c






 c 


O| is a viral infection that progressively destroys certain white blood cells and causes
acquired immunodeficiency syndrome (AIDS).
O| is caused by the viruses HIV-1 and HIV-2 and in young children typically is acquired
from the mother.
O| HIV is a type of virus called a retrovirus, which infects humans when it comes in contact
with tissues such as those that line the vagina, anal area, mouth, or eyes, or a break in the
skin.
O| HIV, or human immunodeficiency virus, infects and takes over certain cells of your
immune system, which is your body's defense for fighting infections and diseases. Once
these cells are infected, HIV uses them to make new copies of itself (replication) and then
go on to infect other cells. Infected cells function poorly and die prematurely, which in
turn weakens the immune system. This allows opportunistic infections to develop, which
take the opportunity to thrive while your immune system is damaged.

º 


Officially, the Philippines is a low-HIV-prevalence country, with less than 0.1 percent of
the adult population estimated to be HIV-positive. As of September 2008, the Department of
Health (DOH) AIDS Registry in the Philippines reported 3,456 people living with HIV/AIDS
(PLWHA)- www.plwha.org

HIV prevalence in the Philippines has been described as "low and slow," but an HIV
epidemic is likely to emerge as the components for such an epidemic are already present in the
Philippines, according to a study published in April 2010 in the ·ournal of the International
AIDS Society.

While the number of people living with HIV throughout Asia is around 5-10 million²
with prevalence estimates well over one percent among adults in numerous countries²the
Philippines has maintained an HIV prevalence of less than 0.1 percent.

In 2000, one HIV case was reported every three days. In 2010, this number changed to 3
cases per day. In February alone, there were 130 new HIV cases recorded in the Philippine HIV
and AIDS Registry report.

According to Tayag, from January to March this year, a total of 68 injecting drug users
tested positive for HIV.

Experts are predicting a dramatic increase in HIV cases in the Philippines due to several
factors: low rates of condom use, increasing casual sexual activity, needle sharing among
injection drug users (IDUs) and lack of education about HIV/AIDS, among other factors.
 ºº  

O| ›oung adults
O| men who have sex with men (MSM) - Most-at-risk groups

Of the cumulative total of 1,097 infected MSMs from 1984 to 2008, 49% were reported
in the last three years (72% asymptomatic); 108 have died when reported, and slightly
more MSMs were reportedly already with AIDS (28%).

O| „ommercial sex workers

Sex workers, because of their infrequent condom use, high rates of sexually transmitted
infections (STIs), and other factors, are also considered to be at risk.

In 2002, just 6 percent of sex workers interviewed said they used condoms in the last
week. As of 2005, however, HIV prevalence among sex workers in „ebu „ity was
relatively low, at 0.2 percent.

O| Injecting drug users (IDUs)

1 percent of whom were found to be HIV-positive in „ebu „ity in 2005. A high rate of
needle sharing among IDUs in some areas (77 percent in „ebu „ity) is of concern.

O| Overseas Filipino workers and sexual partners of people in these groups are particularly
vulnerable to HIV infection.

There is also high STI prevalence and poor health-seeking behaviors among at-risk groups;
gender inequality; weak integration of HIV/AIDS responses in local government activities;
shortcomings in prevention campaigns; inadequate social and behavioral research and
monitoring; and the persistence of stigma and discrimination, which results in the relative
invisibility of PLWHA.

Lack of knowledge about HIV among the Filipino population is troubling. Approximately
two-thirds of young women lack comprehensive knowledge on HIV transmission, and 90 percent
of the population of reproductive age believe you can contract HIV by sharing a meal with
someone.[1]

 
 

Transmission of HIV occurs through horizontal transmission (from either sexual contact or
parenteral exposure to blood and blood products) or through vertical transmission (from HIV-
infected mother to infant).

a| Unprotected sex
a| Injection drug use
 a| Homosexual behavior
a| eedle-stick injury - rare transmission
a| STDs - having other STDs makes catching HIV more likely during sex.
a| Syphilis
a| ùenital herpes
a| „hlamydial infection
a| ùonorrhea
a| acterial vaginosis
a| Unprotected sex
a| Oral sex
a| Anal sex
a| Heterosexual sex
a| lood exposure
a| Injection drug use
a| eedlestick injury
a| Mother-infant transmission
a| reastfeeding transmission
a| Mother-to-fetus transmission
a| Mother-infant childbirth transmission


c


ºc

 


