The document discusses TB-HIV co-infection, including that TB is the leading cause of death for those with HIV worldwide. It covers symptoms of TB, treatment guidelines including first and second line regimens, and considerations for treating TB-HIV co-infected patients. It also addresses management of other conditions like malaria, filariasis, and sexually transmitted diseases. Nursing care involves monitoring patients and ensuring proper treatment, counseling on adherence, and preventing transmission.

1. D R . A N J A L A T C H I M . S C ( N ) M D ( A M )
V I C E P R I N C I P A L C U M N U R S I N G
S U P E R I N T E N D E N T ,
E R A ’ S C O L L E G E O F N U R S I N G A S S O C I A T E D
W I T H E R A ’ S L U C K N O W M E D I C A L C O L L E G E A N D
H O P I T A L , A F F I A L I T E D F R O M E R A ’ S
U N I V E R S I T Y .
MANAGEMENT OF HIV/AIDS
/TB/MALARIA/FILARIA/STD

2. TB and HIV Co-infection (TB-HIV)

 Mycobacterium tuberculosis is the most common cause
of death in people with HIV worldwide.
 i) About one third of the world’s population is infected
with Mycobacterium tuberculosis (TB)
 ii) India accounts for nearly one third of this global TB
burden
 iii) In India, TB accounts for nearly 50% of OI’s in HIV
infected individuals
 iv) TB can be treated easily, but untreated, it is the
leading killer of patients with HIV/AIDS in developing
countries, accounting for one-third of all AIDS deaths v)
Pulmonary TB is the most common form of TB

3. a. Symptoms
 Cough with expectoration > 3 weeks not respond-ing to
usual antibiotic treatment
 Production of purulent, sometimes blood-stained
sputum
 Evening fevers
 Night sweats
 Weight loss
 Loss of appetite
 Anaemia
 Anybody who presents with these symptoms should be
referred for TB testing and treatment if necessary.

4. Treatment OF TB
 TB is treatable. Standard DOTS regimens are to be followed using RNTCP
program in India.
 The patient should be referred to a DOTS centre for ATT.
 The same regimens are used for the treatment of pulmonary and extra-
pulmonary tuberculosis.
 Around 6 to 8 months of treatment appears to be sufficient to many sites of
extra-pulmonary disease.
 Twelve months therapy is recommended for miliary TB, bone or joint
disease and tubercular meningitis.
 Persistently positive sputum culture after 2-3 months of therapy suggests
the possibility of drug resistant tuberculosis or non- compliance with
therapy.
 ATT is started before the initiation of ART.ART is started after completion
of the intensive phase of ATT ( two months duration ).
 During this period, the patient needs to be counselled to adhere to
treatment protocol for his long term benefit.

5. Anti TB drugs

6. continue

7. FIRST LINE REGIMEN
 TAB.RIFAMYCINRMP)
 TAB.INH
 INJ.STREPTOMYCIN
 TAB.PYRAZINAMIDE
 TAB.ETHAMBUTOL

8. SECONDLINE REGIMEN
 FLUROQUINOLONE
 ETHIONAMIDE
 CAPEROMYCIN
 KANAMYCIN
 AMIKACIN
 CYCLOSERINE
 THIOACETAZONE
 MACROLIDES
 BEDAQUILINE

9. continue

10. REVISED NATIONAL TUBERCULOSIS
CONTROL PROGRAM
 Treatment Category
-FIRST
 Type of TB
- New smear +ve pulmonary TB
-New smear –ve; pulmonary TB;
-seriously ill
-New extra pulmonary TB All HIV + individuals
 Regimen IP
-2(EHRZ)3
 Regimen CP
-4(HR)3

11. Continue
 CATEGORY -II
 TYPE OF TB
-Sputum smear positive relapses
-Sputum smear +ve;
treatment failure cases/after default
 REGIMEN IP
-2(SEHRZ)3+1(EHRZ)3
 REGIMEN CP
-5(EHR)3

12. CATEGORY -III
 TYPE OF TB
 New smear –ve; pulmonary TB;
 seriously ill New smear –ve; extra pulmonary TB;
not seriously ill
 REGIMEN IP
 not2(HRZ)3
 REGIMEN CP
 4(HR)3

13. NURSING CARE /MANAGEMENT
 In addition If a patient needs ART, then the doctor
has to consider:
 i) When to start ART
 ii) Which regimen to use in order to avoid drug
interaction and added risk of liver toxicity
 iii) NACO recommends category I or II in HIV
infected, irrespective of site or sputum results

14. c. Monitoring of pulmonary TB:
 Sputum smear examination:
- At the time of diagnosis and initiation of DOTS - At
the end of initial phase (2/3 months)
- During the continuation phase (end of 5 months)
- - On completion of treatment (6/8 months)

