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Hiv test (final)


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  • 1. HIV Test (human immunodeficiency virus) Samairah Usop BSN- 1
  • 2. HIV Tests • are used to detect the presence of the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome(AIDS), in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA. • is a process that determines whether a person is infected with HIV.
  • 3. The symptoms of HIV and AIDS vary, depending on the phase of infection. Primary infection • The majority of people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include: • • • • • • • • • • Fever Muscle soreness Rash Headache Sore throat Mouth or genital ulcers Swollen lymph glands, mainly on the neck Joint pain Night sweats Diarrhea
  • 4. Early symptomatic HIV infection • As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as: • • • • • • Fever Fatigue Swollen lymph nodes — often one of the first signs of HIV infection Diarrhea Weight loss Cough and shortness of breath
  • 5. HIV Testing • HIV testing detects antibodies or antigens associated with HIV in whole blood, saliva, or urine. Blood sampling is the most common mode of testing. The results of different tests can be combined to confirm HIV test results. All testing follows the same basic steps: • 1. Sample is obtained. Most often, a blood sample is taken from a person's fingertip or arm. • 2. Sample is processed. This can be done on site—for example, at the ANC clinic or in labor and delivery for rapid tests—or in a laboratory. • 3. Healthcare worker obtains results. • 4. Healthcare worker provides results to the patient during post-test counseling. o ƒ In an adult, a positive HIV antibody test result means that the person is infected with HIV. o ƒ A negative result usually means that the person is not infected with HIV. o In rare instances, a person with a negative or inconclusive result may be in the ―window period.‖ This is the period of time between the onset of infection with HIV and the appearance of detectable antibodies to the virus. The window period lasts for 4 to 6 weeks but occasionally up to 3 months after HIV exposure. Persons at high risk who initially test negative should be retested 3 months after exposure to confirm results. • 5. Healthcare worker provides post-test counseling, support, and referral.
  • 6. Antibody tests • When HIV enters the body, the body responds by making a protein called an antibody that can be detected by one of several methods:  ƒ Rapid HIV test  ƒ Enzyme-linked immunosorbent assay (ELISA)  ƒ Western blot test
  • 7. Rapid testing • All rapid tests share the following characteristics: • ƒ Highly accurate when performed correctly. • ƒ Usually performed on whole blood (either taken as a finger prick or drawn as a sample); occasionally saliva is collected by using a swab • ƒ Do not require special laboratory equipment or refrigeration • ƒ Results are ready within 30 minutes • ƒ Tests can be done on a single specimen • ƒ Clinic staff can be trained to perform the tests
  • 8. Enzyme-linked immunosorbent assay (ELISA) • ELISA is also used to identify antibodies to HIV in blood, urine, or saliva. Generally, a blood sample is taken with a needle from a vein in the arm, and sent to a laboratory for testing by technicians. The limitations of ELISA include the following: • ƒ Tests are done in batches of 40−90 specimens. • ƒ Positive results must be confirmed either with another ELISA (using a test kit from a different manufacturer) or by Western blot. The Western blot is a highly ―specific‖ antibody test because it is particularly accurate in providing a negative test result on samples from people who are truly negative. Both confirmatory tests can be done on the initial blood sample. • ƒ Reporting of results may take several days or weeks, and women may not return for test results or may give birth before the results are ready. • ƒ Laboratories and trained laboratory technicians are required. • ƒ The test is sensitive to temperature, and reagents require refrigeration. • Results for these tests can take up to two weeks. • The Western blot assay is used to conform seropositivity when the ELISA result is positive. Adult whose blood contains antibodies for HIV are seropositive.
