AIDS

Acquired Immune Deficiency Syndrome

Presented by: Herbert B. Bagasala jr. 2 Nursing 1

DEFINITION

Acquired Immune Deficiency Syndrome

Is acquired, which means it is neither hereditary nor inborn. It involves an immune deficiency. When a persons immune system breaks down, he or she becomes susceptible to many infections which eventually lead to death. It is a syndrome,

a combination of signs and symptoms that form a distinct clinical picture of disorder.

CAUSATIVE AGENT

HIV

HIV Refers to the Human Immunodeficiency Virus which causes AIDS. It is a retrovirus. It belongs to genus of lentivirus, which is sometimes called Slow Virus. Retrovirus-human Lymphotrophic virus 3 (HTLV-3)

HIV

Size of HIV is 180 billionths of a Meter in diameter. Means as following. Almost 0.1 microns in size is HIV's size. And HIV will be about 4 millionths of an inch in scale. If compare with other pathogens HIV is about About 1/20 th of an E coli bacterium If compare to other small human objects HIV is 1/17 th of a WBC or CD4 cell.

HIV is an enveloped virus, containing two identical RNA strands. Each its 72 surface knobs contains a glycoprotein (designated gp120) capable of binding to a CD4 receptor on the surface of a certain host cells.(ex. T helper cells).

The stalk that supports the knob is a transmembrane glyciprotein(designated gp41), which also play a role in attachment to host cells. Reverse transcriptase is an RNA-dependent DNA polymerase.

HIV is able to attach to and invade cells bearing receptors that virus recognizes. The most important of these receptors is designated CD4, and cells possessing that receptors are called CD4+ cells. HIV infections destroy these important cells of the immune system.

Macrophages also possess CD4 receptors and can, thus, be invaded by HIV. HIV also can invade other certain cells that do not possess CD4 receptors, but do possess other receptors that HIV can recognize.

INCUBATION PEROID

The time between infection and the appearance of symptoms tends to be much longer, allowing more opportunities for these microorganisms to be transmitted to other hosts. The period between infection and the appearance of AIDS can take from 7 to 12 years.

Human beings produce antibodies against specific infections. When HIV infection takes place, anti-HIV antibodies are produced but they do not appear immediately. This is called The Window Effect. In some cases, antibodies to HIV become detectable 4 to 6 weeks after infection.

When HIV is in circulation, it invades several types of cells the lymphocytes, macrophages, the Langerhans cells, and neurons within the central nervous system. HIV attacks the immune system. The organism that attacks to a protein molecule called CD4 which is found in the surface of T4 cells.

Once the virus enters the T4, it inserts its genetic materials into the T4 cells nucleus taking over the cell to replicate itself. Eventually, the t4 cell dies after having been used to replicate HIV. The virus mutates rapidly making it more difficult for the bodys immune system to recognize the invaders. The HIV infection progresses through several stages.

PATHOGNOMONIC SIGN

Four Stages of HIV

Stage 1 - Primary

Short, flu-like illness - occurs one to six weeks after infection no symptoms at all

Infected person can infect other people

Stage 2 Asymptomatic

Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to very low levels HIV antibodies are detectable in the blood

Stage 3 - Symptomatic

The symptoms are mild The immune system deteriorates emergence of opportunistic infections and cancers

Stage 4 - HIV AIDS

The immune system weakens

The illnesses become more severe leading to an AIDS diagnosis

Bacterial

Opportunistic Infections Associated With AIDS

MAC-

TB like manifestation that usually occur when the patients CD4 is below 50 Tuberculosis Salmonellosis

Mycobacterium avium complex, , a

Viral
Herpes Hepatitis B Genital warts CMV(Cryptomegalovirus) can cause retinitis, pain on swallowing and numbness of the legs. This can be transmitted through semen, vaginal secretion, blood and breast milk.

Malluscum contagiosum
A disease of the skin and mucous membranes characterized by domeshaped papules that usually occur on the face, trunk, and extremities.

Fungal

Candidiasis Cryptococcal meningitis Histoplasmosis Small lesions that appear on the skin, usually transmitted by direct contact; also autoinoculable. The organism is resistant to treatment. When the CD4 count falls below 200, lesions tend to proliferate and start to spread. Manifestations are fever, adenopathy, cough, shortness of breath, and weight loss.

Pneumonias

Bacterial

Pneucystis carinii pneumonia

(PCP)

Cancers

Kaposis sarcoma cancerous lesion caused by overgrowth of the blood vessel. KS typically appears as pink or purple painless spot or nodules on the surface of the skin or oral cavity. It can also occur internally, especially on the intestine, lymph nodes and lungs. Tea cancer can spread and can also attack the eyes.

Cervical dysplasia and cancer

Researchers found out that women with HIV have higher rates of this type of cancer. Cervical carcinoma is associated with Human Papilloma Virus (HPV).

