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Human Immunodeficiency Virus/ Acquired Immune Deficiency o every 13 seconds someone gets infected with HIV o every 15 seconds another person dies from AIDS History of HIV Disease o 1979 physicians in NY and CA were noting cases of Pneumocystis carinii pneumonia (PCP) and Kaposis sarcoma (KS) o originally dubbed GRID, or Gay-Related Immune Deficiency o AIDS epidemic was discovered June 5, 1981 o in 1982, the CDC introduced the term AIDS describe the newly recognized syndrome, though it was still casually referred to as GRID o 2 species of HIV infect humans o HIV-1 o HIV-2 o HIV-2 may have originated from the Sooty Mangabey monkey of Guinea-Bissau, Gabon, and Cameroon o HIV-1 is the most virulent. it is easily transmitted and is the cause of the majority of HIV infections globally o HIV-2 is less transmittable and is largely confined to West Africa Transmission of HIV o transmitted from human to human o blood semen o cervicovaginal secretions o breast milk o other body fluids that do contain HIV o saliva o urine o tears o feces o Transmission route o Sexual transmission anal or vaginal intercourse receiver more prone to become infected oral is rare o Parenteral exposure contaminated drug injecting equipment and paraphernalia transfusion of blood and blood products occupational exposure decreasing risks related to drug use STOP SHOOTING UP use sterile needles and equipment o Perinatal (vertical) transmission transmission from mother to fetus may occur during pregnancy, delivery, or postpartum breastfeeding a mother does not have to take meds to suppress the virus during pregnancy o Occupational exposure o open wound o needle sticks o Mucocutaneous Pathophysiology How HIV works in the body o Viruses including HIV, cannot make copies of themselves on their own o HIV must invade a healthy cell in your body o HIV like to invade CD4 cells o these are special calls that help the bodys immune system protect you against things that make you sick o HIV has a special chemical to unlock and enter the CD4 cell o the chemical is like a key on the surface of the virus, ready to open the CD4 cell for invasion and infection o HIV uses another chemical (reverse transcriptase) to change so it can gain entry into the cells command center (nucleus) o in healthy CD4 nucleus substances are being produced to signal the immune system to protect the body against disease

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o HIV uses another enzyme (integrase) to get inside the nucleus o HIV takes control, inserting its own codes into the command center so that the reprogrammed CD4 cell will make new virus o the infected CD4 cell is now an HIV factory, pumping out new viral parts o a third enzyme (protease) cuts out and assembles the new viral parts into copies of the virus o new copies of the virus leave the cell ready to seek out more and more CD4 cells to invade o Immune dysfunction o decreases resistance to life-threatening infections Cd4 + 600-1200 normal per microliter CD4 + 200-499 minor immune problems CD4 + below 200 severe immune problems Spectrum of HIV o initial exposure o Primary HIV infection flu-like symptoms develop antibodies to HIV in 1-12 weeks o HIV seropositivy (seroconversion) positive HIV antibody test 95% within 3 months; 99% within 6 months o Infectious; but might not feel ill o Asymptomatic HIV infection Early symptomatic disease CD4+ cell count drops below 500 cells/mcl drenching night sweats chronic diarrhea H/A fatigue Acute retroviral syndrome viral set point 4-6 months p exposure the lower the viral set point the better bc you generally will live longer o AIDS the end-stage of the HIV infection HIV positive and CD4+ (T4) count below 200 or one or more AIDS-indicator conditions o Diagnostic Studies o HIV antibody testing ELISA detects the presence of HIV antibodies if positive, ELISA is done a second time Western blot done if second ELISA is positive more sensitive than ELISA is the confirming test Seronegative not an assurance that an individual is free from HIV infection Seroconversion may not have occurred yet Seropositive all three tests are positive (ELISA x2 and Western blot) does not mean the person has AIDS CD4 count normally 600-1200 microliter decreases as the disease progresses best marker for the immunodeficiency assoc. w/ HIV infection HIV infection in humans is now pandemic is one of the most destructive pandemics in recorded history ppl living w/ HIV/AIDS in 2007

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roughly 33.2 million about are women Trends and Most Affected Populations o African-Am constitute approx. 13% of the total US population, but 40% of the total AIDS cases o the incidence of HIV/AIDS in Hispanics is nearly four times greater than in non-Hispanic Caucasians HIV medications o all anti-HIV meds attack the virus inside of the CD4 cell where the virus is trying to make copies of itself o these meds, called enzyme inhibitors, work by blocking the enzyme used by HIV o there are 3 types: o NRTIs o NNRTIs o PIs (protease inhibitors) o NRTIs and NNRTIs stop the enzyme reverse transcriptase o this is the enzyme HIV uses to change itself and enter the CD4 cell o unable to change, HIV cannot get into the cells command center o HIV is unable to make new copies of itself o PIs stop the enzyme protease o HIV uses it to cut out and assemble new viral parts o Although new viral parts may be produced, the parts dont go together properly o the defective virus cannot go on to infect other cells o combination therapy prevents development of resistance o must be given around the clock o usually initiated when o CD4+ count below 350mcl, or o viral load greater than 30,000 copies/ml Opportunistic Infections (OIs) o fungal pulmonary disease Form of pneumonia o Pneumocystis jiroveci pneumonia o most common infections o Symptoms: fever, night sweat o Kaposis sarcoma o most common neoplasm found in HIV infected o KS-rare skin cancer that also affects your mucous membranes o Symptoms reddish-purple not curable o Cytomegalovirus (CMV) o common virus that infects most ppl during their life o herpes-type virus o the infection may result in pneumonia, gastroenteritis o Symptoms colitis bloody diarrhea pain wt loss o Treatment Gancyclovir Foscarnet o Cryptococcal Meningitis o symptoms stiff neck headache cognitive impairment motor dysfunction

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o Tx sx Amphotericin B Fluconazole o Toxoplasma Gondii o invades the brain o in AIDS pts, the toxoplasma lesion presents as a mass lesion Symptoms fever; H/A mental changes hemiparesis o Nursing Interventions o Duty to treat health care professionals may not pick and choose their pts Rehabilitation Act of 73 prohibits discrimination vs the handicapped and the disabled HIV and AIDs are included o Assisting w/ coping educate about HIV listen maintain sources of psychological support o Need to know basis not every health care worker needs to know dx universal precautions should be used w/ every pt Which are the following are S/S of HIV infections??? o wt loss, sore throat, dyspnea Prevention of HIV infection o HIV testing and counseling o pre and post test counseling o informed consent must be obtained before drawing blood o consent laws are established by state laws o confidential o Risk Assessment o minimum risk assessment Have you ever?? had transfusion before 1985 shared needles o Barriers to prevention Denial it wont happen to me ignoring risks, fears, misunderstanding, and potential for social isolation o No sex limit sexual behavior in which the mouth, penis, vagina, or rectum come into contact w/ blood, semen, or vaginal secretions massage; telephone sex masturbation o Occupational exposure- start HIV med cocktail for 4 weeks to attempt to prevent seroconversion start meds w/in 1-4 hrs no longer than 36 hrs o HIV testing o Live 10-14 yrs in untreated o once dx w/ AID 1.3 yrs w/out tx o mostly its unpredictable how long someone will live