MANAGEMENT OF PATIENTS WITH HIV INFECTION AND

AIDS

Human Immunodeficiency Virus (HIV) infectionand

Acquired Immunodeficiency Syndrome (AIDS)

NOTE: HIV and AIDS is one of the most commonly known

immunodeficiency disorders. When firstidentified in 1981, HIV
and AIDS was fatal and the only treatments available were
comfort measures and hospice care for several years. Today,
there is still no cure but they are now close and drug
administration and FDA-approved medications are being used
for treating HIV and AIDS. If HIV positivepatients are compliant
with their HIV treatment including routine testing to monitor
overall health status and managing the effects of this chronic
disease it can be controlled and a good quality of lifecan be
maintained.

● The epidemic remains a critical public health issue in all

communities across the country andaround the world.
● Prevention, early detection, and ongoing treatment
remain important aspects of care for people with HIV
infection and AIDS.
● Nurses in all settings encounter people who arepositive for
HIV infection; therefore, nurses needan understanding of
the pathophysiology, knowledge of the physical and
psychologicalconsequences associated with the diagnosis,
and expert assessment and clinicalmanagement skills to
provide optimal care for people with HIV infection and
AIDS
A. Description
1. History
● I981(June) - HIV was first reported by the
Centers for Disease Control (CDC)
● The condition was named GRIDS (Gay Related
Immune Deficiency Syndrome) before since all
of its first cases were homosexual men
suffering from general immune deficiency.
● 1982 - the term AIDS replaced GRIDS whenit
became apparent that the disease was notjust
limited to gay men.

● It can occur in a person of any age.

● I984 – the HIV antibody test – enzyme

immunoassay (EIA) formerly called enzyme
linked immunosorbent assay (ELISA) became
available

NOTE:

There are two big personalities: on the left is

the singer Freddie Mercury of the band Queen. The
movie Bohemian Rhapsody, in that movie was shown
the lifestory of Freddie Mercury in which this popular
singer from Great Britain in that age.

The other picture, Earvin “Magic” Johnson Jr.

Unlike Freddie Mercury who passed away in 1991, he
is still connected inthe National Basketball Association
althoughis not playing basketball anymore but he is
one of the officers, the general manager in

1 | Management of Patients with HIV Infection and AIDS

 Los Angeles Lakers in which Lebron Jamesbelong to ● End of 2014 – WHO projected approximately
that team. 36.9 million people living with HIV

● July 2015 – White House released the National

HIV/AIDS Strategy for the United States: Updated
to 2020.

● Strategic goals:

1. Reducing new infections

2. Increasing access to care for American people and

improving health outcomes for people living with HIV
❖ FIRST DECADE
3. Reducing HIV related health disparities and health
§ Recognition and treatment of opportunistic inequities
diseases
4. Achieving a more coordinated nationalresponse to
§ Introduction of prophylaxis against opportunistic the HIV epidemic.
infections (OIs)
● 2015 – A growing number of adults aged 50 and
❖ SECOND DECADE older have HIV/AIDS. Many were diagnosed with
HIV in their younger years and are benefitting from
§ Progress in the development of highly active
effective treatment.
antiretroviral drug THERAPIES (HAART)
o NEW YORK CITY has the oldest and the largest
§ Progress continued in the treatment of
epidemic in the Western world.
opportunistic infections.

❖ THIRD DECADE - Focused on:

§ issues of preventing new infections

§ adherence to antiretroviral therapy(ART)

§ Development of second-generation combination

medications that affect different stages of the
viral life cycle

§ Continued need for an effective vaccine.

2. Epidemiology:

● In the fall of 1982, after the first 100 cases were

reported, the Centers for Disease Control and
Prevention (CDC) issued a casedefinition of AIDS.
● AIDS cases were reported to the CDC usinga uniform
surveillance case definition andcase report form.
● late 1990s, many more states in the U.S. implemented
HIV case reporting in responseto the changing epidemic
and the need for information on the numbers and
characteristics of people with HIV infection who had not
yet developed AIDS.
Note: By the year of 2010, a study was conducted in this
particular period showing now the top 10 Statesin the USA on
the number of adults/adolescents estimated to be living with an
HIV diagnosis on the year end of 2010. As you can see in the
picture theseare the top 10 States with New York on top of it,
witha figure of 132, 523 followed by California, Florida and
the rest.

