Transcript Transmission of HIV

Zoya Minasyan RN-MSN-Edu
Globally
 33 million living with HIV
 2.7 million new infections each year
 2 million HIV-related deaths each year
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In the United States
• 56,000 new infections each year
• Since the beginning of the epidemic, sub-Saharan Africa has
been the most devastated, but the Caribbean, Asia, Eastern
Europe, and South America also have growing epidemics.
• In developing countries, the major route of transmission is
heterosexual sex, and women and children bear a large part
of the burden of illness.
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Fragile virus transmitted only through contact
with body fluids
Blood, semen, vaginal secretions, and breast milk
 Sex with infected partner
 Exposure to infected blood or blood products
 Pregnancy, delivery, or breastfeeding
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RNA virus (retrovirus) discovered in 1983
Binds to specific CD4 and chemokine receptors to enter cell
HIV has gp120 glycoproteins that attach to CD4 and chemokine CXCR4 and CCR5 receptors on the
surface of CD4+ T cells. Viral RNA then enters the cell, produces viral DNA in the presence of reverse
transcriptase, and incorporates itself into the cellular genome in the presence of integrase, causing permanent
cellular infection and the production of new virions. New viral RNA develops initially in long strands that are cut
in the presence of protease and leave the cell through a budding process that ultimately contributes to cellular
destruction.
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Reverse transcriptase assists to make viral
DNA.
Viral DNA enters cell nucleus and splices itself
into genome permanently.
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Integrase
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Initial infection
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Viremia (large viral levels in blood) for 2 to 3 weeks
 Transmission is more likely when viral load is high.
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Followed by prolonged period (years) of low viral
load
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Cells with CD4 receptor sites are infected
 CD4+ T cells (T helper cells)
 Lymphocytes
 Monocytes/macrophages
 Astrocytes
 Oligodendrocytes
Immune problems start when CD4+ T-cell
counts drop to below 500 cells/μL.
 Normal range is 800 to 1200 cells/μL.
Allows for opportunistic diseases
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Acute infection
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Flulike symptoms
 Fever, swollen lymph glands, sore throat, headache,
malaise, nausea, muscle and joint pain, diarrhea, or a
diffuse rash
 Occurs about 2 to 4 weeks after infection
 Lasts for 1 to 2 weeks
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Early chronic infection

Generally asymptomatic
 Fatigue, headache, low-grade fever, and night sweats
often occur.
 Most are not aware of infected status.
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Intermediate chronic
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CD4+ T cells drop to 200 to 500 cells/μL.
 Viral load increases.
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HIV advances to a more active state.
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Intermediate chronic symptoms
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Thrush
Oral hairy leukoplakia
Shingles
Persistent vaginal candidal infections
Herpes
Bacterial infections
Kaposi sarcoma
Oral thrush involving hard and soft palate.
Oral hairy leukoplakia on the lateral aspect of the tongue.
Kaposi sarcoma (KS). Malignant vascular lesions. KS lesions can appear anywhere
on the skin surface or on internal organs. Lesions vary in size from pinpoint to very large and
may appear in a variety of shades.
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Late chronic or AIDS
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Immune system severely compromised
Great risk for opportunistic disease
Possible malignancies, wasting, and dementia
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Common opportunistic diseases
Pneumocystis jiroveci pneumonia
 Cryptococcal meningitis
 Cytomegalovirus retinitis
 Mycobacterium avium complex
 Kaposi sarcoma
 Influenza virus
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Chest x-ray showing interstitial infiltrates as the result of
Pneumocystis jiroveci pneumonia.
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Most useful screening tests detect HIV-specific
antibodies
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May take 2 months (window period) to detect
antibodies
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Progression monitored by CD4+ T-cell counts
and viral load
Abnormal blood tests common
Neutropenia, thrombocytopenia, and anemia
 Altered liver function tests
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Resistance tests
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Monitoring HIV disease progression and
immune function
Initiating and monitoring antiretroviral therapy
(ART)
Preventing, detecting, and treating
opportunistic infections
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Managing symptoms
Preventing or decreasing complications of
therapies
Preventing further transmission
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Initial visit
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Gather baseline data
Education about spectrum of HIV, treatment,
preventing transmission, improving health, and
family planning
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Initial visit
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Gather baseline data
Education about spectrum of HIV, treatment,
preventing transmission, improving health, and
family planning
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Main goals
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Decrease viral load.
