HivInfection &AIDs<br />
overview<br />
Hiv Disease<br />human immunodeficiency virus<br />implies the entire course of HIV infection, from asymptomatic infection...
AIDS<br />Acquired immunodeficiency syndrome<br />Most severe form of a continuum of illnesses associated with HIV infecti...
Etiology & pathophysiology<br />
Causative agent: a retrovirus that infects and depletes the CD4+ T-helper lymphocytes (one of the “protector” cells of the...
Monocytes & macrophages, whose role is to present antigen to T cells, thereby initiating the body's immune response, are a...
The result of this reproductive process is the production of many new HIV virions and cell death for the T4 helper lymphoc...
Body fluids known to transmit HIV: <br /><ul><li>Blood
Vaginal secretions
Semen
Breast milk</li></ul>HIV is transmitted by<br /><ul><li>injection of blood or blood components
sexual contact (vaginal or anal intercourse, oral sex)
perinatally (from an infected mother to the child)</li></li></ul><li>High risk Groups for HIV transmission<br />
Homosexual or bisexual men<br />I.V. drug users<br />Transfusion and blood product recipients (before 1985)<br />Heterosex...
STages of HIV Disease<br />
Primary HIV infection <br />acute HIV infection/acute HIV syndrome<br />Approximately 50% to 90% of persons will experienc...
Adenopathy
Pharyngitis
Rash</li></li></ul><li>
Although most patients seek clinical care, few are diagnosed because the symptoms mimic a common flu<br />During this phas...
Seroconversion occurs when the person has developed enough antibodies to HIV that the serologic test is positive<br />Usua...
HIV Asymptomatic <br />CDC Category A: More Than 500 CD4+ T Lymphocytes/mm3<br />By about 6 months, the rate of viral repl...
On average, 8 to 10 years pass before a major HIV-related complication develops<br />Patients feel well and have few if an...
HIV Symptomatic <br />CDC Category B: 200 to 499 CD4+ T Lymphocytes/mm3<br />The number of CD4+ T cells gradually falls <b...
These conditions must also meet one criteria:<br /><ul><li>The condition is due to HIV infection or a defect in cellular i...
The condition is considered to have a clinical course or to require management that is complicated by HIV infection
If a person was once treated for a category B condition and has not developed a category C disease but is now symptom-free...
This classification has implications for entitlements:<br /><ul><li>Disability benefits
Housing
Food stamps</li></ul> A CD4+ percentage of less than 14% of the total lymphocytes is consistent with an AIDS diagnosis. <b...
Clinical manifestations<br />
Pulmonary <br />Persistent cough with and without sputum production<br />SOB<br />chest pain<br />Fever<br />Pneumocystisc...
GI<br /><ul><li>Salmonella
Shigella
Campylobacter
Entamoebahistolytica
C. difficile
CMV
M. avium complex
herpes simplex
Strongyloides
Giardia
Cryptosporidium
Isospora belli
Chlamydia</li></ul>Diarrhea<br />Weight loss<br />Anorexia<br />Abdominal cramping<br />Rectal urgency (tenesmus)<br />Fro...
Oral manifestations<br />White plaques on oral mucosa, particularly in the posterior pharynx & angular cheilitis from Cand...
Central nervous system<br />Cognitive, motor, behavioral symptoms (AIDS dementia complex/HIV encephalopathy)<br />mental s...
Ocular manifestations<br />Retinopathy<br /><ul><li>due to CMV retinitis</li></ul>Visual impairment<br /><ul><li>progresse...
Malignancies<br />Kaposi's sarcoma <br /><ul><li>(aggressive tumor involving skin, lymph nodes, GI tract, and lungs)</li><...
Diagnostic evaluation<br />
Positive blood test for HIV<br />Enzyme-linked immunosorbent assay (ELISA) -serologic test for detecting antibody to HIV<b...
History of risk factors/high-risk behaviors<br />Lymphocyte panel<br /><ul><li>shows decreased CD4+ count</li></ul>Complet...
candidiasis of esophagus
Kaposi's sarcoma</li></li></ul><li>Diagnostic procedures (biopsies, imaging procedures) of the organ system involved<br />...
