Dr. Jayesh V. Patidar
NURSING CARE OF
THE CLIENT: HIV AND
HIV and AIDS
The human immunodeficiency virus
(HIV), first reported in the U.S. in 1981, is
a retrovirus that causes acquired
immunodeficiency syndrome (AIDS), a
progressively fatal disease that destroys
the immune system and the body’s ability
to fight infection.
By the end of 1998, an estimated 33.4
million people in the world were living with
In the U.S., 688,200 cases of AIDS
reported by the end of 1998, with as many
as 900,000 infected with HIV.
Continuum of HIV Disease
Advanced HIV disease (AIDS)
Early HIV disease (Symptomatic infection)
Persistent, unexplained fever, night sweats, diarrhea, weight loss, fatigue, and lymphadenopathy;
signs and symptoms may not occur until 10 years or more after initial exposure
Asymptomatic HIV Infection (HIV Seropositivity)
Infectious but no evidence of illness except positive HIV antibody test
Primary HIV infection (acute infection)
Flu-like s ymptoms; develop antibodies to HIV in 1 to 6 months
Most AIDS-defining conditions are
opportunistic infections (infections in
persons with a defective immune system
that rarely cause harm in healthy
Pneumocytis carinii pneumonia is the
most frequent AIDS-defining condition in
the U.S. and Europe.
The enzyme-linked immunosorbent assay
(ELISA) is the basic screening test to
detect antibodies of HIV.
A confirmatory test, the Western blot, is
always employed when the ELISA is
The two taken together have an extremely
high accuracy rate.
Obtaining a signed informed consent for
testing is often a nursing responsibility.7/14/2014 6www.drjayeshpatidar.blogspot.in
Demographics of AIDS in the
Age (AIDS affects mainly people during
the most productive years of their life).
Gender (More men from women, though
women’s rates are increasing).
Race (The HIV/AIDS epidemic is growing
most rapidly among some minority
populations and is a leading cause of
death of African American males).
Modes of Transmission
The virus may be found in blood, semen,
vaginal secretions, and breast milk of
No evidence that HIV is spread through
sweat, tears, urine, or feces. Risk of
infection from “deep kissing” or oral sex is
Goal is to keep
long as possible.
by viral load test.
Goal of anti-HIV
treatment is to
keep viral load as
low as possible for
as long as
Use of protease
Common Diagnostic Tests for
HIV and AIDS
Polymerase chain reaction (PCR)
The most common opportunistic infection
associated with advanced HIV disease.
Found primarily in the lungs, but also
reported in the adrenal glands, bone
marrow, skin, thyroid, kidneys, and
Clinical signs include fever, shortness of
breath, nonproductive cough, and
Initial diagnosis made by chest x-ray.7/14/2014 12www.drjayeshpatidar.blogspot.in
An infection caused by the fungus
Histoplasma capsulatum. The fungus has
been isolated in bird droppings, dirt from
chicken coops, and caves.
Histoplasmosis should be suspected if the
person presents with fever of uncertain
origin, cough, and malaise.
Mycobacterium avium complex
In persons with AIDS, involvement of the
bowel is usually extensive. The
microorganism can fill the bone marrow
and lymph nodes.
Most common symptoms are chronic
fever, malaise, anemia, weight loss,
diarrhea, and abdominal pain.
Belongs to the herpes virus group.
Causes disease by destroying the brain,
lung, retina, and liver.
Signs and symptoms include weight loss,
fever, diarrhea, and malaise.
Caused by a protozoan that usually
infects the epithelial cells that line the
Clinical signs include profuse water
diarrhea, up to 20 liters a day. Abdominal
pain, serious weight loss, abdominal
cramping, anorexia, low-grade fever,
dehydration, electrolyte imbalance and
malaise may also be present.
Hepatitis B virus, C virus, and D virus are
commonly seen with HIV infection.
Signs and symptoms include malaise,
weakness, anorexia, nausea, vomiting,
and right upper quadrant pain.
Defined as unexplained weight loss of
more than 10% of body weight
accompanied by weakness, chronic
diarrhea, and fever in those affected with
Signs and symptoms include anorexia,
diarrhea, nausea, vomiting, changes in
taste and smell, aphthous ulcers of mouth
and esophagus, and abdominal pain.
Oral Opportunistic Infections
Oral candidiasis (thrush), a fungal
infection, is seen in more than 90% of
AIDS clients. Symptoms include
unpleasant taste, mouth dryness, and
creamy, white oral plaques.
Oral Hairy Leukoplakia (OHL) usually
appears as a white patch on the lateral
borders of the tongue. OHL is not usually
bothersome to the client and may regress
Vaginal Candidiasis is the most common
initial infection occurring in HIV-infected
Cervical Intraepithelial Neoplasia (CIN) is
of a much higher incidence in women
affected with HIV.
Central Nervous System
AIDS dementia complex.
AIDS Dementia Complex
The most common central nervous
system complication in persons with
This disorder is chronic and progressive
with cognitive, motor, and behavioral
Caused by the protozoan Toxoplasma
gondii, found in cats and other animals.
Clinical signs may be vague and
nonspecific, ranging from mild headache,
fever, and lethargy to poor coordination,
seizures, and coma.
A fungal infection caused by
The most life-threatening fungal infection
associated with AIDS.
Clinical symptoms include fever,
headache, nausea, vomiting, dizziness,
photophobia, mental status changes,
seizures, and stiff neck.
A vascular malignancy that can occur any
place in the body, including the internal
First lesions often appear subtly on the
face or in the oral cavity.
Clinical manifestations include fever,
night sweats, and weight loss.
Treatment of NHL in clients with
advanced HIV disease is often withheld,
because it is not tolerated well and may
even lead to earlier death.
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