Most complications of HIV/AIDS are as a result of suppression of T-cell mediated

immunity. Anti-retroviral drugs, known as Highly Active Anti-Retroviral Therapy (HAART),
are now available to inhibit the replication of the human immunodeficiency virus. This helps to
prolong life, restore the patient's immune system to something approaching normal activity and
reduce the chances of opportunistic infection. „ombinations of three or more drugs are given to
lessen the possibility of resistance.

º




 º 
    

ºneumocystis carinii is now known as ºneumocystis jirovecii. It has been one of the hallmarks
of AIDS but is now less common because of antiretroviral therapy and primary prophylaxis.3
evertheless it remains a significant cause of pathology and is increasing in non-AIDS
immunosuppressed patients (mainly transplant recipients) in whom a reservoir of infection is
maintained. Most AIDS cases occur with a „D4 count < 200/mm3 and mainly at < 100/mm3.

a| º

: Typically develops over a few weeks and includes shortness of breath, dry
cough and fever. There may also be malaise, fatigue, weight loss and chest pain. There
may be surprisingly few signs in the chest apart from a few minor crepitations.
 a| 


o| „hest X-ray may show bilateral perihilar interstitial shadowing.
o| O2 saturation < 95% at rest or falls after exercise.
o| Microscopy of sputum may show º jirovecii cysts and trophozoites with staining.
o| ronchoscopy may be needed - additional findings may be T, fungal infections
and Kaposi's sarcoma.
a| 


o| High dose co-trimoxazole is recommended for 3 weeks first line.

o| Intravenous (IV) co-trimoxazole should be given in moderate to severe cases but
there is a high level of side-effects. Other options include IV
pentamidine/clindamycin/primaquine or dapsone/trimethoprim. One meta-
analysis suggests a low dose cotrimoxazole regime for patients with slower
disease progression.6 In patients with more rapid-onset disease, higher dose co-
trimoxazole may be more effective than aerosolised pentamidine but toxicity
considerations need to be taken into account.7
o| IV steroids may be helpful in moderate to severe pneumonia, e.g. IV
methylprednisolone or oral prednisolone for 5-10 days.
o| Oxygen may also be beneficial.
o| One study found that a reduction in mortality rates in recent years was most likely
to be linked to improved intensive care management of severe respiratory failure.

G 
 
  

„ommonest causes are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella

catarrhalis. In advanced cases, causative organisms may include Staphylococcus aureus ,
Klebsiella spp. and other ùram-negative rods. The presentation may be atypical, with diffuse
infiltrates appearing on the X-ray.

  
 


These may include „ryptococcus spp. In disseminated infection other fungi may be involved.
The first line treatment for most fungal lung infections is IV amphotericin .

-  
 

This is very common in areas where T is endemic. Many cases represent reactivation of
previous infection. HIV-positive patients with T are less likely to be sputum-positive with X-
rays that show less cavitation and more involvement of lower lobes. They are more likely to
relapse after completion of treatment and die prematurely. Treatment is the standard 3-4 drug
regimen but multidrug-resistant T strains are becoming more frequent.10 One study found that
tuberculosis preventive therapy (e.g. isoniazid, co-trimoxazole) was useful in reducing the
incidence of infection and death in children with HIV irrespective of whether they also received
HAART.
D 

  


This is seen In advanced HIV. Patients with „D4 < 50/mm3 are at high risk. In industrialised
countries, it is reported in 40% of patients with AIDS.

a| º

: Infection is disseminated and presents with fever, night sweats, weight
loss, diarrhoea, abdominal pain, anaemia or hepatic dysfunction.
a|   : This is by culture from blood or bone marrow or may be recognised in tissue
biopsy.
a| 

: Various combinations of antituberculous therapy have been tried, including
clarithromycin, ethambutol, rifampicin and streptomycin.12 The addition of IV amikacin
may be beneficial. Recently, trials have shown benefit from the use of aerolised
amikacin.