A higher number (greater than 750,000 copies/mL) indicates greater viremia
High viral loads are usually found in acute seroconversion and late disease, but also occur when patients have another inf...
A viral load test result can be undetectable, meaning the amount of virus is less than 50 copies/mL
This does not indicate that the body is free of HIV
Latent reservoirs exist in the lymphoid tissues indefinitely</li></li></ul><li>complications<br />
Development of HIV virus resistant to antiretroviral treatment<br />Repeated overwhelming opportunistic infections<br />Re...
Hyperlipidemia
Insulin-resistance
Lactic acidosis</li></li></ul><li>Facial Lipoatrophy<br />
management<br />
General considerations<br />
Treatments are available for the underlying immunodeficiency and are usually successful when patients receive at least 90%...
Specific treatment<br />
haart<br />Highly active antiretroviral therapy <br />Consists of medications that belong to four different classification...
Classes of antiretroviral drugs<br />Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI)<br /><ul><li>historical...
Protease inhibitors (PI)<br /><ul><li>the second class of HIV medications “three-drug cocktails, which made ” possible
transformed HIV from a terminal illness to a chronic illness for many patients
Upcoming SlideShare
Loading in …5
×

Comprehensive Presentation on HIV/AIDS

8,558
-1

Published on

Comprehensive Presentation on HIV Infection/AIDS

Published in: Health & Medicine
14 Comments
74 Likes
Statistics
Notes
No Downloads
Views
Total Views
8,558
On Slideshare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
0
Comments
14
Likes
74
Embeds 0
No embeds

No notes for slide

Comprehensive Presentation on HIV/AIDS

  1. 1. HivInfection &AIDs<br />
  2. 2.
  3. 3. overview<br />
  4. 4. Hiv Disease<br />human immunodeficiency virus<br />implies the entire course of HIV infection, from asymptomatic infection and early symptoms to AIDS<br />a chronic condition, controllable with medications and strict adherence to treatment recommendations<br />
  5. 5. AIDS<br />Acquired immunodeficiency syndrome<br />Most severe form of a continuum of illnesses associated with HIV infection<br />If untreated, it causes slow degeneration of the immune system with the development of opportunistic infections and malignancies<br />
  6. 6. Etiology & pathophysiology<br />
  7. 7.
  8. 8. Causative agent: a retrovirus that infects and depletes the CD4+ T-helper lymphocytes (one of the “protector” cells of the immune system)<br />B lymphocytes secrete antibodies into the body fluids, or humors (humoral immunity)<br />T lymphocytes can penetrate living cells (cell-mediated immunity)<br />
  9. 9. Monocytes & macrophages, whose role is to present antigen to T cells, thereby initiating the body's immune response, are also infected by HIV<br />Once HIV has entered the body, it attaches most efficiently to CD4+ molecules, which are predominantly located on the cell membrane of T4 helper lymphocytes<br />After penetrating the cell membrane, the HIV genome and enzymes are released in the cell and integrated into the lymphocyte's genome<br />
  10. 10.