15. D. PRECAUTIONS:
 In HIV infected TB patients, combining Rifampicin with
protease inhibitors or Nevirapine has been found to decrease
the level of these ARVs
 This decreases the effectiveness of the ARVs and increases the
Rifampicin levels, leading to Rifampicin toxicity
 In case ATT and ART are used together, an Efavirenz based
ART regimen should be followed
 If oral candidiasis is also present, administration of anti-TB
drugs together with Fluconazole can result in hepatotoxicity
 Nurses must ensure proper infection control practices to
prevent the spread of TB and other air borne pathogens, e.g.
cough hygiene, cross ventilation, masks, isolating smear
positive patients, disposal of sputum properly

16. MANAGEMENT OF MALARIA
positive cases
TREATMENT:+VE ,P.VIVAX
 CQ-CHLOROQUINE 600mg for 3day
 PQ-PRIMAQUINE-0.25 mg/kg/b.wt for 14 days
Treatment of P.Falciparum:
 Artemether+lumefantrine for 3 days
 PQ-primaquine for single dose on second day
Mixed type treatment:
 ACT-AL for 3 days
 PQ-Primaquine 0.25 mg for 14days
 SP-ACT for 3 days +primaquine 0.25mg for14days.

17. Negative cases
 No treatment
 Clinical care with symptomatic treatment

18. Management of FILARIA
 Acute dermato-lymphangio adenitis(ADLA)
 Tab.paracetomol 500mg for 3-4 days
 Inj.amoxicillin 1.5g three divided dose for 8days
 Incase of allegy to penicilin G go for
 Tab.erythromycin 1000mg three divided dosefor
days

19. Management of severe of ADLA
 Inj.benzylpencillin G 5 million units for three times a
days
 Inj.procain benzyl pencillinG 5 million Units 2 times
/days
 After fever sunsides:
 Tab.phenoxymethypencillin (pencillinV)750mgto 1
gmgiven 3 times/day continue for 8 days

20. Prophylaxis for FILARIA
 Tab.DEC(diethylcarbamazine) for 12 days bd dose
after meals

21. Preventive chemotherapy of FILARIA
 Single doses of 2 medicine given annually to entire
population at risk
 Tab.albendazole 400mg-anti helminthin
 Tab.ivermectin 150-200mcg-antibiotic
 Tab.DEC 6mg/kg (36-72 mg)-antifilarial drugs

22. TREATMENT OF STD
 VAGINITIS:
 Tab. Secnidazole 2mg /ora/single dose
 Tab. Tinidazole 500mg /oral/bd/5 days
 Tab. Metaclopromide taken 30mts prior to
tab.secnidazole to prevent gastric intolerance

23. CANDIDIASIS TRETMENT
 Tab. Fluconazole 150mg /oral/single dose
 Pessary clotrimazole 500mg vaginal pessary at once

24. Cervical infection treatment
 Tab.cefixime 400mg/oral/single dose+
 Tab.azithromycin 1gm 1 hours before lunch
 If vomiting present give anti emetics.
 Follow up after weeks

25. TREATMENT OF PID
 Tab.cefixime 400mg/bd/ for 7days
 Tab.metronidazole 400mg /bd/for 14days
 Tab.doxycycline 100mg /bd/for 2weeks
 Tab.ibuprofen400mg /tds/for 3-5 days
 Tab.raniditine 150mg /bd/along with rantac

26. What are HIV and AIDS?
HIV
 H – Human
 I - Immunodeficiency
 V - Virus

27. AIDS
 A – Acquired (not inherited - contracted by direct
contact with body fluids that have high
concentrations of HIV, either from high risk
behaviour or exposure)
 I – Immune (weakens the immune system)
 D – Deficiency (of certain white blood cells -T4
lymphocytes in the immune system)
 S – Syndrome (a group of symptoms or illnesses as a
result of HIV infection)

28. cell like a factory to reproduce more of itself.
The figure below shows the steps in HIV cell
replication.
 1. Attachment to host CD4 cell
 2. Reverse transcriptase makes DNA from the virus’s
RNA
 3. Integration into host cell’s nucleus
 4. Reproduction of viral components
 5. Assembly of new HIV viruses
 6. Release

29. What is the difference between HIV and AIDS?
 HIV is a virus and AIDS is a disease
• AIDS is deficiency in the body’s defence mechanism
or immune system
• AIDS is acquired, not hereditary
• HIV infection leads to AIDS, depending on the body’s
defence mechanism

30. Body fluids considered at Risk
 Contaminated Blood Semen,
 breast milk.
 Vaginal secretions
 Cerebrospinal Fluid Synovial,
 pleural, peritoneal, pericardial fluids
 Amniotic fluids
 Other fluids contaminated with visible blood

31. Body fluid considered “not at risk” exposure
 (Unless contaminated with visible blood
• Tears
• Sweat
• Urine and faeces
• Saliva