2 | Management of Patients with HIV Infection and AIDS

Note: In 2018, a study on HIV diagnosis among women and girls
by age and transmission category.On the age as we can see in
the picture pinakamalaki yung 25-34 yrs of age, 27% at that
time and it was followed by those who belong at 35-44 yrs of
age 24% and how they got it makikita natinna injection drug use
is only 15% pero ang malaki isheterosexual contact which is
85%.

Note: In the 1984, the first case of AIDS was identified then the
following year the Department of Health began serological
surveillance for HIV. In 1986, HIV was declared a notifiable Predictions for the leading causes of disabilityand mortality in
disease and thefollowing year the National AIDS Prevention and 2030
Control Committee was created. In the year 1991, National
Sentinel Surveillance initiative to monitor trends of HIV/AIDS in
high-risk groups and determine its spread in low-risk groups. In
the year 1992, National AIDS prevention and Control Programs
Surveillance and Education Activities were created.

3 | Management of Patients with HIV Infection and AIDS

Several factors put older adults at risk for HIV infection:
1. Many older adults are sexually active but DO NOT USE
CONDOMS, viewing them only as a means of unneeded birth
control.
● Maybe because walang pambili, as they sayviewing
them as an unneeded birth control itaffects pleasure
some says.
immunity. HIV primarily attaches to the CD4 cell wallreceptors
found on lymphocytes and somemonocytes. The virus must go
to several stagesbefore in can effectively infect a host cell.
Once infected with HIV the host cell and the ability of the cell
mediated immune response is seriously impaired. Once infection
occurs in the CD4 lymphocytes and produces HIV the CD4 cell
itself dies.
B. Etiology:

2. Many older adults do not consider themselves at risk for HIV
infection.
● Because they say that they are so strong. SaPilipinas
usually sinasabi na malakas pa ako sa kalabaw
unknowingly hindi talaga nila alam ang maidudulot ng
HIV
3. Older gay men, who grew up and lived in an era when
disclosure of their sexual orientation was not acceptable and
who have lost long-time partners, may begin new relationships
with younger men.
4. Older adults may be intravenous (IV)/injection drug users.
HIV – is a retrovirus
❖ Cannot replicate outside of living host cells.
❖ Contain only RNA; no DNA
❖ Differs from other viruses because of anenzyme called
reverse transcriptase which help the virus replicate and
place its genetic material in the deoxyribonucleic acid
(DNA) of the host cell.
RESULT = replication of as many 2 billion viralparticles/day
released from the host cell into thecirculatory system, infecting
other cells in the body.

5. Older adults may have received HIV-infected blood through

transfusions before 1985.

6. Normal age-related changes include a reduction in immune

system function, which puts the older adult at greater risk for
infections, cancers, and autoimmune disorders. Many older
adults also experience the loss of loved ones, resulting in
depression and bereavement, factors that areassociated with
depressed immune function.

2 HIV subtypes

1. HIV-1 = found around the world, mutateseasily and

frequently, producing multiple substrains

2. HIV-2 = found mainly in small area in West Africa and

is less transmittable -development of AIDS is longer.
Note: In a healthy immune system, T-cells that havethe protein
CD4 on their surface are known as CD4 Positive and as T-helper
cells. Normally CD4 T-cellsactivate B-cells, natural killer cells and
Phagocytes. These cells participates in both cellular and humoral