 




 



 

Toxoplasmosis is less common than it was since the advent of HAART, although is still
prevalent in resource-poor countries.14 „erebral toxoplasmosis is the most frequent central
nervous system („S) infection when „D4 < 200/mm3. It usually occurs due to reactivation of
cysts in the brain causing local lesions, typically multiple.

a| º

: Sub-acute symptoms include focal neurological disturbances, headache,
confusion, fever and seizures.
a| 


o| „ scan: The appearance is of a mass with a ring of contrast enhancement and
associated oedema.
o| MRI: This may show lesions not visible on „T.
14
o| Polymerase chain reaction (P„R) test may be helpful.
a| 

: The usual practice is to treat these symptoms as toxoplasmosis and consider
biopsy if there is no improvement in 7-10 days. Treatment is sulfadiazine and
pyrimethamine plus folinic acid. High level of side-effects and can use clindamycin
instead of sulfadiazine. A „ochrane review suggested that trimethoprim-
sulfamethoxazole may be useful in resource-poor areas.15 Steroids may be used for
cerebral oedema.

G 


 


a| º

: This is usually sub-acute with non-specific symptoms such as headache,
vomiting and a slight fever. eurological signs are not a major feature. Less commonly,
patients present with psychiatric symptoms, convulsions, cranial nerve palsies or truncal
ataxia.
a| 

: These reveal focal neurological lesions. Diagnosis is by identifying
organisms in the cerebrospinal fluid („SF).
 a| 

: Amphotericin  plus 5-flucytosine are first-line therapy; however,
fluconazole may be used in milder cases. The level of side-effects may be high.
a| º : „linical deterioration is associated with raised intracranial pressure and the
risk of blindness. Relapses occur in 50-80% of cases without prophylaxis with oral
fluconazole.

 º 



 



Progressive multifocal leucoencephalopathy (PML) is a progressive demyelinating condition of

advanced disease caused by the John „unningham virus (J„V) and presents with focal
neurological signs, changes in personality and ataxia. The diagnosis is by MRI. There is no
specific treatment and the patient usually dies within 6 months unless effective antiretroviral
therapy is used.16 Some patients develop PML during combined antiretroviral therapy in the
setting of immune reconstitution. Steroids may be useful in such cases.

- c



a| º

: The HIV virus directly infects the nervous system and most patients dying
of AIDS have histological evidence of brain damage. Up to 10% develop cognitive,
behavioural and mental abnormalities of dementia. In the early stages, the concentration
or memory is affected, with apparent depression and a gradual diminution of intellect.
There may be increasing motor problems affecting activities of daily living. Movements
may be slow. Examination may reveal inco-ordination, motor weakness, hyperreflexia
and extensor plantar responses.
a| 

: MRI shows reduced grey matter volume in the cortex and basal ganglia.
In the late stages there is a need to differentiate from cytomegalovirus („MV)
encephalitis which usually presents with rapidly progressive convulsion and dementia.
a| 

: HAART has considerably improved the prognosis if given early enough.
However, the virus may continue to remain in the body at low levels and continue to
replicate, so prognosis must be guarded.

D º 
 





This can occur at any stage of HIV infection but is more common in advanced disease. At this
point 10-15% of cases show distal symmetrical neuropathy affecting both sensory and motor
systems. The condition may be exacerbated by antiretrovirals.19 It can cause postural
hypotension, diarrhoea, impotence, impaired sweating and bladder dysfunction. HIV may
directly involve the spinal cord, usually presenting with bilateral leg weakness and sensory
symptoms. „MV infection presents with lumbosacral polyradiculopathy resulting in sacral
paraesthesias and numbness, weakness of lower limbs and urinary retention. Treatment is mainly
symptomatic with analgesics and anticonvulsants, although the use of recombinant human nerve
growth factor has shown some promise. Another study found that capsaicin patches may be
useful.

 
 



  



In the absence of antiretroviral therapy, up to 30% cases of AIDS with „D4 < 50/mm3 show
reactivation of „MV with destructive blinding retinitis. It usually presents with blurred vision,
partial loss of vision in one eye, floaters or flashing lights. Typical retinal changes include
irregular retinal pallor with haemorrhages in a perivascular distribution. These usually start
peripherally and rapidly progresses to involve the macular and whole retina causing blindness.
The main treatment is IV ganciclovir which is dose-limited in approximately 10% of patients by
severe neutropenia and thrombocytopenia.

