IT CONTAINS INFORMATION ABOUT AIDS

1. AIDS- AQUIRED IMMUNO-
DEFICIENCY SYNDROME
BY: PIYUSH PARASHAR

2. DEFINITION
•AIDS stands for Acquired Immuno Deficiency Syndrome.
•It is a deficiency of immune system, acquired during the life time of an individual
indicating that it is not a congenital disease.
•AIDS was first reported in USA amongst homosexuals in 1981and last year or so, it
has spread all over the world killing more than 25 million people.
•In India, AIDS infection was detected in 1986.

3. PATHOGEN- HIV
•AIDS is caused by Human Deficiency Virus(HIV), a name given in 1986 by the
International committee on viral Nomenclature.
•This virus belongs to a group of virus called Retrovirus which have an envelope
consisting of a lipid bilayer derived from host membrane.
•This envelope encloses the RNA genome .
•HIV consists of a core RNA with Reverse Transcriptase surrounded by a protein coat5.
•The protein coat around the core consists of a protein called P24.Outside this protein coat
is a layer composed of another protein called P17.
•The outermost envelope consists of a phospholipid bilayer studded with
glycoproteins(GP120 and GP41).
•The major cell infected by HIV is the Helper T-lymphocytes that bears CD4 receptor site.
•The attachment of virus to CD4 receptor site is by help of GP120 on the protein coat of
the virus.

4. MODES OF TRANSMISSION
Sexual contact with infected person.
By transfusion of contaminated blood and blood
products.
By sharing infected needles as in case of intravenous
drug abusers.
From infected mother to her child through placenta.

5. RISK FACTORS
• Individuals who have
multiple sex partners.
• Drug addicts, who
takes drugs
intravenously.
• Individuals who
require repeated
blood transfusion.
• Children born to an
infected mother.

6. CLINICAL MANIFESTATIONS
RESPIRATORY INFECTIONS: Shortness of breath, dyspnea, cough, chest pain and
fever are associated with various opportunistic infections.
Pancreatitis
Hepatitis
Cardio metabolic abnormalities

7. GASTROINTESTINAL MANIFESTATIONS
Loss of appetite.
Nausea
Vomiting
Oral and esophageal candidiasis
Chronic diarrhea- most common in AIDS patient
Fluid and electrolyte imbalances
Perineal skin excoriation
Weakness

8. NEUROLOGICAL MANIFESTATIONS
Most common neurologic symptom.Peripheral Neuropathy
• It may occur in a variety of patterns with distal sensory polyneuropathy or distal symmetric neuropathy the most
frequent occurring type.
• It can lead to significant pain and functional impairment.
It was formerly referred to as AIDS dementia complex.
HIV Encephalopathy
• It is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioural and motor functions as
a direct result of HIV.
It is a demyelinating CNS disorder that affects the oigodendroglia.
Progressive Multifocal
Leukoencephalopathy
• Cllinical manifestation often begin with mental confusion, and rapidly progress to include blindness, aphasia, muscle
weakness and paresis.

9. DEPRESSIVE MANIFESTATIONS
CAUSES OF DEPRESSION ARE MULTIFACTORAL.
It include:
History of preexisting mental illness.
Neuropsychiatric disturbances.
Psychosocial factors
People may experience guilt and shame, loss of self esteem, feeling of helplessness
and worthlessness and suicidal ideation.

10. INTEGUMENTARY MANIFESTATIONS
Cutaneous manifestations are associated with HIV infection.
1. Kaposi sarcoma and opportunistic infections such as herpes zoster and herpes
simplex are associated with painful vesicles that disrupt skin integrity.
Molluscum contagiosum- a viral infection characterized by deforming plaque
formation.
Sebborheic dermatitis- it is associated with an indurated , diffuse, scaly rash involving
the scalp and face.
Patient with AIDS may also exhibit a generalized folliculitis associated with dry,
flaking skin or atopic dermatitis such as eczema or psoriasis.

