Module 4

• Acquired Immune Deficiency Syndrome (AIDS)


  An immune deficiency that is acquired, not hereditary nor inborn. A syndrome, a combination of signs and symptoms that form a distinct clinical picture of disorder.
• Human Immunodeficiency Virus (HIV)


  A retrovirus that belongs to lentivirus, or called "slow virus". The time between infection and the appearance of symptoms tends to be much longer and it allows more opportunities for the microorganism to be transmitted to other host.
• Pathophysiology of AIDS


  1. HIV invades lymphocytes, macrophages, Langerhans cells, and neurons in the CNS

  2. Anti-HIV antibodies are produced but they do not appear immediately (window effect)

  3. Virus attaches to CD4 protein molecule in T4 cells, enters and makes them die after replicating

  4. Virus mutates rapidly making it more difficult for the immune system to recognize
• Ways to be infected with blood-infected HIV


  • Sharing of unsterilized syringes and needles used for IV injections
  • Transmission during pregnancy (trans-placental, greater risk when mother has advanced AIDS)
  • Organ donation
  • Accidental exposure in hospitals or clinics
• Diagnostic Tests for HIV

  • EIA (enzyme immunosorbent assay) or ELISA (enzyme link immunosorbent assay)
  • Particle agglutination PA test
  • Western blot analysis (confirmatory)
  • Immunofluorescent test
  • RIPA (Radio immuno-precipitation assay)
• HIV Antibody Test

  Negative - HIV antibodies not detectable

  Positive - HIV antibodies present, person is HIV positive
• Signs and Symptoms of HIV/AIDS

  • Neurological: Memory loss, altered gait, depression, sleep disorder

  Minor: Persistent cough, generalized pruritic dermatitis, recurrent herpes zoster, oropharyngeal candidiasis, chronic disseminated herpes simplex, generalized lymphadenopathy

  Major: Loss of weight >10%, chronic diarrhea >1 month, prolonged fever >1 month
• Top 10 Parasitic Symptoms of HIV/AIDS

  • Toxoplasmosis

  2. Cryptosporidiosis (watery diarrhea, abdominal cramps, low grade fever, weight loss)
• Preventive Measures for Cryptosporidiosis


  • Wash hands thoroughly after contact with feces

  Practice safe sex

  Be careful not to swallow water when swimming

  Wash/cook food properly

  Drink safe water
• Categories of Antiretroviral Drugs

  • CCR5 antagonists

  Fusion inhibitors

  Integrase inhibitors

  Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

  Nucleoside reverse transcriptase inhibitors (NRTIs)

  Protease inhibitors (PIs)
• Mode of Action of Antiretroviral Drugs

  CCR5 antagonists prevent HIV from entering cells by blocking a membrane receptor

  Fusion inhibitors prevent HIV from entering cells by binding a viral protein needed for entry

  Integrase inhibitors impair the function of HIV's integrase enzyme

  NRTIs bind active sites on HIV's reverse transcriptase enzyme, blocking DNA production

  PIs inhibit HIV's protease enzyme, which cleaves HIV's gene products
• Nursing Management of HIV/AIDS

  • Health Education

  Practice Universal/Standard Precaution

  Isolation of active AIDS

  Encourage monogamous relationship

  Care for HIV infected pregnant women
• Nursing Diagnoses for HIV/AIDS

  • Knowledge deficit

  Social isolation

  Risk for infection

  Anxiety

  Self-esteem disturbance

  Altered role performance
• The 4 C's in the Management of HIV/AIDS

  • Compliance

  Counseling/education

  Contact tracing

  Condoms