4 | Management of Patients with HIV Infection and AIDS

C. Pathophysiology
HIV requires a living host cell for survival and duplication. HIV
enters the body through transmission of infected blood or body
fluids carries its genetic information in RNA and infects cells which
have the CD4 antigen.
Inside the capsid are strands of RNA and 3 important enzymes:
1. Reverse transcriptase – copies RNA into DNA (Reverse
transcription)
2. Integrase – incorporates the reprogrammed DNA
3. Protease – cuts the long chains, freeing the replicated
viral particles into the cytoplasm of the cell.
The transformed DNA provides the blueprint formaking
clones of HIV
Note: For the pathophysiology, HIV requires a livinghost cell for
survival and duplication. HIV enters the body through
transmission of infected blood or bodyfluids, carries its genetic
information in RNA and infects cells which have the CD4 antigen.
Now we have what they call a capsid, as you can see in the
picture nasa gitna, A double layer of lipid material with surface
binding protein called gp120 and this projects in all directions
from the lipid layer.
Inside the capsid are strand of RNA and three important enzymes:
• R – Reverse transcriptase; it copies RNA intoDNA
• I – Integrase; incorporates reprogrammed DNA
• P – Protease; cuts the long chains and frees the
replicated viral particles into the cytoplasmof the cell.
The first stage is your attachment also known as binding.
Glycoproteins of HIV bind with the host’s uninfected CD4
receptors and chemokine receptorsusually which results in fusion
of HIV with the CD4 T-Cell membrane. So makikita natin, yung
mag bibind palang siya.
On the second stage meron tayong tinatawag na Uncoating
and Fusion. Kasi dumikit na po siya ngayon, uncoating and
fusion only the contents of HIV’s viral core, we have your reverse
transcriptase,integrase, and protease are emptied into the CD4
T-Cell. Kasi nakapag fuse na po siya ngayon. So ano po yung
ineempty po niya ulit? Eto yung contents ngHIV’s viral core, eto
po yung binanggit natin kanina na R.I.P. eto po yung Reverse
Transcriptase, the integrase, and the protease.
Next is the DNA synthesis. HIV changes its genetic material
design from RNA to DNA through the action of your Reverse
Transcriptase resulting in the double stranded DNA that carries
instruction for viralreplication. Makikita natin HIV RNA pa
lang siya.
5 | Management of Patients with HIV Infection and AIDS
Makikita natin diba may tuldok na white dun sa gitna,your HIV
RNA have a coating color of gold and thenlater on makikita
natin na nagkaroon na po ngayon ng HIV DNA, yun po yung
kulay na red.
Fourth is integration. Yung viral DNA, eto yung bago ngayon,
so the new viral DNA enters the nucleus of the CD4 T-Cell and
through the action ofIntegrase, uulitin ko through the action of
Integrase is blended with the DNA of the CD4 T-Cell, resultingin
permanent life-long infection.
So this will be followed by transcription. When the CD4 T-Cell
is activated the double stranded DNA forms single stranded
messenger RNA, so we have your mRNA which builds new
viruses.
Then this is followed by translation. The mRNA creates chains of
new proteins and enzymes eto yung polyproteins, that contains
the components needed in the construction of new viruses.
Seventh is cleavage. The HIV enzyme protease cuts now the
polyprotein chains into the individual proteins that make up the
new viruses.
And number 8, we have budding. This time new proteins and
viral rna migrate to the membrane of the infected CD4 T-Cell,
exit from the cell and start the process all over. When the buds
rupture they release many copies of the virus which will infect
other T-Cells.
STAGES OF HIV DISEASE
Note: We have your 2014 CDC Case Definition for HIV
Infections among Adolescents and Adults. We have 4 columns,
for the first column we have stage, second column is the CD4
count, then we have the CD4 percentage, and the clinical
evidence.
Stage 0, for the CD4 count there is early HIV infection.
In stage 1 more than 500 cells per cubic millimeter, so no AIDs
defining condition.
Pagdating sa stage 2, 200-499 cells per cubic millimeter, I
would like you to memorize the figures,because these are very
important figures in the classification according to staging. So
makikita natinsa stage 2 no AIDs defining condition parin siya.
Pero pagdating po sa stage 3 makikita po natin na bumagsak
na po ang kanyang CD4 count, so we have your stage 3, less
than 200 cells per cubic millimeter na ngayon, so meron na po
tayong documentation of AIDs defining condition.
And then on the last we have your Stage Unknown,there is no
data, no information on the presence of AIDs defining condition,
so ang tawag dun is stage unknown.
Stage 0 - Primary Infection (Acute/Recent HIV Infection, Acute
HIV Syndrome)
• The period from infection with HIV to the development of
HIV-specific antibodies (within 2to 4 weeks after infection
with HIV).
• Window period – is the time it takes for the bodyto produce
HIV antibodies after being exposed to HIV.
• During this stage an HIV-positive person tests negative on
the HIV antibody blood test,although he or she is infected
and highly infectious, because his or her viral load is very
high.
• During this very early period, HIV infection may not be
detected by testing. This is because mostHIV tests look for
antibodies rather than thevirus.
Note: Stage 0, this is also known as your primary infection, acute
or recent HIV infection, acute HIVsyndrome. This is the period
from infection of HIV to the development of HIV specific
antibodies.Then we have what we call your Window Period,the
window period is the time it takes for the bodyto produce HIV
antibodies, after being exposed to
6 | Management of Patients with HIV Infection and AIDS
HIV. During this stage an HIV-positive person,nahawa na po
siya, will test negative, uulitin ko during this stage, an HIV
positive person pag nagpa checkup po siya, magiging? Sa HIV
pero positive po siya, so person will test negative on the HIV
antibody blood test, pag nagpa-examine siya ulit, magtetest
siya ng negative on the HIV antibody test pero HIV positive na
siya. Although he or she is infected, the person remains highly
infectious because his or her viral load is very high. During this
very early period, HIV infection may not be detected by testing.
This is because most HIV tests look for antibodies rather than
the virus.
Increased viral replication occurs 2-4 weeks after
exposure to HIV→ widespread dissemination of HIV
throughout the body, and destruction of CD4 T cells →
dramatic drop in CD4 t-cell counts, which are normally
500 to 1500 cells/mm3 of blood.
During this time the immune system reacts tothe virus by
developing antibodies – this is referred to as