11. GYNECOLOGIC MANIFESTATIONS
Persistent, recurrent vaginal candidiasis may be first sign of HIV infection in in women.
Women with HIV infection is more susceptible to genital ulcers and venereal warts.
Human Papillomavirus(HPV) causes venereal warts and is a risk factor for cervical
intraepithelial neoplasia.
Pelvic inflammatory disease are common.

12. PATHOPHYSIOLOGY
The HIV life cycle is complex and consists of the following steps:
1) Attachment: The GP120 and GP41 glycoproteins of HIV bind with the host’s uninfected CD4+
receptor and chemokine coreceptors, usually CCR5, which result in fusion of HIV with the CD4+ T-
cell membrane.
2) Uncoating: Only the contents of HIV’s viral core are emptied into theCD4+ T-cell.
3) DNA synthesis: HIV changes its genetic material from RNA to DNA through action of reverse
transcriptase.
4) Integration: New viral DNA enters the nucleus of the CD4+ T cell and through the action of
integrase is blended with the DNA of the CD4+ T- cell, resulting in permanent, lifelong infection.
5) Transcription: When the cd4+ T cell is activated, the double stranded DNA forms single stranded
messenger RNA (mRNA), which builds new viruses.
6) Translation: The mRNA creates chains of new proteins and enzymes that contain the components
needed in the construction of viruses.

13. 7) Cleavage: The HIV enzyme protease cuts the polyprotein chain into the individual
proteins that make up new viruses.
8) Budding: New proteins and viral RNA migrate to the membrane of the infected
CD4+ T cell, exit from the cell and start the process all over.
In resting CD4+ cells, HIV can survive in a latent state as an integrated provirus that
produces few or no viral particles.
These resting CD4+ T cells can be stimulated to produce new particles if something
activated them, such as another infection.
When a T cell that harbors this integrated DNA becomes activated against HIV or
other microbes, the cell begins to produce new copies of both RNA and viral proteins.

14. STAGES OF HIV INFECTION
Stages Laboratory
evidence
Clinical evidence
Stage 1 Laboratory confirmation of HIV and
CD4+ T – lymphocytes count >500mcL
OR CD4+ T- lymphocytes percentage
>29.
None required.
Stage 2 Laboratory confirmation of HIV infection
and CD4+ T – lymphocytes count 200-
499 mcL OR CD4+ T lymphocytes
percentage of 14-28
No AIDS defining condition
Stage 3( AIDS) Laboratory confirmation of HIV infection
and CD4+ count < 200mcL OR CD4+ T-
lymphocyte percentage <14
Documentation of an AIDS defining
condition.
State unknown Laboratory confirmation of HIV infection
and no information of CD4+ T
lymphocyte count or CD4+ T lymphocyte
percentage.
No information on presence of AIDS
defining condition

15. ASSESSMENT AND DIAGNOSTIC FINDINGS
TEST Findings in HIV infection
ELA OR ELISA Antibodies are detected, resulting in positive results and marking the
end of the window period.
Western Blot Also detects antibodies to HIV; used to confirm ELA.
Viral Load Measures HIV RNA in plasma.
CD4/CD8 These are the markers found on lymphocytes. HIV kills CD4+ cells,
which results in a significantly impaired immune system.
OraQuick In Home HIV test.

17. GOALS OF TREATMENT
The major goals for initiating ART are:
1) Reduce HIV- associated morbidity.
2) prolong the duration and quality of survival.
3) restore and preserve the immunologic function.
4) prevent HIV transmission.

18. ANTIRETROVIRAL AGENTS
Nucleoside
reverse
Transcriptase
inhibitors
Non Nucleoside
reverse
Transcriptase
inhibitors
Protease
Inhibitors
Fusion Inhibitors Integrase Strand
Transfer
Inhibitors
Multiclass
Combination
Inhibitors
Abacavir Delavirdine Amprenavir Enfuvirtide Raltegravir Efavirenz+
Emtricitabine+
tenofovir disoproxil
fumarate
Tenofovir disoproxil
fumarate
Efavirenz Atazanavir Maraviroc
Zidovudine Nevirapine fosamprenavir
Lamivudine Etravirine Indinavir