   

The incidence of both Kaposi's sarcoma and non-Hodgkin's lymphoma have been markedly
reduced since the introduction of HAART, although the incidence of other cancers in HIV
patients has not changed.

 

a| º

: This characteristically presents as multiple ecchymotic skin nodules,
macules or papules. It occurs in about 15% of patients despite the advent of HAART. It
often affects the face early in HIV. It is also found on mucosal surfaces, usually on the
hard palate. Visceral disease commonly affects the lungs and ùI tract causing dyspnoea,
cough, haemoptysis, abdominal pain or bleeding.
a| 

: Radiotherapy, cryotherapy or intralesional vinblastine has been the treatment
of localised disease but is being superseded by pegylated liposomal doxorubicin or
liposomal daunorubicin.23 The drugs are given intravenously and have been found to
produce shrinkage of the tumour in the majority of patients.24

c 


This develops in 3-10% of HIV-positive cases with most tumours being extranodal. Around half
of these are associated with Epstein-arr virus (EV) infection and these are more aggressive
with lower survival rates. „S sites are common, presenting with symptoms and signs of space-
occupying cerebral tumour and this carries very poor prognosis with 3 months' survival without
highly active antiretroviral treatment. Tumours outside the „S can respond to standard
chemotherapy regimens. Opportunistic infections may cause death during chemotherapy.


   

This presents with retrosternal pain on swallowing and is usually caused by „andida albicans.
This is an AIDS-defining condition. The first line of treatment is fluconazole. Other antifungal
drugs tried in refractory cases include micafungin and posaconazole.

ºcºc


º  


  


Four basic stages:

1.| Incubation period - asymptomatic and usually lasts between two and four weeks.
2.| Acute infection ± period of rapid viral replication that immediately follows the
individual's exposure to HIV leading to an abundance of virus in the peripheral blood
with levels of HIV commonly approaching several million viruses per mL

-| lasts an average of 28 days and can include symptoms such as fever,

lymphadenopathy (swollen lymph nodes), pharyngitis (sore throat), rash,
myalgia (muscle pain), malaise, and mouth and esophageal sores
-| fever, lymphadenopathy, pharyngitis, rash, myalgia, malaise, mouth and esophageal
sores, and may also include, but less commonly, headache, nausea and vomiting,
enlarged liver/spleen, weight loss, thrush, and neurological symptoms.

3.| Latency stage - shows few or no symptoms and can last anywhere from two weeks to
twenty years and beyond

-| HIV is active within lymph nodes, which typically become persistently swollen, in
response to large amounts of virus that becomes trapped in the follicular dendritic
cells (FD„) network.
-| During this stage of infection early initiation of antiretroviral therapy significantly
improves survival, as compared with deferred therapy.

4.| AIDS - shows as symptoms of various opportunistic infections:

1.| Pneumocystis carinii pneumonia

2.| Oral candidiasis
3.| Toxoplasmosis of the „S
4.| „hronic diarrhea/wasting syndrome
5.| Pulmonary/extra-pulmonary tuberculosis
6.| „ancers
a.|   ± affects small blood vessels and internal organs
b.| „ervical dysplasia and cancer. Researchers found out that women with HIV
have higher rates of this type of cancer. „ervial carcinoma is associated with
Human Papilloma Virus (HPV).
c.| on-Hodgkin¶s lymphoma ± cancerous tumor of the lymph nodes. This is
usually a late manifestation of HIV infection.




c




O| most appropriate test for routine diagnosis of HIV among adults.

 O| inexpensive and very accurate. The ELISA antibody test (enzyme-linked
immunoabsorbent) also known as EIA (enzyme immunoassay) was the first HIV test to
be widely used.

c




When a person is infected with HIV, their body responds by producing special proteins that fight
infection, called antibodies. An HIV antibody test looks for these antibodies in blood, saliva or
urine. If antibodies to HIV are detected, it means a person has been infected with HIV. There are
only two exceptions to this rule:

a| abies born to HIV infected mothers retain their mother's antibodies for up to 18 months,
which means they may test positive on an HIV antibody test, even if they are actually
HIV negative. ormally babies who are born to HIV positive mothers receive a P„R test
after birth.
a| Some people who have taken part in HIV vaccine trials may have HIV antibodies even if
they are not infected with the virus.