Maintain/raise CD4+ counts.
Delay HIV-related symptoms and opportunistic
infections.
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Nucleoside, non-nucleoside, and nucleotide
reverse transcriptase inhibitors
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Inhibit the ability of HIV to make a DNA copy early
in replication
Protease inhibitors
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Interfere with activity of enzyme protease
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Fusion inhibitors
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Interfere with HIV CD4 receptor site binding and
entry into cells
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Combination antiretroviral therapy
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Three or more drugs from different groups are
prescribed at full strength.
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Prophylactic medication given to prevent
opportunistic infection
Ongoing research seeks a biochemical means of
preventing HIV transmission.
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Ask at-risk patients:
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Received blood transfusion or clotting factors before
1985?
Shared needles, syringes, or other injection
equipment with another person?
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Ask at-risk patients:
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Had a sexual experience with your penis, vagina,
rectum, or mouth in contact with these areas of
another person?
Had a sexually transmitted disease (STD)?
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Assess diagnosed patients
Repeat assessments over time as circumstance
changes
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Interventions
Adhere to drug regimens.
 Promote healthy lifestyle.
 Prevent transmission to others.
 Have supportive relationships.
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Interventions
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Maintain productive activity.
Explore spirituality.
Come to terms with living with disease, disability,
and death.
Cope with symptoms and treatments.
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HIV is a highly variable chronic disease.
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Holistic and individualized approach is best.
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Major goal: Prevention
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Four strategies
 Use testing as routine health care.
 Use rapid testing.
 Work to modify risky behaviors.
 Offer tests universally to pregnant women.
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Prevention of HIV
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Decreasing risks: Sexual intercourse
 Use of barriers
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Prevention of HIV
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Decreasing risks: Drug use
 Do not use drugs.
 Do not share equipment.
 Do not have sexual intercourse under the influence of
any impairing substance.
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Prevention of HIV
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Decreasing risks: Perinatal transmission
 Prevent HIV in women.
 Appropriately medicate HIV-infected pregnant women.
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Prevention of HIV
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Decreasing risks: Work
 Adhere to precautions and safety measures to avoid
exposure.
 Postexposure prophylaxis with combination ART.
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Testing is only sure method to determine
infection.
Negative results: Opportunity for prevention
education
 Positive results: Treatment and education to protect
sexual and drug-using partners
 All testing should be accompanied by pretest and
posttest education
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Early intervention promotes health and delays
disability.
Reactions to positive HIV test
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Similar to any life-threatening, chronic illness
 Panic, anxiety, fear, guilt, depression, denial, anger,
hopelessness
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Multidrug therapy can reduce viral load and
disease progression, but it
Is complex
 Has interactions
 Does not work for everyone
 Is expensive
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When to start therapy
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Patient readiness is the most important concern.
To avoid burnout and nonadherence, treatment is
recommended when immune suppression is great.
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Adherence to drug regimens is critical to
prevent
Disease progression
 Opportunistic disease
 Viral drug resistance
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Ways to improve adherence
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Understand each patient is unique.
Provide electronic reminders or timers.
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Recurring problems of infection, cancer,
debility, and psychosocial/economic issues
affect ability to cope.
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Social stigma
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Behaviors may be viewed as immoral, illegal, or
uncontrolled by infected person.
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Discrimination causes loss of jobs, homes, and
insurance.
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Most severe for women
Americans with Disabilities Act makes
discrimination illegal.
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Common physical problems
Anxiety, fear, depression
 Diarrhea
 Peripheral neuropathy
 Pain
 Nausea/vomiting
 Fatigue
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Common metabolic disorders
Lipodystrophy
 Hyperlipidemia
 Insulin resistance
 Bone disease
 Lactic acidosis
 Cardiovascular disease
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FiLipodystrophy manifestations.
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Management of metabolic disorders
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Early detection
Dealing with symptoms
Helping to cope
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Focus of nursing intervention
Patient comfort
 Promoting acceptance of finite nature of life
 Helping significant others deal with loss
 Maintaining safe environment
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