19. MEDICAL MANAGEMENT
Treatment of Opportunistic infections.
Prevention of Opportunistic Infection: TMP- SMZ is an antibacterial agent used to
treat various organism causing infection. It also confers cross- protection against
toxoplasmosis and some common respiratory infections.
Antidiarrheal therapy: Therapy with Octreotide acetate, a synthetic analogue of
somatostatin, has been shown to effectively manage chronic diarrhea.
Chemotherapy: Interferon alpha -2b (intron) is approved for use in AIDS related KS.
Antidepressant therapy: Antidepressants such as imipramine, desipramine and
fluoxentine may be used. A psychostimulant such as methylphenidate may be used in
low doses in patients with neuropsychiatric impairment.
Electroconvulsive therapy may be an option for patients with severe depression.

20. Nutritional therapy:
1. Appetite stimulants have been successfully used in patients with AIDS- related
anorexia.
2. Megestrol acetate, a synthetic preparation of progesterone preparation, promotes
significant weight gain and inhibits cytokine IL-1 synthesis.
3. Dronabinol, which is synthetic cannabinol has been used to relieve nausea and
vomiting associated with cancer chemotherapy.
4. oral supplements may be used when diet is deficient in in calories and proteins.
Oral supplements should be lactose free, high in calories and easily digestible protein
and low in fat.

21. COMPLEMENTARY AND ALTERNATIVE MODALITIES
People with HIV infection, including those who use illicit drugs, report substantial use
of complementary and alternative medicine.
CAM can be divided into four categories:
Spiritual or psychosocial therapies may include humor, hypnosis(a trance like state
that resembles sleep),faith healing, guided imagery and positive affirmations.
Nutritional therapies: It include vegetarian or macrobiotic diets; vitamin C OR Beta
carotene supplements; turmeric, which contains curcumin, a food spice supplement.
Drugs and biological therapies: It include medications and other substances not
approved by FDA. Example: N- acetylcysteine.
Treatment with physical forces and devices: It include acupuncture, acupressure,
massage therapy, reflexology, therapeutic touch, yoga and crystals.

22. NURSING DIAGNOSIS
• Diarrhea related to enteric pathogens or HIV infection.
•Risk for infection related to immunodeficiency.
•Ineffective airway clearance related to Pneumocystis pneumonia.
•Imbalanced nutrition less than body requirements related to
decreased oral intake.
•Deficient knowledge related to means of preventing HIV
transmission.
•Social isolation related to stigma of the disease.

23. NURSING INTERVENTION
Check vital signs of the patient.
Monitor intake and output.
Promote skin integrity
Promote usual bowel pattern
Prevent infection
Promote self care activity.
Maintain coherent thought process.
Improve airway clearance
Improve Nutritional status.

24. POSTEXPOSURE PROPHYLAXIS FOR HEALTH CARE
PROVIDERS
oAlert your supervisor/ nursing faculty and initiate the injury reporting system used in setting.
oIdentify source patient, who may need to be tested for HIV, hepatitis B, Hepatitis C.
oReport as quickly as possible to the employee health services, the emergency department or
other designated treatment facility.
oGive consent baseline testing for HIV, hepatitis B and C. Confidential HIV testing can be
performed upto 72 hours after the exposure.
oGet post exposure prophylaxis for HIV in accordance with Centers for Disease Control and
Prevention guidelines.
oFollow up with post exposure testing at 1 month, 3 months and 6 months and perhaps 1 year.
oDocument the exposure in detail for your own records as well as for the employer.
oTake the psychosocial support offered or seek support outside of the employment setting.

25. RECOMMENDATIONS FOR STANDARD
PRECAUTIONS
Hand Hygiene
Personal protective equipment: gloves, gown, mask, eye protection, face shield.
Soiled patient care equipment
Environmental Control: Disinfection of environmental surfaces.
Patient resuscitation
Do not recap, bend, break or hand manipulate used needles.
Prioritize for single patient room if patient is at increased risk of transmission.
Respiratory hygiene.
Handle laundry sheets in a manner that prevents transfer of microorganisms to others and to
the environment.