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  1. 1. AIDS (Acquired Immune Deficiency Syndrome) by: Policarpio, Anna Marie Lo BSN 4-0
  2. 2. A I D S <ul><li>a chronic infectious disease caused by Human Immuno- defiency Virus (HIV) which destroys helper T-lymphocytes causing loss of the immune response and increased susceptibility to secondary infection and cancer, and eventually lead to death. </li></ul><ul><li>severe form of continuum of illness associated with HIV </li></ul>
  3. 3. <ul><li>CD4 T-helper lymphocytes are < 200 with increased viral load of more than 100,000 </li></ul><ul><li>a NO CURE infection </li></ul>
  4. 4. Causative Agent: <ul><li>HIV retrovirus (belongs to lentivirus, which sometimes called “slow virus” </li></ul><ul><li>Human T-cell lymphotropic virus 3 (HTLV-3) </li></ul><ul><li>consist of genetic material in the form of RNA (instead of DNA ) surrounded by a lipoprotein envelope. </li></ul><ul><li>HIV type 1 in Europe and America, HIV type 2 in Africa </li></ul>
  5. 5. Mode of Transmission: <ul><li>sexual contact </li></ul><ul><li>blood transfusion </li></ul><ul><li>contaminated syringes, needles, nipper, razor blades </li></ul><ul><li>direct contact of open wound/mucous membrane with contaminated blood, body fluids, semen and vaginal discharges </li></ul><ul><li>vertical or perinatal transmission (mother to fetus, child delivery, breastfeeding) </li></ul><ul><li>organ donations with infected blood </li></ul>
  6. 6. Persons at Risks: <ul><li>with polygamous relationships </li></ul><ul><li>gay-lesbian relationships </li></ul><ul><li>drug addicts </li></ul><ul><li>sex workers </li></ul><ul><li>organ transplant recipient </li></ul><ul><li>receiving blood transfusion </li></ul><ul><li>healthworkers </li></ul>
  7. 7. Incubation Period: <ul><li>Variable – 1 to 3 months (time of infection to the development of detectable antibodies) </li></ul><ul><li>1 to 15 years (time from HIV infection to diagnosis of AIDS) </li></ul>
  8. 8. Signs and Symptoms: (AIDS-related Complex) ARC <ul><li>a person may remain asymptomatic, feel and appear healthy for years even though he is infected with HIV. The immune system starts to be impaired. </li></ul><ul><li>AIDS is the active stage of infection </li></ul><ul><li>CD4 T-helper lymphocytes are < 200 with increased viral load of more than 100,000 </li></ul>
  9. 9. a. Physical <ul><ul><li>maculo-papular rashes </li></ul></ul><ul><ul><li>loss of appetite </li></ul></ul><ul><ul><li>weight loss (10% of body weight) </li></ul></ul><ul><ul><li>fever of unknown origin </li></ul></ul><ul><ul><li>body malaise </li></ul></ul><ul><ul><li>chronic diarrhea (more than one month) </li></ul></ul><ul><ul><li>persistent cough for one month </li></ul></ul><ul><ul><li>gaunt-looking, apprehensive (anxious looking) </li></ul></ul>
  10. 10. <ul><ul><li>generalized lympadenopathy </li></ul></ul><ul><ul><li>recurrent herpes zoster </li></ul></ul><ul><ul><li>tuberculosis (localized and disseminated) </li></ul></ul><ul><ul><li>esophageal/oropharyngeal candidiasis </li></ul></ul><ul><ul><li>Kaposi’s sarcoma ( skin cancer) </li></ul></ul><ul><ul><li>pneumocystis carinii pneumonia </li></ul></ul>
  11. 11. b. Mental <ul><li>(Early Stage) </li></ul><ul><ul><li>forgetfulness </li></ul></ul><ul><ul><li>loss of concentration </li></ul></ul><ul><ul><li>loss of libido </li></ul></ul><ul><ul><li>apathy (lack of interest or feeling) </li></ul></ul><ul><ul><li>psychomotor-retardation </li></ul></ul><ul><ul><li>withdrawal (anti-social) </li></ul></ul>
  12. 12. <ul><li>(Later Stage) </li></ul><ul><li>- confusion </li></ul><ul><li>- disorientation </li></ul><ul><li>- seizures </li></ul><ul><li>- mutism (speechlessness) </li></ul><ul><li>- loss of memory </li></ul><ul><li>- coma </li></ul>
