Comprehensive Presentation on HIV/AIDS

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Hiv Infection & AIDs:

Hiv Infection & AIDs

overview:

overview

Hiv Disease:

Hiv Disease human immunodeficiency virus implies the entire course of HIV infection, from asymptomatic infection and early symptoms to AIDS a chronic condition, controllable with medications and strict adherence to treatment recommendations

AIDS:

AIDS Acquired immunodeficiency syndrome Most severe form of a continuum of illnesses associated with HIV infection If untreated, it causes slow degeneration of the immune system with the development of opportunistic infections and malignancies

Etiology & pathophysiology:

Etiology & pathophysiology

Slide 8:

Causative agent: a retrovirus that infects and depletes the CD4 + T-helper lymphocytes (one of the “protector” cells of the immune system) B lymphocytes secrete antibodies into the body fluids, or humors ( humoral immunity) T lymphocytes can penetrate living cells (cell-mediated immunity)

Slide 9:

Monocytes & macrophages, whose role is to present antigen to T cells, thereby initiating the body's immune response, are also infected by HIV Once HIV has entered the body, it attaches most efficiently to CD4 + molecules, which are predominantly located on the cell membrane of T4 helper lymphocytes After penetrating the cell membrane, the HIV genome and enzymes are released in the cell and integrated into the lymphocyte's genome

Slide 11:

The result of this reproductive process is the production of many new HIV virions and cell death for the T4 helper lymphocyte With progressive invasion of HIV, cellular and humoral immunity declines and opportunistic infections that characterize this disease begin to emerge

Slide 12:

Body fluids known to transmit HIV: Blood Vaginal secretions Semen Breast milk HIV is transmitted by injection of blood or blood components sexual contact (vaginal or anal intercourse, oral sex) perinatally (from an infected mother to the child)

High risk Groups for HIV transmission:

High risk Groups for HIV transmission

Slide 14:

Homosexual or bisexual men I.V . drug users Transfusion and blood product recipients (before 1985) Heterosexual contacts of HIV-positive individuals Newborn babies of mothers who are HIV-positive

STages of HIV Disease :

STages of HIV Disease

Primary HIV infection :

Primary HIV infection acute HIV infection/acute HIV syndrome Approximately 50% to 90% of persons will experience a brief flulike illness about 2 to 4 weeks following exposure to HIV Typical symptoms include: Fever Adenopathy Pharyngitis Rash

Slide 18:

Although most patients seek clinical care, few are diagnosed because the symptoms mimic a common flu During this phase the immune system is compromised by a sudden decrease in T4 helper cells and an increase in viral load for a brief period before returning to baseline

Slide 19:

Seroconversion occurs when the person has developed enough antibodies to HIV that the serologic test is positive Usually occurs 4 to 6 weeks after acute HIV infection

HIV Asymptomatic :

HIV Asymptomatic CDC Category A: More Than 500 CD4 + T Lymphocytes/ mm 3 By about 6 months, the rate of viral replication reaches a lower but relatively steady state that is reflected in the maintenance of viral levels at a kind of “set point” Set point varies greatly and dictates the subsequent rate of disease progression

Slide 21:

On average, 8 to 10 years pass before a major HIV-related complication develops Patients feel well and have few if any symptoms Apparent good health continues because CD4 + T-cell levels remain high enough to preserve defensive responses to other pathogens

HIV Symptomatic :

HIV Symptomatic CDC Category B: 200 to 499 CD4 + T Lymphocytes/ mm 3 The number of CD4 + T cells gradually falls Category B consists of symptomatic conditions in HIV-infected patients that are not included in the conditions listed in category C

Slide 23:

These conditions must also meet one criteria: The condition is due to HIV infection or a defect in cellular immunity The condition is considered to have a clinical course or to require management that is complicated by HIV infection If a person was once treated for a category B condition and has not developed a category C disease but is now symptom-free, that person's illness is considered category B.

AIDS:

AIDS CDC Category C: Fewer Than 200 CD4 + T Lymphocytes/ mm 3 As levels decrease to fewer than 100 cells/ mm 3 , the immune system is significantly impaired. Once a patient has had a category C condition, he or she remains in category C.

Slide 25:

This classification has implications for entitlements: Disability benefits Housing Food stamps A CD4 + percentage of less than 14% of the total lymphocytes is consistent with an AIDS diagnosis. One complication of advanced HIV infection is anemia , which may be caused by HIV, opportunistic diseases, or medications

Clinical manifestations:

Clinical manifestations

Pulmonary :

Pulmonary Persistent cough with and without sputum production SOB chest pain Fever Pneumocystis carinii pneumonia (PCP) -most common bacterial pneumonia (CAP) M. tuberculosis disseminated Mycobacterium avium complex CMV Histoplasma Kaposi's sarcoma Cryptococcus Legionella other pathogens

GI:

GI Diarrhea Weight loss Anorexia Abdominal cramping Rectal urgency ( tenesmus ) From enteric pathogens: Salmonella Shigella Campylobacter Entamoeba histolytica C. difficile CMV M. avium complex herpes simplex Strongyloides Giardia Cryptosporidium Isospora belli Chlamydia