  11. 11. The result of this reproductive process is the production of many new HIV virions and cell death for the T4 helper lymphocyte<br />With progressive invasion of HIV, cellular and humoral immunity declines and opportunistic infections that characterize this disease begin to emerge<br />
  12. 12. Body fluids known to transmit HIV: <br /><ul><li>Blood
  13. 13. Vaginal secretions
  14. 14. Semen
  15. 15. Breast milk</li></ul>HIV is transmitted by<br /><ul><li>injection of blood or blood components
  16. 16. sexual contact (vaginal or anal intercourse, oral sex)
  17. 17. perinatally (from an infected mother to the child)</li></li></ul><li>High risk Groups for HIV transmission<br />
  18. 18. Homosexual or bisexual men<br />I.V. drug users<br />Transfusion and blood product recipients (before 1985)<br />Heterosexual contacts of HIV-positive individuals<br />Newborn babies of mothers who are HIV-positive<br />
  19. 19. STages of HIV Disease<br />
  20. 20. Primary HIV infection <br />acute HIV infection/acute HIV syndrome<br />Approximately 50% to 90% of persons will experience a brief flulike illness about 2 to 4 weeks following exposure to HIV<br />Typical symptoms include:<br /><ul><li>Fever
  21. 21. Adenopathy
  22. 22. Pharyngitis
  23. 23. Rash</li></li></ul><li>
  24. 24. Although most patients seek clinical care, few are diagnosed because the symptoms mimic a common flu<br />During this phase the immune system is compromised by a sudden decrease in T4 helper cells and an increase in viral load for a brief period before returning to baseline<br />
  25. 25. Seroconversion occurs when the person has developed enough antibodies to HIV that the serologic test is positive<br />Usually occurs 4 to 6 weeks after acute HIV infection<br />
  26. 26. HIV Asymptomatic <br />CDC Category A: More Than 500 CD4+ T Lymphocytes/mm3<br />By about 6 months, the rate of viral replication reaches a lower but relatively steady state that is reflected in the maintenance of viral levels at a kind of “set point”<br />Set point varies greatly and dictates the subsequent rate of disease progression<br />
  27. 27. On average, 8 to 10 years pass before a major HIV-related complication develops<br />Patients feel well and have few if any symptoms<br />Apparent good health continues because CD4+ T-cell levels remain high enough to preserve defensive responses to other pathogens<br />
  28. 28. HIV Symptomatic <br />CDC Category B: 200 to 499 CD4+ T Lymphocytes/mm3<br />The number of CD4+ T cells gradually falls <br />Category B consists of symptomatic conditions in HIV-infected patients that are not included in the conditions listed in category C<br />
  29. 29. These conditions must also meet one criteria:<br /><ul><li>The condition is due to HIV infection or a defect in cellular immunity
  30. 30. The condition is considered to have a clinical course or to require management that is complicated by HIV infection
  31. 31. If a person was once treated for a category B condition and has not developed a category C disease but is now symptom-free, that person's illness is considered category B.</li></li></ul><li>AIDS<br />CDC Category C: Fewer Than 200 CD4+ T Lymphocytes/mm3<br />As levels decrease to fewer than 100 cells/mm3, the immune system is significantly impaired. <br />Once a patient has had a category C condition, he or she remains in category C. <br />
  32. 32. This classification has implications for entitlements:<br /><ul><li>Disability benefits
  33. 33. Housing
  34. 34. Food stamps</li></ul> A CD4+ percentage of less than 14% of the total lymphocytes is consistent with an AIDS diagnosis. <br />One complication of advanced HIV infection is anemia, which may be caused by HIV, opportunistic diseases, or medications<br />
  35. 35.
  36. 36. Clinical manifestations<br />
  37. 37. Pulmonary <br />Persistent cough with and without sputum production<br />SOB<br />chest pain<br />Fever<br />Pneumocystiscarinii pneumonia (PCP) -most common<br />bacterial pneumonia (CAP)<br />M. tuberculosis<br />disseminated Mycobacterium avium complex<br />CMV<br />Histoplasma<br />Kaposi's sarcoma<br />Cryptococcus<br />Legionella<br />other pathogens<br />
  38. 38.
  39. 39.
  40. 40.
  41. 41. GI<br /><ul><li>Salmonella
  42. 42. Shigella
  43. 43. Campylobacter
  44. 44. Entamoebahistolytica
  45. 45. C. difficile
  46. 46. CMV
  47. 47. M. avium complex
  48. 48. herpes simplex
  49. 49. Strongyloides
  50. 50. Giardia
  51. 51. Cryptosporidium
  52. 52. Isospora belli
  53. 53. Chlamydia</li></ul>Diarrhea<br />Weight loss<br />Anorexia<br />Abdominal cramping<br />Rectal urgency (tenesmus)<br />From enteric pathogens: <br />
  54. 54.
  55. 55.
  56. 56.
  57. 57. Oral manifestations<br />White plaques on oral mucosa, particularly in the posterior pharynx & angular cheilitis from Candida albicans of mouth & esophagus<br />Vesicles with ulceration from herpes simplex virus<br />White, thickened lesions on lateral margins of tongue from hairy leukoplakia<br />Oral warts due to human papillomavirus and associated gingivitis<br />Periodontitis progressing to gingival necrosis<br />Aphthous ulcers of unclear etiology -painful, solitary lesions with raised margins<br />
  58. 58.