  13. 13. Top 10 Symptoms of HIV/AIDS: <ul><li>depression </li></ul><ul><li>diarrhea </li></ul><ul><li>thrush </li></ul><ul><li>weight loss </li></ul><ul><li>lipodystrophy (fat redistribution syndrome) </li></ul><ul><li>sinus infection </li></ul><ul><li>fatigue </li></ul><ul><li>nausea and vomiting </li></ul><ul><li>lactic acidosis ( lactic acid build up in the body due to damage in the mitochondria) </li></ul><ul><li>peripheral neuropathy (burning and tingling of feet and hands) </li></ul>
  14. 14. Stages in the development of AIDS: <ul><ul><li>a. Acute HIV (primary infection) </li></ul></ul><ul><ul><ul><li>from infection of HIV to development of antibodies to HIV </li></ul></ul></ul><ul><ul><ul><li>“ window period” (test negative with HIV antibody) </li></ul></ul></ul><ul><ul><ul><li>viremia stage (flu-like symptoms) </li></ul></ul></ul><ul><ul><ul><li>viral setpoint (balance between HIV & immune response) </li></ul></ul></ul><ul><ul><ul><li>mild symptoms </li></ul></ul></ul><ul><ul><ul><li>0 to 12 months </li></ul></ul></ul>
  15. 15. <ul><ul><li>HIV-positive </li></ul></ul><ul><ul><ul><li>asymptomatic (CD4 is >500, feeling well) </li></ul></ul></ul><ul><ul><ul><li>symptomatic (CD4 is 200-499, gradual falling of CD4) </li></ul></ul></ul><ul><ul><ul><li>more antibodies form </li></ul></ul></ul><ul><ul><ul><li>small amount of virus in blood </li></ul></ul></ul><ul><ul><ul><li>1 to 7 years or more </li></ul></ul></ul>
  16. 16. <ul><ul><li>c. AIDS </li></ul></ul><ul><ul><ul><li>active infection </li></ul></ul></ul><ul><ul><ul><li>decreasing CD4 count </li></ul></ul></ul><ul><ul><ul><li>AIDS indicator diseases (opportunistic infections, kaposis sarcoma, wasting syndrome, HIV encephalopathy, pneumonia) </li></ul></ul></ul><ul><ul><ul><li>7 to 12 years or more </li></ul></ul></ul>
  17. 17. Common Opportunistic Infections: <ul><li>Bacterial - Mycobacterium avium complex MAC (TB –like symptoms) </li></ul><ul><li>disseminated disease involving lung, bone marrow, liver; CD4 <= 100/ml </li></ul><ul><ul><ul><li>Tuberculosis </li></ul></ul></ul><ul><ul><ul><li>Salmonillosis </li></ul></ul></ul>
  18. 18. <ul><li>Viral </li></ul><ul><li>- Herpes </li></ul><ul><li>- Hepatitis </li></ul><ul><li> - Genital Warts </li></ul><ul><li>- Cryptomegalovirus CMV (causes retinitis, pain in swallowing, leg numbness) </li></ul><ul><li>- malluscum contangiosum (dome- shame papule on face, trunk, extremities) </li></ul>
  19. 19. <ul><li>Fungal </li></ul><ul><li>- Candidiasis (infections of trachea, esophagus, lungs) </li></ul><ul><li>- Cyrptococcal meningitis </li></ul><ul><li>- Histoplasmosis </li></ul><ul><li>Pneumonias </li></ul><ul><li> - Bacterial </li></ul><ul><ul><ul><li>Pneucystitis carinii Pneumonia (PCP) </li></ul></ul></ul>
  20. 20. <ul><li>Cancers </li></ul><ul><li>- Kaposi’s sarcoma (tumors in the skin and linings of the internal organs) </li></ul><ul><li>- Cervical dysplasia and carcinoma </li></ul><ul><li>- Non-Hodgkin’s lymphoma (usually late manifestation of HIV infection) </li></ul><ul><li>Parasitic </li></ul><ul><li>- Toxoplasmosis </li></ul><ul><li>- Cryptosporidiosis (spreads by contact of feces containing crypto) </li></ul>
  21. 21. Pathophysiology: <ul><li>HIV Infection: </li></ul><ul><li>(sexual contact, blood transfusion,mother-to-fetus, </li></ul><ul><li>contaminated sharps, organ donation, direct contact with open wounds </li></ul><ul><li>on contaminated fluids & discharges) </li></ul><ul><li> </li></ul><ul><li>HIV particles attaches to receptors on Helper-T4 lymphocyte </li></ul><ul><li>(CD4) cell surfaces </li></ul><ul><li> </li></ul><ul><li>Viral RNA and reverse transcriptase enzyme </li></ul><ul><li>enter Helper-T4 cell </li></ul><ul><li> </li></ul><ul><li>enzyme converts Viral RNA to Viral DNA </li></ul><ul><li>Drug AZT blocks transcription </li></ul><ul><li> </li></ul><ul><li>Viral DNA joins Helper-T4 cell DNA </li></ul><ul><li> </li></ul>
