Medical Management

• Treatment of Infections
• Antidiarrheal Therapy
• Chemotherapy
• Antidepressant Therapy
• Nutrition Therapy
• Complimentary and Alternative Modalities
• Supportive Care

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Nursing Interventions

• Promote skin integrity
• Promote usual bowel patterns
• Prevent infections
• Improve activity tolerance
• Maintain thought processes
• Improve airway clearance
• Relieve pain and discomfort
• Improve nutritional status
• Decrease sense of isolation
• Increase coping ability

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Nursing Interventions

• Monitor and manage potential complications
• Opportunistic infections
• Respiratory failure
• Cachexia and wasting
• Side effects of medications