Introduction

AIDS (acquired immunodeficiency syndrome)

is one of the sexually transmitted disease of the human immune system caused by
the human immunodeficiency virus (HIV).
reduces the effectiveness of the immune system and leaves individuals susceptible
to opportunistic infections and tumors.
transmitted through direct contact of a mucous membrane or the bloodstream with
a bodily fluid containing HIV, such as blood, semen, vaginal fluid, pre-seminal fluid, and breast
milk.
This transmission can involve anal, vaginal or oral sex, blood transfusion,
contaminated hypodermic needles, exchange between mother and baby
during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids.
AIDS is now a pandemic.
In 2007, it was estimated that 33.2 million people lived with the disease worldwide,
AIDS killed an estimated 2.1 million people, including 330,000 children. 
Genetic research indicates that HIV originated in west-central Africa during the late
nineteenth or early twentieth century. 
AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in
1981
First case of AIDS in Philippines reported in 1984.
Ma. Dolzura Cortez (1992)
- first Filipino AIDS victim who came out
- 1993 Filipino film Dahil Mahal Kita (English “Because I Love You: The Dolzura Cortez Story”), starring
Vilma Santos

Salazar died on June 11, 2000

- was a Filipino AIDS activist and educator and the second Filipino to come out in public about
her HIV status at the age of 19 in 1994 
- movie The Secrets of Sarah Jane/Sana'y mapatawad mo in 1994 starring Gelli de Belen,
- She contracted HIV from a foreign customer while working as as a club entertainer in the
early 90's.
- oyfriend Ritchie and 2 children who are both HIV positive, Lyka from a previous relationship
and Ritchie Jr
- Salazar died on June 11, 2000 at the age of 25 from AIDS complications

As of May 2000, based on Philippine National AID Council (PNAC) records, there were
1385 HIV positive, 464 AIDS cases and 206 death.
Body affected

Blood  Immune system  Brain

Cryptoccoccal Menigitis 

HIV-related Encephalopathy 

Progressive Multifocal Leukoencephalopathy (PML) 

Toxoplasmosis 

Eyes

Cytomegalovirus (CMV) 

Gastrointestinal Tract

Cryptosporidiosis 
Cytomegalovirus 
Mycobacterium Avium Complex 
Genitals
Candidiasis 
Herpes Simplex 
Human Papilloma Virus (HPV) 
Liver
Liver Disease
Lungs
Coccidiomycosis .
Histoplasmosis 
Pneumocystis Carinii 
Recurrent Pneumonia 
Tuberculosis (TB) 
Lymphatic System
Non-Hodgkin's Lymphoma 

Mouth and Throat

Candidiasis 
Skin
Herpes Simplex
Kaposi's Sarcoma 
Shingles

Pathology of AIDS

Human immunodeficiency virus (HIV) is the causative agent for AIDS. The most
common type is known as HIV-1 and is the infectious agent that has led to the worldwide AIDS
epidemic. There is also an HIV-2 that is much less common and less virulent, but eventually
produces clinical findings similar to HIV-1. The HIV-1 type itself has a number of subtypes (A
through H and O) which have differing geographic distributions but all produce AIDS similarly.
HIV is a retrovirus that contains only RNA.

HIV is a sexually transmitted disease. Infection is aided by Langerhans cells in mucosal

epithelial surfaces which can become infected. Infection is also aided by the presence of other
sexually transmitted diseases that can produce mucosal ulceration and inflammation. The CD4+
T-lymphocytes have surface receptors to which HIV can attach to promote entry into the cell.
The infection extends to lymphoid tissues which contain follicular dendritic cells that can
become infected and provide a reservoir for continuing infection of CD4+ T-lymphocytes.

When HIV infects a cell, it must use its reverse transcriptase enzyme to transcribe its
RNA to host cell proviral DNA. It is this proviral DNA that directs the cell to produce additional
HIV virions which are released.