  59. 59.
  60. 60.
  61. 61.
  62. 62. Central nervous system<br />Cognitive, motor, behavioral symptoms (AIDS dementia complex/HIV encephalopathy)<br />mental slowing, impaired memory & concentration, loss of balance, lower extremity weakness, ataxia, apathy, social withdrawal<br />May be caused by CNS toxoplasmosis, cryptococcal meningitis, herpes virus infections, CMV encephalitis, progressive multifocal leukoencephalopathy, CNS lymphoma.<br />Sensory symptoms (distal symmetric polyneuropathy) -demonstrated by numbness, tingling, neuropathic pain<br />
  63. 63.
  64. 64.
  65. 65.
  66. 66. Ocular manifestations<br />Retinopathy<br /><ul><li>due to CMV retinitis</li></ul>Visual impairment<br /><ul><li>progresses to blindness if untreated</li></li></ul><li>
  67. 67.
  68. 68.
  69. 69.
  70. 70. Malignancies<br />Kaposi's sarcoma <br /><ul><li>(aggressive tumor involving skin, lymph nodes, GI tract, and lungs)</li></ul>Non-Hodgkin's lymphoma and lymphomas<br />Cervical carcinoma<br />
  71. 71.
  72. 72.
  73. 73.
  74. 74.
  75. 75. Diagnostic evaluation<br />
  76. 76. Positive blood test for HIV<br />Enzyme-linked immunosorbent assay (ELISA) -serologic test for detecting antibody to HIV<br />Western blot test - used to confirm a positive result on ELISA<br />When infected with HIV, it usually takes the body up to 12 weeks to develop enough antibody to HIV for the test result to be positive, resulting in a false-negative test if evaluated early.<br />
  77. 77. History of risk factors/high-risk behaviors<br />Lymphocyte panel<br /><ul><li>shows decreased CD4+ count</li></ul>Complete Blood Count <br /><ul><li>may show anemia and low WBC count</li></ul>Presence of indicator disease <br /><ul><li>PCP
  78. 78. candidiasis of esophagus
  79. 79. Kaposi's sarcoma</li></li></ul><li>Diagnostic procedures (biopsies, imaging procedures) of the organ system involved<br /><ul><li>to confirm opportunistic infection, malignancy, or other causes</li></ul>Neuropsychological testing<br /><ul><li>to identify cognitive deficits associated with AIDS dementia complex</li></li></ul><li>Viral load <br /><ul><li>a measure of the amount of HIV in the blood
  80. 80. A higher number (greater than 750,000 copies/mL) indicates greater viremia
  81. 81. High viral loads are usually found in acute seroconversion and late disease, but also occur when patients have another infectious process in the body
  82. 82. A viral load test result can be undetectable, meaning the amount of virus is less than 50 copies/mL
  83. 83. This does not indicate that the body is free of HIV
  84. 84. Latent reservoirs exist in the lymphoid tissues indefinitely</li></li></ul><li>complications<br />
  85. 85. Development of HIV virus resistant to antiretroviral treatment<br />Repeated overwhelming opportunistic infections<br />Respiratory failure<br />Wasting<br />Medication-related conditions:<br /><ul><li>Lipodystrophy
  86. 86. Hyperlipidemia
  87. 87. Insulin-resistance
  88. 88. Lactic acidosis</li></li></ul><li>Facial Lipoatrophy<br />
  89. 89. management<br />
  90. 90. General considerations<br />
  91. 91. Treatments are available for the underlying immunodeficiency and are usually successful when patients receive at least 90% of doses<br />Patient education that stresses adherence to treatment and monitoring adherence are essential elements of treatment success<br />Treatment is available for some opportunistic infections and other diseases associated with AIDS<br />
  92. 92. Specific treatment<br />
  93. 93. haart<br />Highly active antiretroviral therapy <br />Consists of medications that belong to four different classifications because they act to prevent HIV replication at four different points along the replication process. <br />Standard: take a minimum of 3 different drugs from at least 3 different drug classifications<br />
  94. 94. Classes of antiretroviral drugs<br />Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI)<br /><ul><li>historically, the first class of medications used in the treatment of HIV</li></ul>Nonnucleoside reverse transcriptase inhibitors (NNRTI)<br />
  95. 95. Protease inhibitors (PI)<br /><ul><li>the second class of HIV medications “three-drug cocktails, which made ” possible
  96. 96. transformed HIV from a terminal illness to a chronic illness for many patients
