Definition:

 Acquired immune deficiency syndrome or

acquired immunodeficiency syndrome
(AIDS) is a disease of the human immune system
caused by the Human Immunodeficiency
Virus (HIV)
 This condition progressively reduces the effectiveness of the immune system and leaves
individuals susceptible to opportunistic infections and tumors.
 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.
 AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived with the
disease worldwide, and it killed an estimated 2.1 million people, including 330,000
children.

History:

 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 and its cause, HIV, identified in the early 1980s.

Pathophysiology of HIV/AIDS

Signs and Symptoms

 The symptoms of AIDS are primarily the

result of conditions that do not normally
develop in individuals with healthy immune
systems
 Most of these conditions are infections caused
by bacteria, viruses, fungi and parasites that are
normally controlled by the elements of the
immune system that HIV damages.
 A person may remain asymptomatic, feel, and
appear healthy for even years even though he
 or she is infected with HIV. While he or she does not exhibit AIDS, the immune system
starts to be impaired.
 The person may exhibit neurological symptoms such as memory loss, altered gait,
depression, sleep disorders or chronic diarrhea.
 This set of symptoms is often called AIDS-related Complex (ARC) by clinicians. As the
symptom progress, the patient becomes an AIDS patient.

Minor Signs:

1. Persistent Cough for one month

2. Generalized pruritic dermatitis
3. Recurrent herpes zoster
4. Oropharyngeal candidiasis
5. Chronic disseminated herpes simplex
6. Generalized lymphadenopathy

Major Signs:

1. Loss of weight – 10 percent of body weight

2. Chronic diarrhea for more than one month
3. Prolonged fever for one month

Common Opportunistic Infections

1. Pneumocystis carinii pneumonia

2. Oral candidiasis
3. Toxoplasmosis of the CNS
4. Chronic diarrhea/wasting syndrome
5. Pulmonary/extra-pulmonary
tuberculosis
6. Cancers
a. Kaposi’s sarcoma – affects
small blood vessels and
internal organs
b. Cervical dysplasia and
cancer. Researchers found
out that women with HIV
have higher rates of this type of cancer. Cervial carcinoma is associated with
Human Papilloma Virus (HPV).
c. Non-Hodgkin’s lymphoma – cancerous tumor of the lymph nodes. This is usually
a late manifestation of HIV infection.
Mode of Transmission:

1. Sexual intercourse
2. Blood transfusion and sharing of
infected syringes and needles among
intravenous drug users
3. Vertical or perinatal transmission
(from a pregnant woman to the fetus
during pregnancy, child delivery or
breast-feeding)

There are several ways of receiving infected

blood:

1. Blood transfusion
2. Sharing of unsterilized syringes and needles used for intravenous injections
3. Transmission during pregnancy
a. Maybe transplacental
b. There is greater risk of transmission when mother has developed advanced AIDS
4. Organ donation
5. Accidental exposure in hospitals or clinics
Diagnostic Examination:

1. ELA or ELISA – Enzyme link immunosorbent assay

2. Particle agglutination (PA) test
3. Western blot analysis – confirmatory diagnostic test
4. Immunofluorescent test
5. Radio immuno-precipitation assay (RIPA)

 Many people are unaware that they are infected with HIV.
 HIV tests are usually performed on venous blood.
 Many laboratories use fourth generation screening tests which detect anti-HIV antibody
(IgG and IgM) and the HIV p24 antigen.
 The detection of HIV antibody or antigen in a patient previously known to be negative is
evidence of HIV infection.
 Individuals whose first specimen indicates evidence of HIV infection will have a repeat
test on a second blood sample to confirm the results.

Treatment Modalities:

 “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:

1. Reverse trancriptase inhibitors – they inhibit the enzyme called reverse transcriptase
which is needed to “copy” information for the virus to replicate. These drugs are:

a. Zedovudine (ZDV) – Retirvir

b. Zalcitabine – Havid

c. Stavudine – Zerit

d. Lamivudine – Epivir

e. Nevirapine – Viramune

f. Didanosine – Videx
 2. Protease inhibitors. They work by inhibiting the enzyme protease which are needed for
the assembly of viral particles. These drugs are:

a. Saquinavir – Invarase

b. Ritonavir – Norvir

c. Indinavir – Crixivan

Nursing Management:

1 Health education – The healthcare worker must:

a. Know the patient
b. Avoid fear tactics
c. Avoid judgmental and moralistic messages
d. Be consistent and concise
e. Use positive statement
f. Give practical advice
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, CD gown, face shield/goggles are very necessary.
3 Prevention
a. Care should be taken to avoid accidental pricks from sharp instruments
contaminated with potentially infectious materials form AIDS patient.
b. Gloves should be worn when handling blood specimens and other body secretions
as well as surfaces, materials and objects exposed to them.
c. Blood and other specimens should be labeled with special warning “AIDS
Precaution”.
d. Blood spills should be cleaned immediately using common household
disinfectants, like “chlorox”.
e. Needles 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.

The Four Cs in the Management of HIV/AIDS

1. Compliance – giving of information and counseling the client which results to the
client’s successful treatment, prevention and recommendation.

2. Counseling/education
 a. Giving 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. Contact tracing

a. Tracing out and providing treatment or partners

4. Condoms

a. Promoting the use of condom, giving instructions about its use, and giving
away available condoms