In addition to the CD4 receptor, a receptor known as a chemokine is needed for HIV
infection. Chemokines are cell surface fusion-mediating molecules. Such receptors include
CXCR4 and CCR5. Their presence on cells can aid binding of the HIV envelope glycoprotein
gp120, promoting infection. Initial binding of HIV to the CD4 receptor is mediated by
conformational changes in the gp120 subunit, but such conformational changes are not sufficient
of fusion. The chemokine receptors produce a conformational change in the gp41 subunit which
allows fusion of HIV. The differences in chemokine receptors that are present on a cell also
explains how different strains of HIV may infect cells selectively. There are strains of HIV
known as T-tropic strains which selectively interact with the CXCR4 chemokine receptor to
infect lymphocytes. The M-tropic strains of HIV interact with the CCR5 chemokine receptor to
infect macrophages. Dual tropic HIV stains have been identified. The presence of a CCR5
mutation may explain the phenomenon of resistance to HIV infection in some cases. Over time,
mutations in HIV may increase the ability of the virus to infect cells via these routes. Infection
with cytomegalovirus may serve to enhance HIV infection via this mechanism, because CMV
encodes a chemokine receptor similar to human chemokine receptors

Signs and Symptoms

A. Physical
 Mascu-papular rashes
 Loss of appetite
 Weight loss
 Fever of unknown origin
 Malaise
 Persistent diarrhea
 Tuberculosis (localized and disseminated)
  Esophageal candidiasis
 Kaposi’s sarcoma (skin cancer)
 Pneumocystis carinii pneumonia
 Gaunt-looking, apprehensive

B. Mental
Early Stage
 Forgetfulness
 Loss of concentration
 Loss of libido
 Apathy
 Psychomotor-retardation
 Withdrawal
Late Stage
 Confusion
 Disorientation
 Seizures
 Multism
 Loss of memory
 Coma

Incubation Period

Variable. About 1 to 6 months from the time of infection to the time of detectable
antibodies in the blood. The time from HIV infection to the diagnosis of AIDS has been noted to
be anywhere from 2 months to 10 years or longer. So, even if you tested negative last week, that
still means you might be positive in 4 months or so.

Diagnosis

 Enzyme Linked Immuno-Sorbent Assay (ELISA) – presumptive test

ELISA was the first screening test widely used for HIV because of its high sensitivity. In
an ELISA, a person's serum is diluted 400-fold and applied to a plate to which HIV antigens are
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" — an antibody that binds to other antibodies — 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.

 Western Blot – Confirmatory Test

The confirmatory HIV test employs a Western blot to detect anti-HIV antibody in a
human serum sample. Proteins from known HIV-infected cells are separated and blotted on a
membrane as above. Then, the serum to be tested is applied in the primary antibody incubation
step; free antibody is washed away, and a secondary anti-human antibody linked to an enzyme
signal is added. The stained bands then indicate the proteins to which the patient's serum contains
antibody.

Preventive Measures

 Sexual contact with many persons should be strictly avoided.

 The use of condoms should be promoted.
 Only disposable syringe and injection needle should be used for getting oneself injected.
Narcotic Drugs are usually consumed though injection.
 The injection syringe used once for the AIDS patient should in no case be used for
anyone else. The blood transfusion should be avoided unless inevitable. Even when the
blood transfusion is unavoidable the blood of professional donors should in no case be
used.
 When the surgical operation is preplanned the patient should deposit his or her own blood
in bank well in advance and should insist its usage at the time of operation.
 HIV positive women should strictly avoid pregnancy and take precautionary measures to
avoid the spread of AIDS in other persons.

Following precautions are given for health workers dealing with AIDS patients:
 Extreme care must be taken to avoid accidental wound from sharp instrument
contaminated from AIDS patients.
 Gloves and gowns should be worn when handling blood specimen, secretions, body
fluids and excretions.
 Hands should be washed thoroughly and immediately after removing gowns and
gloves and before leaving the room.
 Blood, articles with soiled with blood and other specimen should be labeled “AIDS
Precautions”
 Sterilized instruments with lenses
 Disposable needles and syringes are preferred.
 AIDS Patient should be isolated and thermometer should be reserved

Roles and Functions of Community Health Nursing

 The responsibilities and function Community Health Nurse are mostly along prevention,
case finding and supportive-care during management of AIDS cases.
 The nurse must be well-informed of signs and symptoms as well as the mode of
transmission of the disease in order to give effective health education