seroconversion.
Note: To continue, we can see in the picture that thedotted lines
represented by a blue line refers toantibodies. Viral load kulay
pink. So this is the weeks since infections from 0, 2, 3, 4-12, going
nowto pahaba na siya ng years. For the first part we haveyour
primary HIV infection, so dito ngayon makikitanatin that during
that time, yung antibodies diba kanina wala pa, so nag
dedevelop palang siya and then during that time very infectious
po yung ating patient because the viral load is increasing as
shown by the pink line that is particularly on the 2nd, 3rd
umaakyat na po siya, pero later part, the body reactsby making
antibodies so we have your seroconversion so nung tumaas na
po yung antibodies bumaba na din yung viral load natin.
• When the body's immune system puts up a fight
– it is called acute retroviral syndrome (ARS)
– viremia, which often is mistaken for flu.
• Early symptoms of infection disappear on theirown
within weeks.
o fever (most common)
o headache
o lymphadenopathy
o pharyngitis
o skin rash (red rash that doesn't itch, usuallyon the
torso)
o myalgias/arthralgias
o diarrhea
o night sweats
Note: In stage 0, when the body’s immune system puts up a fight,
it is called ARS, yung akala flu lang. So eto yung time na
sasabihin ng infected client na parang trinatrangkaso ako
because he got the infection at the time. So early symptoms of
infection disappear on their own within weeks, ay ok na ko
minsan sasabihin niya. Going back we have theearly symptoms,
this would include most common ofall we have fever, nilalagnat
po ang ating patient. Then makakaramdam po siya ng
headache, lymphadenopathy, pharyngitis, skin rash, body
aches, we have your myalgias, arthralgias, then we have your
diarrhea and night sweats.
Note: In the picture, we have your HIV progression, the blue
circles, small circles, are represented by your CD4 cells, those on
the small red circles we have your HIV. So before the infection
on the first test tube makikita natin its all blue, but when the
infection sets in, because of sexual contact or accidental puncture
of needles of patients who havethe disease, na nainfect na po
yung individual, so makikita natin we have your acute HIV
infection,
7 | Management of Patients with HIV Infection and AIDS
meron na po siyang blue and red dun sa test tube, and then as
it progresses to weeks to months goingnow to years, we have
your Chronic HIV infection,makikita natin if the patient does not
comply with her or his medications and will not change his
lifestyle, and will not take care of himself then this will lead now
to AIDs.
Stage 1 - HIV Asymptomatic /Chronic HIV infection (More
Than 500 CD4 T Lymphocytes/mm3)
● Stage is free from symptoms, person may lookand feel
well but HIV is continuing to weaken his immune system.
● Level of HIV in the blood drops to very low levels.
● HIV neutralizing antibodies are detectable in the blood
● May have : Persistent generalized lymphadenopathy
(PGL) - painless, non- tender enlarged lymph nodes
(lymphadenopathy) in at least two areas of thebody for
at least 3 months,
Viral set point - a state in which a patient’s primaryinfection with
HIV has subsided and an equilibrium now exists between HIV
levels and the patient’simmune response. The remaining amount
of virus in the body after primary infection or initial immune
response subside.
The higher the viral load of the set point, the faster the virus will
progress to AIDS; the lower the viral load of the set point, the
longer the patient will remain in clinical latency. The only
effective way to lower the set point is through highly active
antiretroviral therapy.[
The higher the viral set point, the poorer, the prognosis.
Refer to the pic above: “Within 4-8 weeks, yung viralset point
natin is represented by red lines after that, bumagsak or kumonti
ung viral set point which is pagdating ng 2-12 years”
Stage 2 - HIV Symptomatic ( 200 to 499 CD4 T
Lymphocytes/mm3)
The immune system becomes damaged and weakened
by HIV and symptoms develop.
The symptoms are caused by the emergence of
opportunistic infections (illness caused by various
organisms, some of which USUALLY do not cause disease
in people with normal immune system. (but because of the
trap in theimmune system of patient with HIV, this time
they can’t protect themselves so opportunistic infection
emerges.)
It is typically at this point that the person seeks help.
(nakakaramdam na sila ng mga kung ano ano lumalabas sa
katawan nila kaya they need to seek for health/medical
attention)
Examples of conditions
1. Bacillary angiomatosis - a disorder characterized by
neovascular proliferation in the skin or the internal organs
and presenting as tumor-like masses due to infection with
Bartonella henselae or Bartonella quintana.
8 | Management of Patients with HIV Infection and AIDS
2. Candidiasis (a fungal infection caused by candida),
oropharyngeal (thrush) or vulvovaginal (persistent, frequent, or
poorly responsive to therapy)
3. Cervical dysplasia (moderate or severe)- a precancerous
condition in which abnormal cell growth occurs on the surface
lining of the cervix or endocervical canal.
4. Constitutional symptoms, such as fever (38.5C)or diarrhea
exceeding 1 month in duration
5. Hairy leukoplakia - is a white patch on the side of the tongue
with a corrugated or hairy appearance.It is caused by Epstein-
Barr virus (EBV) and usually occurs in a person who is
immunocompromised.
• It is a white lesion on the lateral border of thetongue
and associated with AIDS.
6. Oral Herpes zoster (shingles), involving at leasttwo distinct
episodes or more than one dermatome.
Herpes zoster is a viral infection that occurs with
reactivation of varicella zoster virus, it is usually a painful
but self-limited dermatomal rash.
Reactivation of varicella zoster virus has beenremained
dormant (nasa katawan lang natin) with in dorsal root
ganglia often for decades after the patient initial
exposure to the virus in the form of varicella (pag nagka
chickenpox tayo, results to herpes zoster or shingles)
7. Idiopathic thrombocytopenic purpura - is an immune
disorder in which the blood doesn't clot normally and can cause
excessive bruising and bleeding.
This condition is more commonly referred to as
immune thrombocytopenia
8. Listeriosis a serious infection caused by the germ Listeria
monocytogenes
It is caused by eating contaminated ready to eat meat
and dairy products. High risk foodsare: polony, viennas
and other sausages. Unpasteurized products are also
included.
9 | Management of Patients with HIV Infection and AIDS
 11. Wasting syndrome refers to unwanted weight loss of more
than 10 percent of a person's body weight, with either diarrhea
or weakness and fever that have lasted at least 30 days.