  22. 22. <ul><li>Replication of HIV Helper-T4 cell produces </li></ul><ul><li>viral components </li></ul><ul><li>Anti-HIV protease inhibitor </li></ul><ul><li>drugs block </li></ul><ul><li> </li></ul><ul><li>Assemble new virus particles </li></ul><ul><li> </li></ul><ul><li>infected Helper-T4cells shed many HIV particles to invade </li></ul><ul><li>other Helper-T4 cells & lymphoid tissue (VIREMIA) </li></ul><ul><li> </li></ul><ul><li>infected Helper-T4 cells are destroyed </li></ul>
  23. 23. <ul><li> </li></ul><ul><li>Phase 1: initial infection usually in 3-6 weeks with mild, non-specific </li></ul><ul><li> “ flu-like” symptoms </li></ul><ul><li> self-limiting – initially the immune response limits infection </li></ul><ul><li> antibodies from in 2-10 wks. (blood test) </li></ul><ul><li>TEST HIV POSITIVE </li></ul><ul><li>Phase 2: LATENT – may last years-asymptomatic or lymphadenopathy may be present </li></ul><ul><li> Helper-T4 cell count decreases & weaker immune response </li></ul><ul><li> gradually move into active infection </li></ul><ul><li>Phase 3: ACUTE – AIDS IMMUNODEFICIENCY </li></ul><ul><li> very low T4 cell count </li></ul><ul><li> multiple severe opportunistic infections, </li></ul><ul><li> cancers, wasting syndrome, CNS involvement </li></ul>
  24. 24. Diagnosis: <ul><li>Physical Exam </li></ul><ul><ul><li>evaluate for oral candidiasis, &quot;cottage cheese and ketchup&quot; appearance of retina, adenopathy, skin abnormalities, respiratory symptoms, abdominal tenderness, and signs of dementia </li></ul></ul><ul><li>Chest X ray </li></ul><ul><ul><li>for pneumonia, tuberculosis. Brain imaging if neurological symptoms are present. </li></ul></ul>
  25. 25. <ul><li>Laboratory Tests: </li></ul><ul><li>1. ELISA (Enzyme link immunosorbent assay) </li></ul><ul><ul><li>screening test/presumptive test </li></ul></ul><ul><ul><li>produces false positive results in people who have been exposed to parasitic diseases such as malaria </li></ul></ul><ul><li>2. Western Blot analysis </li></ul><ul><ul><li>confirmatory test/positive result </li></ul></ul><ul><ul><li>to confirm reactive seropositive results obtained by ELISA test </li></ul></ul>
  26. 26. <ul><li>3. Polymerase Chain Reaction test (PCR) </li></ul><ul><li>- screen for viral RNA and therefore allow detection of the virus after very recent exposure </li></ul><ul><li>- viral load (measures HIV RNA in the plasma) </li></ul><ul><li>- better predictor of risk of HIV progression than CD4 count) </li></ul><ul><li>4. CD4 count (CD4-CD8 Ratio) </li></ul><ul><li>- significant lowering of CD4 over CD8 </li></ul>
  27. 27. <ul><li>5 . Radio immuno-precipitation assay (RIPA) </li></ul><ul><li>6. Immunofluorescent test </li></ul><ul><li>Particle Agglutination test </li></ul><ul><li>HIV Antibody tests </li></ul><ul><li>- negative test (HIVantibodies not detectable in the blood at the time of test) </li></ul><ul><li>- positive test (HIV antibodies are present in blood, person is considered HIV positive) </li></ul>
  28. 29. Treatment: <ul><li>AIDS drugs are medicines used to treat but not cure HIV infection . </li></ul><ul><li>These drugs are sometimes referred to as “anteroviral drugs” , work by reducing the replication of the virus. </li></ul>
  29. 30. <ul><li>There are 2 groups of anteroviral drugs: </li></ul><ul><li>Reverse transcriptase inhibitors </li></ul><ul><li>- inhibits the enzyme “reverse transcriptase” which is needed to “copy” information for the virus to replicate. </li></ul><ul><ul><ul><ul><li>Zidovudine (ZDV) / Azidothymidine - Retirvir (best known drug) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Zalcitabine - Havid </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Stavudine - Zerit </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lamivudine - Epivir </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nevirapine - Viramune </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Didanosine - Videx </li></ul></ul></ul></ul>
  30. 31. <ul><li>Protease inhibitors – inhibits the enzyme protease which are needed for the assembly of viral particles. </li></ul><ul><li>- Saquinavir - Invarase </li></ul><ul><li>- Ratinovir - Norvir </li></ul><ul><li>- Indinavir - Crixivan </li></ul>