Non Hodgkins lymphoma Is a cancerous tumor of the lymph nodes. This is usually a late manifestation of HIV infection.

Parasitic

Toxoplasmosis Cryptosporidiosis Is caused by a microscopic parasite cryptosporidium commonly known as crypto. It can cause severe illness in the people with HIV. If CD4 count is below 200, crypto may give symptoms for a long time. If the CD4 count is above 200, symptoms may appear only for 1 to 3 weeks. Cryptosporidiosis spreads by having contact with feces containing crypto.

MODE OF TRANSMISSION

Sexual Intercourse

Through IV/Needle Drug Use

Blood Transfusion

Perinatal or vertical transmission.

Through Bodily Fluids

Blood products
Semen

Vaginal fluids
Breast Milk

Through IV Drug Use

Sharing Needles

Without sterilization

Increases the chances of contracting HIV

Through Sex

Intercourse (penile penetration into the vagina) Oral Anal

Mother-to-Baby

Before Birth During Birth Postpartum

After the birth

Diagnostic Examination

Anonymous Testing

No name is used Unique identifying number Results issued only to test recipient 23659874515
Anonymous

Confidential Testing

Persons name is recorded along with HIV results

Name and positive results are reported to the Health Department for further intervention.

Results issued only to test recipient

Administration
Blood Urine Oral

Blood Detection Tests

Enzyme-Linked Immunosorbent Assay/Enzyme Immunoassay (ELISA/EIA) Radio Immunoprecipitation Assay/Indirect Fluorescent Antibody Assay (RIP/IFA) Polymerase Chain Reaction (PCR) Western Blot Confirmatory test

HIV antibody test

When HIV antibodies are not detectable in the blood at the time of examination, it is considered as

Negative Antibody Test.

When HIV antibodies are present in the blood in the Positive Antibody Test, the person is considered HIV positive.

Urine Testing

Urine Western Blot

As sensitive as testing blood Safe way to screen for HIV Can cause false positives in certain people at high risk for HIV

Oral Testing

Orasure

The only FDA approved HIV antibody. As accurate as blood testing Draws blood-derived fluids from the gum tissue. NOT A SALIVA TEST!

Counseling

Pre-test Counseling

Transmission Prevention Risk Factors Voluntary & Confidential Reportability of Positive Test Results

Post-test Counseling

Clarifies test results Need for additional testing Promotion of safe behavior Release of results

Treatment Options

AIDS drugs are medicines used to TREAT but not to CURE HIV infection. These drugs are sometimes referred to as Anteroviral Drugs. These work by inhibiting the reproduction of the virus. There are two groups of Anteroviral drugs Reverse transcriptase inhibitors and Protease inhibitors.

Reverse transcriptase inhibitors They inhibit the

enzyme called Reverse Transcriptase which is needed to copy information for the virus to replicate. These drugs are:

Zedovudine (ZDV) Zalcitabine Stavudine Lamivudine Nevirapine Didanosine

Retirvir Havid Zerit Epivir Viramune Videx

Protease inhibitors They work by inhibiting the enzyme protease which are needed for the assembly of viral particles. These drugs are:
Saquinavir Ritonavir Indinavir

-Invarase -Norvir -Crixivan

Nursing Management

Health education The healthcare worker must:

Give practical advice, Inform the client of the disease process and the mode of transmission, Emphasize the AIDS Awareness Program,

Avoid judgmental and moralistic messages, Be consistent and concise in giving instruction especially in taking medication. Use positive statement. Encourage client to trace or identify previous contact for proper management

Practice Universal/Standard precaution There is a need for thorough medical hand washing 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. Use of universal barrier or personal protective equipment (PPE) e.g., cap, mask, gloves, CD gown, face shield/goggles, is very necessary.

Antiretroviral Drugs

Nucleoside Reverse Transcriptase inhibitors

AZT (Zidovudine)

Non-Nucleoside Transcriptase inhibitors

Viramune (Nevirapine) Norvir (Ritonavir)

Protease inhibitors

Four ways to protect yourself?

Abstinence Monogamous Relationship Protected Sex Sterile needles

Abstinence

It is the only 100 % effective method of not acquiring HIV/AIDS. Refraining from sexual contact: oral, anal, or vaginal. Refraining from intravenous drug use

Monogamous relationship

A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected

Protected Sex

Use condoms (female or male) every time you have sex (vaginal or anal) Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex

When Using A Condom Remember To:

Make sure the package is not expired Make sure to check the package for damages Do not open the package with your teeth for risk of tearing Never use the condom more than once Use water-based rather than oil-based condoms

Sterile Needles

If a needle/syringe or cooker is shared, it must be disinfected:

Fill the syringe with undiluted bleach and wait at least 30 seconds. thoroughly rinse with water Do this between each persons use

Needle Exchange Program

Non-profit Organization, which provides sterile needles in exchange for contaminated ones

Thank You!