32. HIV cannot be transmitted by:
• Kissing
• Hugging
• Swimming in the same pool/pond
• Sharing cooking utensils, same toilet, clothing and
bed linen
• Cooking/Eating food cooked by a PLHA
• Having daily contact with PLHAs
• Insect bites

33. The commonly used HIV tests in India which are
• HIV rapid tests
• HIV antibody test (ELISA)
 3 tests are done before declaring whether a person is
HIV positive or negative. In case of indeterminate
results or if the person is in the window period the
person is advised to return for HIV testing again and
is counseled to stay HIV negative .
 The tests are antigen or antibody based tests
 Western blot test –to detect antibodies viral core of
HIV protein (p24) and glycogen (g41)

34. ANTI RETROVIRAL THERAPY
 Antiretroviral treatment for HIV infection consists of
drugs which work against HIV infection itself by
slowing down the replication of HIV in the body.
ANTIRETROVIRAL THERAPY (ART increases the
body’s ability to fight disease.
 The drugs are often referred to as:
 ART – AntiRetroviral Therapy
 ARVs – AntiRetroVirals
 HAART - Highly Active AntiRetroviral Therapy

35. Benefits of ART
 1. Alters/reverses course of existing Opportunistic
Infections(OIs)
 2. Decreases hospitalizations
 3. Increases survival
 4. Restores hope
 5. Improves quality of life
 6. Reduces HIV transmission
 7. Benefits both adults and children

36.  c) Limitations of ART Although ART dramatically
improves the health and life expectancy for PLHAs,
a. ART is not a cure for AIDS i. HIV is never entirely
eliminated from the body b. HIV can still be
transmitted to others, even when the PLHA is
healthy and taking his/her medication regularly c.
ART is to be taken lifelong

37. Nucleoside Reverse transcriptase
Inhibitors(NRTI)
 d) Antiretroviral Agents (listed by class):
I.Nucleoside
 Zidovudine (AZT, ZDV)
 Lamivudine (3TC)
 Stavudine (d4T)
 Didanosine (ddI)
 Abacavir (ABC)
 Tenofovir (TDF)
 Emtricitibine (FTC)


38. Non-nucleoside reverse transcriptase
inhibitors(NNRTI)
 Efavirenz (EFZ)
 Nevirapine (NVP)

39. PROTEASE INHIBITOR
 Fosamprenavir (FPV)
 Indinavir (IDV)
 Atazanavir (ATV)
 Nelfinavir (NFV)
 Ritonavir (RTV) *
 Lopinavir/ritonavir (LPV/RTV)
 Saquinavir (SQV)
 Amprenavir (APV)
*Recommended as a booster only

40. Control Programme
Government has provision for first line regimens consisting of fixed dose combinations
of the following ARV drugs for adults and adolescents:
 Stavudine (30mg) + Lamivudine (150mg) + Nevirapine (200 mg)
 Zidovudine (300mg) + Lamivudine (150mg) + Nevirapine (200 mg)
 Stavudine (30 mg) + Lamivudine (150mg)
 Zidovudine (300mg) + Lamivudine (150mg)
 Nevirapine (200mg) for lead in dosage
 Efavirenz (600mg) for single dose
Considering current operational constraints, within the 1st line ART regimen, priority
of usage should be in the following order:
 AZT + 3TC + NVP (for patients with Hb > 8 g/dl)
 D4T + 3TC + NVP (for patients with Hb > 8 g/dl)
 ARVs must be given in a 3-drug combination.
 This combination is referred to as the ARV regimen – also known as a drug cocktail
 Giving only 1 or 2 ARVs to treat HIV disease is incorrect & leads to resistance of
drugs. Starting antiretroviral medication is not anemerg-ency!!

41. SUMMARY
 HIV is a virus that destroys the immune system
 ☛ It uses the CD4 cells for its replication
 ☛ AIDS is the end-stage of HIV infection
 ☛ HIV is transmitted through
 Unprotected sexual contact
 Transfusion of infected blood/blood products
 Sharing needles
 Infected mother to child during pregnancy, child birth and breast feeding
 ☛ Women are at greater risk of acquiring HIV through sex
 ☛ HIV progression to AIDS can be controlled by
 Taking good nutrition
 Practicing safe sex
 Getting support for emotional problems
 Treating any infection correctly
 Taking ART when prescribed

42. CONTINUE
☛ Accurate knowledge of HIV disease progression will
enable the nurse to:
-Recognise a person with a possible HIV infection
-Refer people at risk for HIV infection
 for HIV testing Educate and counsel patients and
families on:
-The importance of early testing and diagnosis What the
patient can expect
-A healthy lifestyle
- The importance of ART Adherence to treatment
Prevention of transmission
- Palliative Care

43. Stay together with PLHA