  31. 32. <ul><li>“ Cocktail drugs” (combination of three to five drugs) – are used to prolong the latent phase </li></ul><ul><li>- as well as reduce the viral load during the final phase </li></ul><ul><li>HARRT (Highly Active Anti-Retrovirus Therapy) - very effective at controlling the virus by reducing the viral load in the blood and returning CD4 cell counts to near normal levels </li></ul>
  32. 33. <ul><li>PRIMARY FOCUS: </li></ul><ul><li>- minimize the effects of complications such as infections or malignancy by prophylactic medications and immediate treatment. </li></ul>
  33. 34. Nursing Management:
  34. 35. 1. Health Education. <ul><ul><li>inform client of the disease process and mode of transmission </li></ul></ul><ul><ul><li>emphasize “AIDS awareness Program” </li></ul></ul><ul><ul><li>give practical advice </li></ul></ul><ul><ul><li>avoid judgemental and moralistic messages </li></ul></ul><ul><ul><li>be consistent & concise in giving instructions especially in taking medication </li></ul></ul><ul><ul><li>use positive statement </li></ul></ul><ul><ul><li>encourage client to trace or identify previous contact for proper management </li></ul></ul>
  35. 36. 2. Practice universal/standard precautions. <ul><ul><li>thorough medical handwashing after every contact with patient and after removing the gown & gloves, and before leaving the room of an AIDS suspect or known AIDS patient. </li></ul></ul><ul><ul><li>use of universal barrier or personal protective equipment is very necessary </li></ul></ul>
  36. 37. 3. Prevention . <ul><ul><li>avoid accidental pricks from sharp instruments contaminated with potentially infectious materials from AIDS patient </li></ul></ul><ul><ul><li>gloves should be worn when handling blood specimens & other body secretions as well as surfaces, materials and objects exposed to them </li></ul></ul><ul><ul><li>blood and other specimens should be labeled with special warning “AIDS Precaution” </li></ul></ul><ul><ul><li>blood spills should be cleaned immediately, like using chlorox </li></ul></ul><ul><ul><li>needles should not be bent after use, but are disposed to sharps-container </li></ul></ul><ul><ul><li>personal articles like toothbrush and razors should not be shared with other family members </li></ul></ul>
  37. 38. <ul><ul><li>patients with active AIDS should be isolated </li></ul></ul><ul><ul><li>clients considered at risk should not be allowed to donate blood or any organ of the body </li></ul></ul><ul><ul><li>encourage monogamous relationship </li></ul></ul><ul><ul><li>HIV-infected pregnant women should go into regular prenatal, interpartal, postpartal care </li></ul></ul><ul><ul><li>speak openly with partners about safer sex techniques and HIV status </li></ul></ul>
  38. 39. <ul><li>4 C’s in HIV/AIDS Management: </li></ul><ul><ul><li>Compliance </li></ul></ul><ul><ul><li>Counseling/Education </li></ul></ul><ul><ul><li>Contact tracing </li></ul></ul><ul><ul><li>Condoms </li></ul></ul>
  39. 40. <ul><li>Nursing Diagnosis: </li></ul><ul><li>Knowledge deficit </li></ul><ul><li>Strict isolation </li></ul><ul><li>Risk for infection </li></ul><ul><li>Anxiety </li></ul><ul><li>Self-esteem disturbance </li></ul><ul><li>Altered role performance </li></ul>
  40. 41. Prognosis: <ul><li>at present, persons living with HIV/AIDS infection are living longer with improved drug treatment... </li></ul>
  41. 42. <ul><li>References: </li></ul><ul><ul><ul><li>Public Health Nursing (DOH Book) , 2nd Edition </li></ul></ul></ul><ul><ul><ul><li>Contemporary Medical-Surgical Nursing, J. Tazbir </li></ul></ul></ul><ul><ul><ul><li>Handbook of Common Communicable & Infectious Diseases, D. Navales </li></ul></ul></ul><ul><ul><ul><li>Pathophysiology for the Health Professions, B. Gould </li></ul></ul></ul><ul><ul><ul><li>E-Encyclopedia Britannica 2007 </li></ul></ul></ul>