Most people develop detectable HIV antibodies within 6 to 12 weeks of infection. In very rare
cases, it can take up to 6 months and there are nearly always very particular reasons for
antibodies developing so late such as other auto-immune disorders. It is exceedingly unlikely that
someone would take longer than 6 months to develop antibodies.

‰  

O| a term used to describe the period of time between HIV infection and the production of
antibodies. During this time, an antibody test may give a µfalse negative¶ result, which
means the test will be negative, even though a person is infected with HIV. To avoid false
negative results, antibody tests are recommended three months after potential exposure to
HIV infection.A negative test at three months will almost always mean a person is not
infected with HIV. If an individual¶s test is still negative at six months, and they have not
been at risk of HIV infection in the meantime, it means they are not infected with HIV. It
is very important to note that if a person is infected with HIV, they can still transmit the
virus to others during the window period.

 

Antibody tests are extremely accurate when it comes to detecting the presence of HIV
antibodies. ELISA tests are very sensitive and so will detect very small amounts of HIV
antibody. This high level of sensitivity however, means that their specificity (ability to
distinguish HIV antibodies from other antibodies) is slightly lowered. There is therefore a very
small chance that a result could come back as µfalse positive¶.

A false positive result means that although a person may not be infected with HIV, their antibody
test may come back positive. All positive test results are followed up with a confirmatory test,
such as:
 a| A Western blot assay ± One of the oldest but most accurate confirmatory antibody tests.
It is complex to administer and may produce indeterminate results if a person has a
transitory infection with another virus.

-| The Western lot test places multiple proteins (antigens) believed to be from HIV in
a line on a test strip (according to molecular weight). Serum is added to see which
antibody/antigen reactions occur. This test allows not only positive or negative
results, but also 'indeterminate', where at least one protein reactions, but not enough
to be considered positive. There are many different interpretations of this test, so it is
possible to be positive under one interpretation and indeterminate in another, used by
a different organization or in a different country. Since the Western lot is an
antibody test, like the initial ELISA test, it is not fully independent, and the very
common use of this as a confirmatory test for ELISA is thus questionable.
-|

a| An indirect immunofluorescence assay ± Like the Western blot, but it uses a microscope
to detect HIV antibodies.
a| A line immunoassay - „ommonly used in Europe. Reduces the chance of sample
contamination and is as accurate as the Western lot.
a| A second ELISA ± In resource-poor settings with relatively high prevalence, a second
ELISA test may be used to confirm a diagnosis. The second test will usually be a
different commercial brand and will use a different method of detection to the first.

-| In an ELISA test, a person's serum is diluted 400-fold and applied to a plate to which
HIV antigens have been attached. If antibodies to HIV are present in the serum, they
may bind to these HIV antigens. The plate is then washed to remove all other
components of the serum. A specially prepared "secondary antibody" ² an antibody
that binds to human antibodies ² is then applied to the plate, followed by another
wash. This secondary antibody is chemically linked in advance to an enzyme. Thus
the plate will contain enzyme in proportion to the amount of secondary antibody
bound to the plate. A substrate for the enzyme is applied, and catalysis by the enzyme
leads to a change in color or fluorescence. ELISA results are reported as a number;
the most controversial aspect of this test is determining the "cut-off" point between a
positive and negative result.

When two tests are combined, the chance of getting an inaccurate result is less than 0.1%.





1.| Rapid HIV tests

An OraQuick HIV-1/2 rapid test kit

These tests are based on the same technology as ELISA tests, but instead of sending the sample
to a laboratory to be analysed, the rapid test can produce results within 20 minutes.

Rapid tests can use either a blood sample or oral fluids. They are easy to use and do not require
laboratory facilities or highly trained staff.

All positive results from a rapid test must be followed up with a confirmatory test, the results of
which can take from a few days to a few weeks.

2.| Antigen test (P24 test)

Antigens are the substances found on a foreign body or germ that trigger the production of
antibodies in the body. The antigen on HIV that most commonly provokes an antibody response
is the protein P24. Early in HIV infection, P24 is produced in excess and can be detected in the
blood serum (although as HIV becomes fully established in the body it will fade to undetectable
levels).