Oral manifestations:

Oral manifestations White plaques on oral mucosa, particularly in the posterior pharynx & angular cheilitis from Candida albicans of mouth & esophagus Vesicles with ulceration from herpes simplex virus White, thickened lesions on lateral margins of tongue from hairy leukoplakia Oral warts due to human papillomavirus and associated gingivitis Periodontitis progressing to gingival necrosis Aphthous ulcers of unclear etiology -painful, solitary lesions with raised margins

Central nervous system:

Central nervous system Cognitive, motor, behavioral symptoms (AIDS dementia complex/HIV encephalopathy) mental slowing, impaired memory & concentration, loss of balance, lower extremity weakness, ataxia, apathy, social withdrawal May be caused by CNS toxoplasmosis, cryptococcal meningitis, herpes virus infections, CMV encephalitis, progressive multifocal leukoencephalopathy , CNS lymphoma. Sensory symptoms (distal symmetric polyneuropathy ) -demonstrated by numbness, tingling, neuropathic pain

Ocular manifestations:

Ocular manifestations Retinopathy due to CMV retinitis Visual impairment progresses to blindness if untreated

Malignancies:

Malignancies Kaposi's sarcoma (aggressive tumor involving skin, lymph nodes, GI tract, and lungs) Non-Hodgkin's lymphoma and lymphomas Cervical carcinoma

Diagnostic evaluation:

Diagnostic evaluation

Positive blood test for HIV:

Positive blood test for HIV Enzyme-linked immunosorbent assay (ELISA) - serologic test for detecting antibody to HIV Western blot test - used to confirm a positive result on ELISA When infected with HIV, it usually takes the body up to 12 weeks to develop enough antibody to HIV for the test result to be positive, resulting in a false-negative test if evaluated early.

Slide 57:

History of risk factors/high-risk behaviors Lymphocyte panel shows decreased CD4 + count Complete Blood Count may show anemia and low WBC count Presence of indicator disease PCP candidiasis of esophagus Kaposi's sarcoma

Slide 58:

Diagnostic procedures (biopsies, imaging procedures) of the organ system involved to confirm opportunistic infection, malignancy, or other causes Neuropsychological testing to identify cognitive deficits associated with AIDS dementia complex

Slide 59:

Viral load a measure of the amount of HIV in the blood A higher number (greater than 750,000 copies/ mL ) indicates greater viremia High viral loads are usually found in acute seroconversion and late disease, but also occur when patients have another infectious process in the body A viral load test result can be undetectable, meaning the amount of virus is less than 50 copies/ mL This does not indicate that the body is free of HIV Latent reservoirs exist in the lymphoid tissues indefinitely

complications:

complications

Slide 61:

Development of HIV virus resistant to antiretroviral treatment Repeated overwhelming opportunistic infections Respiratory failure Wasting Medication-related conditions: Lipodystrophy Hyperlipidemia Insulin-resistance Lactic acidosis

Slide 62:

Facial Lipoatrophy

management:

management

General considerations:

General considerations

Slide 65:

Treatments are available for the underlying immunodeficiency and are usually successful when patients receive at least 90% of doses Patient education that stresses adherence to treatment and monitoring adherence are essential elements of treatment success Treatment is available for some opportunistic infections and other diseases associated with AIDS

Specific treatment:

Specific treatment

haart:

haart Highly active antiretroviral therapy Consists of medications that belong to four different classifications because they act to prevent HIV replication at four different points along the replication process. S tandard: take a minimum of 3 different drugs from at least 3 different drug classifications

Classes of antiretroviral drugs:

Classes of antiretroviral drugs Nucleoside/nucleotide reverse transcriptase inhibitors ( NRTI ) historically, the first class of medications used in the treatment of HIV Nonnucleoside reverse transcriptase inhibitors ( NNRTI )

Slide 69:

Protease inhibitors (PI) the second class of HIV medications “three-drug cocktails, which made ” possible transformed HIV from a terminal illness to a chronic illness for many patients became available in 1996 Entry inhibitors newest class of HIV treatment

Goals of antiviral therapy::

Goals of antiviral therapy: Prolong life and improve quality of life Reduce viral load to as low as possible for as long as possible Increase the CD4 + count to allow immune reconstitution Maintain options for future treatment by preventing the development of treatment-resistant virus Avoid drug toxicities

Supportive Care:

Supportive Care Treatment of reversible illnesses Nutritional support Palliation of pain Evaluation and management of psychological and social aspects of HIV/AIDS infection Treatment to relieve symptoms (cough, diarrhea ) Antidepressant drugs; psychiatric interventions

Nursing Managment:

Nursing Managment

Nursing assessment:

Nursing assessment

Slide 74:

Obtain: hx of risk factors constitutional s/ sx recent infections + blood test for HIV antibodies most recent CD4 + count HIV RNA viral load Review present complaints cough, SOB, diarrhea Evaluate nutritional status wt loss, body mass depletion hypoalbuminemia , decreased iron-binding capacity, anemia

