HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Etiology: Family: Retroviridae

Genus: Lentivirus
Species: HIV-1(inferred origin: common chimpanzee)
HIV-2(inferred origin: sooty mangabey)

Mode of transmission:
• Through sexual contact -- including oral, vaginal, and anal sex
• Through blood -- via blood transfusions (now very rare in the U.S.) or needle sharing
• From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood
circulation, or a nursing mother can pass it to her baby in her breast milk

Stages and Symptoms:

Stage I: Incubation period

Last for 2 to 4 weeks
• Asymptomatic

Stage II: Acute Infection

Last for 28 days
• Moderate unexplained weight loss (under 10% of presumed or measured body weight)
• Fever
• Lymphadenopathy
• Rash, Myalgia, malaise
• Mouth and esophageal sores
• Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis media, pharyngitis)
• Fungal nail infections

Stage III: latency

Last from 2 weeks to 20 years
• Unexplained severe weight loss (over 10% of presumed or measured body weight)
• Unexplained chronic diarrhea for longer than one month
• Unexplained persistent fever (intermittent or constant for longer than one month)
• Pulmonary tuberculosis
• Oral candidiasis
• Severe bacterial infections (e.g. pneumonia, empyema, pyomyositis, bone or joint infection, meningitis,
bacteremia)
• Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis

Stage IV: progression from HIV to AIDS

• Anorexia, Dyspnea
• Lymphadenopathy
• Fatigue, diarrhea
• HIV encephalopathy: memory loss, partial paralysis, lack of coordination
• HIV wasting syndrome
• Recurrent severe bacterial pneumonia
• Opportunistic infection: Kaposi sarcoma, cytomegalovirus, pneumocystic carinii, cryptococcocis,
tuberculosis, cryptosporidiosis
Diagnostic procedure: ELISA test ( enzyme-linked immunosorbent assay)
CBC
Western blot
Prevention:
• Avoid injected illicit drugs. If you use injected drugs, avoid sharing needles or syringes. Always use
new needles. (Boiling or cleaning them with alcohol does not guarantee that they're sterile and safe.)
• Avoid oral, vaginal, or anal contact with semen from HIV-infected people.
• Avoid unprotected anal intercourse, since it causes small tears in the rectal tissues, through which HIV
in an infected partner's semen may enter directly into the other partner's blood.
• If you have sex with many people or with people who have multiple partners, always use protection.
• People with AIDS or who have had positive HIV antibody tests can pass the disease on to others. They
should not donate blood, plasma, body organs, or sperm. They should not exchange genital fluids during
sexual activity.
• Safer sex behaviors may reduce the risk of getting the infection. There is still a slight risk of getting the
infection even if you practice "safe sex" by using condoms. Abstinence is the only sure way to prevent
sexual transmission of the virus.

Management:
• provide frequent rest periods
• provide high calorie, high protein diet to prevent weight loss
• provide skin care and good oral hygiene
• protect client from secondary infection: assess for early signs
• teach client the importance of safer sex
• continuing medical supervision: Antiretroviral therapy

Complications:
• Cancers
• Chronic wasting (weight loss) from HIV infection
• HIV dementia
• HIV lipodystrophy
• Opportunistic infections
 Bacillary angiomatosis
 Candidiasis
 Cryptococcal infection
 Mycobacterium avium complex (MAC) infection
 Pneumocystis jiroveci pneumonia (previously called Pneumocystis carinii pneumonia or
PCP)
 Salmonella infection in the bloodstream
 Toxoplasmosis
 Tuberculosis (in the lungs or spread throughout the body)
 Viral infection of the brain (progressive multifocal leukoencephalopathy)