P24 antigen tests are not usually used for general HIV diagnostic purposes, as they have a very
low sensitivity and they only work before antibodies are produced in the period immediately
after HIV infection. They are now most often used as a component of 'fourth generation' tests.

3.| Fourth generation tests

Some of the most modern HIV tests combine P24 antigen tests with standard antibody tests to
reduce the µdiagnostic window¶. Testing for antibodies and P24 antigen simultaneously has the
advantage of enabling earlier and more accurate HIV detection.

In the UK, fourth generation tests are the primary recommendation for HIV testing among
individuals, but are not offered by all testing sites. During June 2010, the FDA approved the first
fourth generation test in the United States.
4.| P„R test

A P„R test (Polymerase „hain Reaction test) can detect the genetic material of HIV rather than
the antibodies to the virus, and so can identify HIV in the blood within two or three weeks of
infection. The test is also known as a viral load test and HIV AAT (nucleic acid amplification
testing).

abies born to HIV positive mothers are usually tested using a P„R test because they retain their
mother's antibodies for several months, making an antibody test inaccurate. lood supplies in
most developed countries are screened for HIV using P„R tests. However, they are not often
used to test for HIV in individuals, as they are very expensive and more complicated to
administer and interpret than a standard antibody test.

5.| HIV home sampling and HIV home testing

It is generally recommended that an HIV test is carried out in a healthcare setting. However, in
some countries home sampling and home testing kits are available.

a.| Home sampling

With a home sampling kit, a person can take a sample (usually a blood sample) and send it to a
laboratory for testing. They can phone up for the results a few days later. If the result is positive
then a professional counsellor will provide emotional support and referrals. The main advantages
of home sampling are convenience, speed, privacy and anonymity.

There is one company in the USA that offers an FDA-approved home sampling kit for HIV.
Many home sampling kits that have not been approved by the FDA are being marketed online.

There is also a company in the UK that offers home sampling services using oral fluid instead of
blood. If a person¶s test result is positive they will need a follow up blood-test at a clinic.

b.| Home testing

A home self-test involves a person conducting a rapid antibody HIV test in their home. The
person takes either a blood or saliva sample and can interpret the result within minutes. A
positive result will require a further confirmatory blood-test in a clinic.

In many countries it is illegal to sell HIV test kits to the public. If a test is purchased over the
internet, there is no guarantee that the test kit is genuine or will provide accurate results.

There is currently a debate about allowing the kits to be sold in America and the UK. AVERT
opposes the legalisation of the sale of home testing kits in the UK because of the lack of post-test
counselling.






 






 
 




This is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from
becoming ill for many years. The treatment consists of drugs that have to be taken every day for
the rest of a person¶s life.

The aim of antiretroviral treatment is to keep the amount of HIV in the body at a low level. This
stops any weakening of the immune system and allows it to recover from any damage that HIV
might have caused already.

The drugs are often referred to as:

a| antiretrovirals
a| anti-HIV or anti-AIDS drugs
a| HIV antiviral drugs
a| ARVs

These drugs include the following:

a| 
 
  
 These drugs prevent HIV reverse transcriptase from
converting HIV RA into DA. There are three types of these drugs: nucleoside,
nucleotide, and non-nucleoside.

a. Zedovudine (ZDV) ± Retirvir

b. Zalcitabine ± Havid
c. Stavudine ± Zerit
d. Lamivudine ± Epivir
e. evirapine ± Viramune
f. Didanosine ± Videx

a| º
  
 These drugs prevent protease from activating certain proteins inside
newly produced viruses. The result is immature, defective viruses that do not infect new
cells.

a. Saquinavir ± Invarase
b. Ritonavir ± orvir
c. Indinavir ± „rixivan
 a|    
 These drugs prevent HIV from entering cells. To enter a human cell,
HIV must bind to a „D4 receptor and one other receptor, such as the „„R-5 receptor.
One type of fusion inhibitor, „„R-5 inhibitors, blocks this receptor, preventing HIV from
entering human cells.
a| 
  
 These drugs prevent HIV DA from being integrated into human
DA.

