Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome HIV

1. Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome �HIV / AIDS� K. Brooks, RN, MSNEd Nursing 240

2. Human Immunodeficiency Virus

3. Recent United States Epidemiology HIV Estimated 800,000-900,000 people with HIV 40,000 new cases each year Hepatitis B 750,000-1 million carriers in the US Hepatitis C Estimated 3.9 million total US infections (1.8% of US population) CDC � AIDS Surveillance Report

4. AIDS Is a World Wide Epidemic! 16 million people were killed and 50 million were infected 13 million people killed by AIDS

9. By 2002 � there were (only) 57 health care workersin the US who had been infected with HIV after an occupational exposure

10. Transmission What we know about HIV transmission � US Cases � What about blood transfusions? What about perinatal incidence?

11. Exposure: Infectious Body Fluids Definitely infectious Potentially infectious Not infectious unless visibly bloody

12. Estimates of Per-ExposureInfection Risk Type of Exposure % Probability Unprotected Receptive Anal Intercourse 1.7 Sharing Needles 0.67 Percutaneous Occupational Exposure 0.32 Receptive Vaginal Intercourse (female) 0.05 - 0.14 Insertive Vaginal Intercourse (male) 0.03 - 0.09 Oral Sex unknown; not zero

13. �About 1/2 of all new HIV infections in the United States are among people under age 25 years! �The majority are infected through sexual behavior. � �HIV infection is the leading cause of death for African American men aged 25 to 44�

14. What does the HIV virus do? Cell invasion and replication Reverse transcriptase (RNA to DNA) Rapid destruction of CD4+ T (T helper) cells B-lymphocytes make antibodies Changes in the immune system

15. �Viral Load� �Large amounts of the virus can be found in the blood during the first 2 to 6 months after infection and then again in the late stages of the disease�

16. �CD4+ (T) Cell Counts� Uninfected Individuals CD 4+ levels: 800-1200 cells/microliter �T cells� (helper cells) HIV Infected Individuals HIV virus destroys 1 billion CD4+ cells per day CD4+ gradually declines to very low levels Immune problems begin when the level drops to 200-500 < 50 cells/ml in advanced disease is common

17. �The Train Wreck� Think of the �Viral Load� as the train and the �CD4+ T cell count� as the track. When the train reaches the end of the track, AIDS has begun. GOAL: So, you are hoping for a �slow train� (or low viral count) or a �long train track� (high CD4+ count)

19. Clinical Manifestations:The Phases Of Infection Initial Infection �Acute Retroviral Syndrome� 1 to 3 weeks �Flu-Like Symptoms� Early Chronic Infection (Latent Phase) 10 to 12 years Intermediate Chronic Infection (AIDS syndrome)

20. Primary HIV Infection - Symptoms Fever 87% Rash 68% Pharyngitis 48% Myalgias 42% Headache 39% Diarrhea 32% Abdominal Pain 32% Arthralgias 29% Nausea/Vomiting 29%

21. Diagnostic Testing: �HIV Antibody� FIRST: The EIA (ELISA) detects serum antibodies (positive ) SECOND: EIA (ELISA) is repeated THIRD: Western Blot is done Be aware of the �window period� Diagnosis of newborns can be problematic Table 14-2 pg 271

22. CDC Diagnostic Criteria for AIDS �HIV disease progresses to AIDS when your CD4+ cell count drops below 200 cells/mm3 and/or you develop an AIDS defining condition (an illness that is very unusual in someone who is not HIV positive)�

23. Common Opportunistic Diseases Candida Albicans (thrush) � yeast/fungus Pneumocystis Carinii - fungus Kaposi�s Sarcoma - cancer Toxoplasma gondii - protozoa Cytomegalovirus - virus HSV-2 peri-anal � virus Tuberculosis - myobacteria * Review the common signs/symptoms of each of these syndromes

24. Opportunistic Diseases

29. Herpes Simplex (HSV)Herpes Simplex (HSV)

32. Nursing Process: Assessment What are important assessment foci for those at risk for HIV or those who may have been infected with HIV? Health Promotion Primary Prevention Secondary Prevention

33. Nursing Process: Planning and Implementation

35. Nursing Process: Planning What are the major goals for patients with HIV?

36. Goals of Drug Therapy in HIV Decrease HIV RNA levels < 50 copies Maintain or raise CD4+ T cell counts >200 Preferred CD4 count 800-1200 Delay opportunistic symptoms

37. Nursing Process: Evaluation Successful treatment suppresses HIV to very low levels (e.g., < 50 copies/ml), preventing destruction of CD4 cells by HIV However, if treatment is withdrawn, viral rebound can occur quickly Monitoring labs and symptoms of patient *** �Viral load� counts (PCR assay) CD4+ cell (T-lymphocyte) counts

38. �Antiretroviral Therapy� - medication that has been demonstrated to suppress viral replication

39. Recommended: HAART 1) NRTI�s 2) NNRTI�s 3) PI�s Common side effects: Liver problems, diabetes, lipodystrophy, high cholesterol, increased bleeding, decreased bone density, skin rash I. I.

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41. Adherence / Compliance �Drugs don�t work if people don�t take them.� C. Everett Koop, MD Former U.S. Surgeon General

42. Strategies for Health Care Providers�Increase Adherence / Compliance� Establish patient/HCP rapport Clarify the regimen Tailor regimen to lifestyle Have pt establish time to set out pills Establish set places for pill taking Plan any changes in routine in advance Make plans for holidays, weekends Lower barriers to care Refer to social services / cost factors Follow-up

43. Be SAFE and RESPONSIBLE! What would you do if you received a needle stick injury in the workplace? What is the procedure you must follow? What does OSHA say???