Slide 75:

complications of drug toxicities ( hyperlipidemia , hyperglycemia , lipodystrophy ) Assess RR & depth Auscultate lungs for breath sounds Assess for skin color & temperature, palpable lymph nodes, evidence of fever, night sweats Inspect mouth for lesions ( candida in posterior pharynx) examine skin for rash, sores, Kaposi's sarcoma lesions Record number, size, locations

Slide 76:

Ask about: bowel patterns, changes in habits, constipation, abdominal cramping, number & volume of stools, presence of perianal pain & ulceration O riented to time, place, person? Affect? Any problem with memory & concentration? Headaches? Seizures? How much does he know about HIV/AIDS? Etiology ? Signs & symptoms? Mode of transmission? Methods for limiting exposure?

Slide 77:

Disease progression & importance of CD4 + count & HIV RNA viral load monitoring? Find out about: premorbid personality, experience, skills, social support system Assess the adherence to medications Review all prescribed drugs, dose, how often the he is taking the medication Ask how many times over the last day/week he may have missed a dose

Nursing diagnoses:

Nursing diagnoses

Slide 79:

Activity intolerance Disturbed body image Fatigue Hopelessness Hyperthermia Imbalanced nutrition: Less than body requirements Impaired oral mucous membrane Impaired skin integrity Impaired tissue integrity

Slide 80:

Ineffective coping Ineffective health maintenance Ineffective protection Ineffective sexuality patterns Interrupted family processes Noncompliance (treatment regimen) Powerlessness Risk for deficient fluid volume Risk for infection Social isolation

Key outcomes:

Key outcomes

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The patient will: verbalize the importance of balancing activity, as tolerated, with rest verbalize feelings about a changed body image express that he has more energy make decisions on his own behalf maintain a normal body temperature maintain current weight or achieve ideal weight (patient's) oral mucous membranes will remain intact

Slide 83:

The patient will: voice feelings about changes in sexual identity (patient's) wounds & lesions will heal without complications site of impaired tissue will have reduced redness, swelling, pain use support systems to assist with coping perform health maintenance activities according to the level of his ability demonstrate use of protective measures, including conserving energy, maintaining a balanced diet, getting plenty of rest

Slide 84:

The patient will: ( family will) state ways to support & assist the patient comply with the treatment regimen express feelings of control over his condition & situation maintain adequate fluid balance experience no fever, chills, or other signs or symptoms of illness maintain peer & family relationships

Nursing interventions:

Nursing interventions

Slide 86:

Recognize that a diagnosis of AIDS is profoundly distressing because of the disease's social impact & the discouraging prognosis The patient may lose his job, financial security, support of family & friends. Coping with an altered body image, emotional burden of serious illness, and threat of death may overwhelm the patient Monitor for fever, noting any pattern, signs of skin breakdown, cough, sore throat, diarrhea Assess for swollen, tender lymph nodes Check laboratory values regularly

Slide 87:

Avoid glycerine swabs for mucous membranes Try normal saline or bicarbonate mouthwash for daily oral rinsing Record the patient's caloric intake Ensure adequate fluid intake during episodes of diarrhea Provide meticulous skin care, especially if the patient is debilitated

Slide 88:

Encourage the patient to maintain as much physical activity as he can tolerate Make sure his schedule includes time for both exercise & rest If the patient develops Kaposi's sarcoma, monitor the progression of lesions Monitor opportunistic infections or signs of disease progression Treat infections as ordered

Patient teaching:

Patient teaching

Slide 90:

Combination antiretroviral therapy is used to maximally suppress HIV replication, thereby improving survival Poor drug compliance may lead to resistance & treatment failure Patients must understand that medication regimens must be followed closely & may be required for many years, if not throughout life Urge the patient to inform potential sexual partners & health care workers that he has HIV infection

Slide 91:

Teach the patient how to identify the signs of impending infection Stress the importance of seeking immediate medical attention Involve the patient with hospice care early in treatment so he can establish a relationship If the patient develops AIDS dementia in stages, help him understand the progression of this symptom

Preventing AIDS transmission:

Preventing AIDS transmission

Slide 93:

Use precautions in all situations that risk exposure to blood, body fluids, secretions Standard precautions can prevent the inadvertent transmission of AIDS, hepatitis B, & other infectious diseases Educate the patient and his family, sexual partners, friends about disease transmission & prevention of extending the disease to others Inform the patient not to donate blood, blood products, organs, tissue, sperm If the patient uses I.V . drugs, caution him not to share needles

Slide 94:

High-risk sexual practices for AIDS transmission are those that exchange body fluids vaginal or anal intercourse without a condom Discuss safer sexual practices Hugging, petting, mutual masturbation, protected sexual intercourse Abstaining is also the most protective method of not transmitting the disease Advise female patients of childbearing age to avoid pregnancy Explain that an infant may become infected before birth, during delivery, or during breast-feeding

THANK YOU! Have a nice day : ):

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