  




The surgical management of clients with HIV is limited to the placement of a venous
access device, surgical intervention for treatment of malignancies, or biopsy. Venous access
devices, such as ùroshung catheter, are used to facilitate frequent blood drawing, administration
of intravenous medications (gancyclovir), hyperalimentation and transfusions.

  



1.| Health education ± The healthcare worker must:

a.| Know the patient
b.| Avoid fear tactics
c.| Avoid judgmental and moralistic messages
d.| e consistent and concise
e.| Use positive statement
f.| ùive practical advice
g.| Patient education

a| interpretation of a positive result

a| nature of HIV and treatment options
a| method of transmission
a| need for ongoing medical and psychological care
a| availability of psychological and social support services and groups
a| OT to donate blood, semen or other body tissues or organs
a| to use safe sexual practices, ie body fluids should not be exchanged
a| notify all health workers dealing with the patient¶s ongoing care
a| the patient should not receive any vaccinations without prior discussion with
the medical officer involved in the ongoing HIV management.

2.| Practice universal/standard precaution

a.| There is a need for a thorough medical handwashing after every contact with
patient and after removing the gown and gloves, and before leaving the room of
an AIDS suspect or known AIDS patient.
b.| Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap, mask,
gloves, „D gown, face shield/goggles are very necessary.
3.| Prevention
a.| „are should be taken to avoid accidental pricks from sharp instruments
contaminated with potentially infectious materials form AIDS patient.
 b.| ùloves should be worn when handling blood specimens and other body secretions
as well as surfaces, materials and objects exposed to them.
c.| lood and other specimens should be labeled with special warning ³AIDS
Precaution´.
d.| lood spills should be cleaned immediately using common household
disinfectants, like ³chlorox´.
e.| eedles should not be bent after use, but should be disposed into a puncture-
resistant container.
f.| Personal articles like razor or razor blades, toothbrush should not be shared with
other members of the family. Razor blades may be disposed in the same manner
as needles are disposed.
g.| Patients with active AIDS should be isolated.

  
 


c
1.

 ± giving of information and counseling the client which results to the
client¶s successful treatment, prevention and recommendation.
2. „ounseling/education
a. ùiving instruction about the treatment
b. Disseminating information about the disease
c. Providing guidance on how to avoid contracting STD again
d. Sharing facts about HIV and AIDS
3. „ontact tracing
a. Tracing out and providing treatment or partners
4. „ondoms
a. Promoting the use of condom, giving instructions about its use, and giving
away available condoms
.


º 


 

1. A previously healthy 19 year old man was admitted to a medical ward with a history of fever,
sore throat, and a maculopapular rash on his trunk. An upper respiratory tract infection had been
diagnosed in the community a few days before. A monospot test (for infectious mononucleosis
caused by Epstein-arr virus) was negative, and he initially denied risky sexual behaviour and
declined an offer of HIV testing. His symptoms improved, but before discharge he mentioned to
the ward sister that he had had a casual sexual encounter with a man a few weeks earlier. He then
consented to an HIV test, which was positive for the p24 antigen. Why is primary HIV infection
missed?

A: Primary HIV infection is symptomatic in most individuals but is easy to miss. The infection
may be missed because the symptoms are transient, often lasting less than two weeks, and tend to
overlap with those of infections that are much more common in clinical practice. Failure to elicit
a history of exposure to the virus, reluctance to test, and lack of awareness of the limitations of
testing in the acute phase may also contribute to diagnostic delay. First line testing comprises
both HIV antibody and p24 antigen levels Diagnosis is easier if the patient volunteers the
information of possible exposure to HIV or is known to belong to a high risk group for the
disease.


 
c

      

a| Have unprotected sex. Unprotected sex means having sex without using a new latex or
polyurethane condom every time. Anal sex is more risky than is vaginal sex. The risk
increases if you have multiple sexual partners.
a| Have another STD. Many sexually transmitted diseases (STDs) produce open sores on
your genitals. These sores act as doorways for HIV to enter your body.
a| Use intravenous drugs. People who use intravenous drugs often share needles and
syringes. This exposes them to droplets of other people's blood.
a| Are an uncircumcised man. Studies indicate that lack of circumcision increases the risk
for heterosexual transmission of HIV.