Chapter 52

Management of Patients With

HIV Infection and AIDS

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Transmission of HIV
Transmitted by body fluids containing HIV or infected
CD4 lymphocytes
Blood, seminal fluid, vaginal secretions, amniotic
fluid, and breast milk
Most prenatal infections occur during delivery
Casual contact does not cause transmission
Breaks in skin or mucosa increase risk

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High-Risk Behaviors
Sharing infected injection equipment
Having sexual relations with infected individuals

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement True or False?
The major means of HIV transmission are unprotected sex
and the sharing of injection drug use equipment.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True
The major means of HIV transmission are unprotected sex
and the sharing of injection drug use equipment.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prevention
Standard precautions
Safer sex practices and safer behaviors
Abstain from sharing sexual fluids

Reduce the number of sexual partners to one

Always use latex condoms; if allergic to latex, use
non-latex condoms
Do not share drug injection equipment
Blood screening and treatment of blood products

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

HIV Life Cycle

Attachment
Uncoating

DNA synthesis
Integration
Transcription

Translation
Cleavage
Budding

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Structure of HIV-1

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Life Cycle of HIV-1

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Stages of HIV Disease

Primary infection
HIV asymptomatic
HIV symptomatic
AIDS

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Primary Infection
AKA acute HIV infection/acute HIV syndrome
Part of CDC category A
Symptoms: none to flu-like syndrome
Window period: lack of HIV antibodies
Period of rapid viral replication and dissemination
through the body

Viral set point: balance between amount of HIV and the

immune response

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HIV Asymptomatic
CDC category A
More than 500 CD4+ T lymphpocytes/mm3
Upon reaching the viral set point, chronic asymptomatic
state begins
Body has sufficient immune response to defend against
pathogens

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HIV Symptomatic
CDC category B
200499 CD4+ lymphpocytes/mm3
CD4 T cells gradually fall
The patient develops symptoms or conditions related to
the HIV infection, which are not classified as category C
conditions
Patients who are once treated for a category B condition
are considered category B

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

AIDS
CDC category C
Less than 200 CD4+ lymphocytes/mm3
As levels drop below 100 cell/mm3 the immune system is
significantly impaired
Development of listed conditions

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Treatment
Treatment and protocols are continually evolving
Antiretroviral agents
Nucleoside reverse transcriptase inhibitors (NRTIs)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Protease inhibitors (PIs)
Fusion inhibitors

Use of combination therapy

Management also focuses upon the treatment of specific
manifestations and conditions related to the disease
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Question
Is the following statement True or False?
A fungal infection present in almost all patients with
HIV/AIDS is Kaposis sarcoma.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False
A fungal infection present in almost all patients with
HIV/AIDS is candidiasis, not Kaposis sarcoma.

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Clinical Manifestations of HIV/AIDS:

Respiratory
Pneumocystic carini pneumonia (PCP):
Most common infection
Initial symptoms may be nonspecific and may include
nonproductive cough, fever chills, dyspnea, and
chest pain
If untreated, progresses to pulmonary impairment
and respiratory failure
Treatment: TMP-SMZ or pentamidine, prophylactic
TMP-SMZ
Mycobacterium avium complex (MAC)
Tuberculosis
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Clinical Manifestations of HIV/AIDS: GI

Oral candidiasis
May progress to esophagus and stomach
Treatment with Mycelex troches or nystatin,
ketoconazole
Diarrhea related to HIV infection or enteric pathogens
Octretide acetate for severe chronic diarrhea
Wasting syndrome
10% weight loss and chronic diarrhea or chronic
weakness and fever with absence of other cause
Protein energy malnutrition
Anorexia, diarrhea, GI malabsorption, and lack of
nutrition may contribute
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Clinical Manifestations of HIV/AIDS:

Oncologic
Kaposi's sarcoma
Cutaneous lesions, but may involve multiple organ
systems

Lesions cause discomfort, disfigurement, ulceration,

and potential for infection
B-cell lymphomas

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Lesions of Kaposis Sarcoma

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Manifestations of HIV/AIDS: Neurologic

HIV encephalopathy
Progressive cognitive, behavioral, and motor decline
Probably directly related to the HIV infection
Cryptococcus neoformans
Other neurologic disorders
Depression

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Nursing Process: The Care of the Patient

with HIV/AIDSAssessment
Assess physical and psychosocial status
Identify potential risk factors: IV drug abuse, risky sexual
practices
Immune system function
Nutritional status
Skin integrity
Respiratory status neurologic status
Fluid and electrolyte balance
Knowledge level
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Nursing Process: The Care of the Patient

with HIV/AIDS- Diagnosis
Impaired skin integrity
Diarrhea
Risk for infection
Activity intolerance
Disturbed thought processes
Ineffective airway clearance
Pain
Imbalanced nutrition
Social isolation

Anticipatory grieving
Deficient knowledge
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Collaborative Problems/Potential
Complications
Opportunistic infections
Impaired breathing or respiratory failure
Wasting syndrome
Fluid and electrolyte imbalance
Adverse reaction to medication

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Nursing Process: The Care of the Patient

with HIV/AIDSPlanning
Goals may include:

Achievement and maintenance of skin integrity

Resumption of usual bowel patterns

Absence of infection

Improved activity tolerance

Improved thought processes

Improved airway clearance

Increased comfort, improved nutritional status

Increased socialization

Expression of grief

Increased knowledge regarding disease prevention and self-care

Absence of complications
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Skin Integrity
Frequent routine assessment of skin and mucosa
Encourage patient to maintain balance between rest and
activity
Reposition at least every 2 hours and as needed
Pressure reduction devices
Instruct patient to avoid scratching
Use gentle, nondrying soaps or cleansers
Avoid adhesive tape
Perianal skin care
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Promoting Usual Bowel Pattern

Assess bowel pattern and factors that may exacerbate
diarrhea
Avoid foods that act as bowel irritants, such as raw fruits
and vegetables, carbonated beverages, spicy foods, and
foods of extreme temperatures
Small, frequent meals
Administer medications as prescribed

Assess and promote self-care strategies to control

diarrhea

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Activity Intolerance
Maintain balance between activity and rest
Instruction regarding energy conservation techniques
Relaxation measures
Collaboration with other members of the health care
team

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Maintaining Thought Processes

Assess mental and neurologic status
Use clear, simple language if mental status is altered
Establish and maintain a daily routine
Orientation techniques
Ensure patient safety and protect from injury
Strategies to maintain and improve functional ability
Instruct and involve family in communication and care

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Nutrition
Monitor weight, I&O, dietary intake, and factors that
interfere with nutrition
Dietary consult

Control of nausea with antiemetics

Oral hygiene
Treatment of oral discomfort

Dietary supplements
May require enteral feedings or parenteral nutrition
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Decreasing Isolation
Promote an atmosphere of acceptance and
understanding
Assess social interactions and monitor behaviors

Allow patient to express feelings

Address psychosocial issues
Provide information related to the spread of infection

Educate ancillary personnel, family, and partners

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Other Interventions
Improving airway clearance
Position in semi-Fowler's or high Fowlers
Pulmonary therapy; coughing and deep breathing,
postural drainage, percussion, and vibration
Ensure adequate rest
Pain

Medications as prescribed
Skin and perianal care
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Question
What antiretroviral medication when taken with a highfat/high-caloric meal increases peak plasma
concentrations of capsules?
A. Delavirdine (Rescriptor)
B. Efavirenz (Sustiva)
C. Nevirapine (Viramune)

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
B
The antiretroviral medication that when taken with a highfat/high-caloric meal increases peak plasma
concentrations of capsules is efavirenz (Sustiva).

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