HIV

• Common risk factors for HIV transmission

  • Blood
  • Sex
  • Mother to baby
• Blood transmission


  • IV drug use
  • Needle stick
• Sex transmission


  • Oral, vaginal, or anal sex
  • Unprotected sex with multiple partners
• Mother to baby transmission

  • Moms have HIV
  • Breast milk
  • Fetal blood circulation
• HIV


  • It is an RNA retrovirus
  • It is unable to survive and replicate unless it is inside a living human cell
  • It destroys CD4 cells (helper T cells or CD 4+ lymphocytes)
  • Destruction of CD4 cells by HIV results in immune deficiency
  • CD4 cell count indicates immune function in those with HIV
• HIV pathophysiology stages


  1. Binding

  2. Fusion

  3. Virus releases

  4. Reverse transcription

  5. Integration

  6. Replication

  7. Assembly

  8. Infect other cells
• After initial infection (2 to 12 weeks after HIV exposure), rapid viral replication occurs resulting in a high level of HIV in circulation (high viral load)
• The virus then attacks and destroys the CD4 cells
• This causes a drop in CD4+ cells, which triggers an immune response that results in CD4+ cell replacement and HIV antibody production
• The CD4+ cells continue to drop as HIV viral load increases causing the immune system becoming weaker and unable to fight off infections
• If you skip 1 or 2 doses your body will not be able to take that drug (resistance)
• Acute retroviral syndrome


  Range from mild to severe, occurs 2-12 weeks after HIV exposure, includes fever, fatigue, pharyngitis, myalgia or arthralgia, lymphadenopathy, headache, and night sweats
• During this stage people are highly infectious and symptoms can often be mistaken for flu like illness (few people get diagnosed in this phase)
• CD4 slows decline and at the end will have 0 CD4 and becomes AIDS
• Goals of antiretroviral therapy

  • Maximal and durable suppression of viral load
  • Restore and preserve immunologic function- CD4 levels up!
  • Improve quality of life
  • Reduction of HIV –related morbidity and mortality
  • Reduction of sexual HIV transmission
  • Prevention of vertical transmission (mother to child during pregnancy, delivery or breast-feeding)
• The key goal of therapy is to achieve and maintain a viral load below the limits of detection (<20 to 40 copes/mL)
• Specific issues of medication adherence to antiretroviral agents

  • Stigma
  • Forgetting doses
  • Feeling ill
  • Side effects
  • Not having the medicine when doses are due
  • Pill fatigue (due to the stress and monotony of constant pill swallowing)
  • Drug costs, loss of health insurance
  • Lack of transportation to the pharmacy
• Adherence of 95 or greater!!
• Improving adherence


  • Drug organizers
  • Alarms on cell phones or mobile devices
  • Medication "maps" with picture
  • Drug diaries
  • Friends, family, personal support system
  • Nurses can facilitate adherence by allowing sufficient time to educate patients about drugs, developing a trusting relationship, and building a partnership with the patient
• Types of exposure recommendations


  • Occupational post-exposure prophylaxis
  • Non-occupational post-exposure prophylaxis
• Occupational post-exposure prophylaxis


  Due to a possible HIV exposure related to work
• Non-occupational post-exposure prophylaxis


  Due to a possible HIV exposure not related to work such as during sex (don't forget about being sexually assaulted) or injection drug use. Or a needle stick
• Start as soon as possible but must be within 72 hours
• 3 ART medications for 28 days/4 weeks
• REPORT IMMEDIATELY
• Labs monitored for a patient with HIV

  • CD4 counts
  • Plasma HIV viral load
• CD4 counts


  • When to start therapy
  • When to change drugs
  • Degree of immunodeficiency
  • Damage to immune system
• Plasma HIV viral load

  • Predictor of patient prognosis
  • Goal is to decrease viral load to undetectable numbers (20-40 copies/mL)
• Viral load


  • A test that monitors the effects and improvement in infection status after an antiretroviral treatment has been detected with HIV; done with blood sample
  • A high viral load indicates that HIV is present
  • A low viral load means that the virus is not progressing, and that HIV is not actively attacking the immune system
• Protease inhibitors (PI)


  Inhibits protease activity causing formation and release of immature, defective, and noninfectious virus particles
• Protease inhibitors (PI)


  • Numerous metabolic abnormalities that include dyslipidemia and insulin resistance
  • PK enhancers can alter these adverse effects by potentially increasing side effects
  • Dermatologic: SJS
  • CV: ECG changes
• PI-based regimens (one or two PIs plus two NRTIs) have revolutionized the treatment of HIV infection, especially with PK enhancement (boosters such as cobicistat and ritonavir)
• When added to NRTIs it helps decrease how many pills they are taking
• Patient education on ART

  • Purpose of each drug
  • The dosage schedule
  • Food and fluid restrictions
  • Recommended food choices
  • Storage of drugs
  • Possible side effects