  97. 97. became available in 1996</li></ul>Entry inhibitors<br /><ul><li>newest class of HIV treatment</li></li></ul><li>Goals of antiviral therapy:<br />Prolong life and improve quality of life<br />Reduce viral load to as low as possible for as long as possible<br />Increase the CD4+ count to allow immune reconstitution<br />Maintain options for future treatment by preventing the development of treatment-resistant virus<br />Avoid drug toxicities<br />
  98. 98. Supportive Care<br />Treatment of reversible illnesses<br />Nutritional support<br />Palliation of pain<br />Evaluation and management of psychological and social aspects of HIV/AIDS infection<br />Treatment to relieve symptoms (cough, diarrhea)<br />Antidepressant drugs; psychiatric interventions<br />
  99. 99. Nursing Managment<br />
  100. 100. Nursing assessment<br />
  101. 101. Obtain:<br /><ul><li>hx of risk factors
  102. 102. constitutional s/sx
  103. 103. recent infections
  104. 104. + blood test for HIV antibodies
  105. 105. most recent CD4+ count
  106. 106. HIV RNA viral load</li></ul>Review present complaints<br /><ul><li>cough, SOB, diarrhea</li></ul>Evaluate nutritional status <br /><ul><li>wt loss, body mass depletion
  107. 107. hypoalbuminemia, decreased iron-binding capacity, anemia</li></li></ul><li><ul><li>complications of drug toxicities (hyperlipidemia, hyperglycemia, lipodystrophy)</li></ul>Assess RR & depth<br /><ul><li>Auscultate lungs for breath sounds
  108. 108. Assess for skin color & temperature, palpable lymph nodes, evidence of fever, night sweats</li></ul>Inspect mouth for lesions (candida in posterior pharynx)<br /><ul><li>examine skin for rash, sores, Kaposi's sarcoma lesions
  109. 109. Record number, size, locations</li></li></ul><li>Ask about:<br /><ul><li>bowel patterns, changes in habits, constipation, abdominal cramping, number & volume of stools, presence of perianal pain & ulceration</li></ul>Oriented to time, place, person? <br /><ul><li>Affect?
  110. 110. Any problem with memory & concentration? Headaches? Seizures?</li></ul>How much does he know about HIV/AIDS? <br /><ul><li>Etiology? Signs & symptoms? Mode of transmission? Methods for limiting exposure? </li></li></ul><li><ul><li>Disease progression & importance of CD4+ count & HIV RNA viral load monitoring?</li></ul>Find out about:<br /><ul><li>premorbid personality, experience, skills, social support system</li></ul>Assess the adherence to medications <br /><ul><li>Review all prescribed drugs, dose, how often the he is taking the medication
  111. 111. Ask how many times over the last day/week he may have missed a dose</li></li></ul><li>Nursing diagnoses<br />
  112. 112. Activity intolerance <br />Disturbed body image <br />Fatigue <br />Hopelessness <br />Hyperthermia <br />Imbalanced nutrition: Less than body requirements <br />Impaired oral mucous membrane <br />Impaired skin integrity <br />Impaired tissue integrity <br />
  113. 113. Ineffective coping <br />Ineffective health maintenance <br />Ineffective protection <br />Ineffective sexuality patterns<br />Interrupted family processes <br />Noncompliance (treatment regimen) <br />Powerlessness <br />Risk for deficient fluid volume<br />Risk for infection <br />Social isolation<br />
  114. 114. Key outcomes<br />
  115. 115. The patient will:<br />verbalize the importance of balancing activity, as tolerated, with rest<br />verbalize feelings about a changed body image<br />express that he has more energy<br />make decisions on his own behalf<br />maintain a normal body temperature<br />maintain current weight or achieve ideal weight<br />(patient's) oral mucous membranes will remain intact<br />
  116. 116. The patient will:<br />voice feelings about changes in sexual identity<br />(patient's) wounds & lesions will heal without complications<br />site of impaired tissue will have reduced redness, swelling, pain<br />use support systems to assist with coping<br />perform health maintenance activities according to the level of his ability<br />demonstrate use of protective measures, including conserving energy, maintaining a balanced diet, getting plenty of rest<br />
  117. 117. The patient will:<br />(family will) state ways to support & assist the patient<br />comply with the treatment regimen<br />express feelings of control over his condition & situation<br />maintain adequate fluid balance<br />experience no fever, chills, or other signs or symptoms of illness<br />maintain peer & family relationships<br />
  118. 118. Nursing interventions<br />
  119. 119. Recognize that a diagnosis of AIDS is profoundly distressing because of the disease's social impact & the discouraging prognosis<br /><ul><li>The patient may lose his job, financial security, support of family & friends.