  • 9. In addition to this HIV-1 antibody assay, two additional technique are now available.  The OraSure test uses saliva to perform an ELISA antibody test. Using less than drop of blood, the OraQuick Rapid HIV-1 Antibody Test quickly (approximately 20 minutes) and reliably (99.6% accuracy) detects antibodies to HIV-1. The OraQuick test is becoming the standard method of testing in setting where a delay would seriously affect treatment, such as in labor and delivery rooms or in emergency departments when the HIV status of a sexual abuset is unknown.  Home-based testing for HIV antibodies using a small amount of blood was first proposed in 1985 and approved in the FDA in 1995. However, use of home testing kits raises concerns because of the lack of counseling and possible inaccurative results, including both false-negative results.
  • 10. HIV Test results: Implications for Patients Interpretation of Positive Test Results • Antibodies to HIV are present in the blood (the patient has been infected with the virus, and the body has produced antibodies) • HIV is active in the body, and the patient can transmit the virus to others. • Despite HIV infection, the patient does not necessarily have AIDS. • The patient is not immune to HIV (the antibodies do not indicate immunity) Interpretation of Negative Test Results • Antibodies to HIV are not present in the blood at this time, which can mean that the patient has not been infected with HIV or, if infected, the body has not yet produced antibodies (window period-usually 3 weeks to 6 months). • The patient should continue the precautions. The test result does not mean that the patient is immune to the virus, nor does it mean the patient is not infected, it just means that the body may not have produced antibodies yet.
  • 11. PRE-TEST Patient Preparation  An informed witnessed consent from must be properly singed by any person being tested for HIV/AIDS.  It is essential that counseling precedes and follows the HIV antibody test. This test should not be informed without the subject’s informed consent, the persons who need to access results legitimately must be mentioned.  Assess frequency and intensity of symptoms: elevated temperature, anxiety, fear,, diarrhea, neuropathy, nausea and vomiting, depression, and fatigue.  Infection control measures mandate use of standard precautions.
  • 12. POST-TEST Patient Preparation • Interpret test outcomes. Explain significance of test result along with CD4 cell counts. • Advise patient that screening tests must be confirmed before the results are reported as HIV reactive. Provide options for immediate counseling if necessary. Explain treatment with potent antiviral drugs and protease inhibitors.
  • 13. Complication • HIV infection weakens your immune system, making you highly susceptible to all sorts of infections and certain types of cancers such as Kaposi's sarcoma is a tumor of the blood vessel walls. Lymphomas is the type of cancer originates in your white blood cells. Lymphomas usually begin in your lymph nodes. • Tuberculosis (TB). In resource-poor nations, TB is the most common opportunistic infection associated with HIV and a leading cause of death among people living with AIDS. Millions of people are currently infected with both HIV and tuberculosis, and many experts consider the two diseases twin epidemics. • Salmonellosis. You contract this bacterial infection from contaminated food or water. Although anyone exposed to salmonella bacteria can become sick, salmonellosis is far more common in people who are HIV-positive. • Cytomegalovirus (CMV). This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. • Candidiasis is a common HIV-related infection.
  • 14. Treatment for HIV  Antiretroviral Agents A triple drug regimen has been used effectively containing:  Zidovudine – formerly azidothymidine  Dideoxyinosine  Dideoxycytidine  Medications for HIV • There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each of the classes of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two different classes to avoid creating strains of HIV that are immune to single drugs. The classes of anti-HIV drugs include: • Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). • Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir). • Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir). • Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). • Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.
  • 15. Anticancer Agents • KS: alpha-interferon, surgical excision of lesions, liquid nitrogen to lesions, vinblastine injected into intraoral lesions, interferon; chemotherapy with doxorubicin (Adriamycin), bleomycin, and vincristine (ABV); radiation • Lymphomas: limited successful treatment; chemotherapy and radiation therapy may be used.
  • 16. Reference: • Textbook of Medical-Surgical Nursing, 12 Edition, Brunner & Suddarth’s, Volume 1 & 2. • Handbook for Textbook of Medical-Surgical Nursing, 10 Edition, Brunner & Suddarth’s, by Joyce Young Jonhson • A Manual of Laboratory and Diagnostic Tests, 7 Edition, by Frances Fischbach