  120. 120. Coping with an altered body image, emotional burden of serious illness, and threat of death may overwhelm the patient</li></ul>Monitor for fever, noting any pattern, signs of skin breakdown, cough, sore throat, diarrhea<br /><ul><li>Assess for swollen, tender lymph nodes
  121. 121. Check laboratory values regularly</li></li></ul><li>Avoid glycerine swabs for mucous membranes<br /><ul><li>Try normal saline or bicarbonate mouthwash for daily oral rinsing</li></ul>Record the patient's caloric intake<br />Ensure adequate fluid intake during episodes of diarrhea<br />Provide meticulous skin care, especially if the patient is debilitated<br />
  122. 122. Encourage the patient to maintain as much physical activity as he can tolerate<br /><ul><li>Make sure his schedule includes time for both exercise & rest</li></ul>If the patient develops Kaposi's sarcoma, monitor the progression of lesions<br />Monitor opportunistic infections or signs of disease progression<br /><ul><li>Treat infections as ordered</li></li></ul><li>Patient teaching<br />
  123. 123. Combination antiretroviral therapy is used to maximally suppress HIV replication, thereby improving survival<br /><ul><li>Poor drug compliance may lead to resistance & treatment failure
  124. 124. Patients must understand that medication regimens must be followed closely & may be required for many years, if not throughout life</li></ul>Urge the patient to inform potential sexual partners & health care workers that he has HIV infection<br />
  125. 125. Teach the patient how to identify the signs of impending infection<br /><ul><li>Stress the importance of seeking immediate medical attention</li></ul>Involve the patient with hospice care early in treatment so he can establish a relationship<br />If the patient develops AIDS dementia in stages, help him understand the progression of this symptom<br />
  126. 126. Preventing AIDS transmission<br />
  127. 127. Use precautions in all situations that risk exposure to blood, body fluids, secretions<br /><ul><li>Standard precautions can prevent the inadvertent transmission of AIDS, hepatitis B, & other infectious diseases</li></ul>Educate the patient and his family, sexual partners, friends about disease transmission & prevention of extending the disease to others<br />Inform the patient not to donate blood, blood products, organs, tissue, sperm<br />If the patient uses I.V. drugs, caution him not to share needles<br />
  128. 128. High-risk sexual practices for AIDS transmission are those that exchange body fluids <br /><ul><li>vaginal or anal intercourse without a condom</li></ul>Discuss safer sexual practices <br /><ul><li>Hugging, petting, mutual masturbation, protected sexual intercourse
  129. 129. Abstaining is also the most protective method of not transmitting the disease</li></ul>Advise female patients of childbearing age to avoid pregnancy <br /><ul><li>Explain that an infant may become infected before birth, during delivery, or during breast-feeding</li></li></ul><li>
  130. 130. http://nurseRD.blogspot.com<br />www.authorstream.com/reynel89/Nursing<br />www.slideshare.net/reynel89/slideshows<br />THANK YOU!Have a nice day : )<br />- RDG<br />

×