For a 150-pound man, this means a weight loss of 15

pounds or more. Weight loss can result in loss of both fat
and muscle.

9. Pelvic inflammatory disease (may also develop, it is an

infection of female reproductive organ), particularly if
complicated by tubo-ovarian abscess

It is usually caused by complication of sexuallytransmitted

disease and can cause great damage to uterus, ovaries, Stage 3 - AIDS (Fewer Than 200 CD4 TLymphocytes/mm3)
fallopian tubes andother organs.
Significantly impaired Immune system and thebody can’t
fight off opportunistic infections.

The illness becomes more severe leading to an AIDS

diagnosis

If preventive medications not started the HIV infected

person is at risk for:

Pneumocystis carini pneumonia(PCP)

o Pneumocystis carinii is a cause of diffuse
pneumonia in
immunocompromised hosts. Even in fatalcases, the
organism and the disease remain localized to the
lung

10. Peripheral neuropathy - loss of blood flowcauses nerve

damage and pain.

Diagnosis: X ray film. Very noticeable na mayinfection sa

lungs.

10 | Management of Patients with HIV Infection and AIDS

If preventive medications not started the HIVinfected person is at
risk for:

● Cryptococcal meningitis - a typeof meningitis

caused by a fungus called Cryptococcus.
This type of meningitis mainly affects people with
weakened immune systems due to another illness

STAGES OF HIV DISEASE

● Toxoplasmosis - is a disease that results from infection

with the Toxoplasma gondii parasite, one of the world's
most common parasites.
● Infection usually occurs by eating undercooked
contaminated meat, exposure from infected cat feces,
or mother-to-child transmission during pregnancy

We can see in the picture the time where infection set in and the
time of years in horizontal lines. May decline sa CD4 cell from
1st year to 2nd year to 3rd year and 4th year makikita natin
na may bacteria infection then varicella zoster, these are early
opportunistic infection then later on may late opportunistic
infections as CD4 cells continue todecline
Stage unknown refers to a person with laboratory confirmation
of HIV infection, but no information about CD4 cell count or
percentage (and no information about the presence of AIDS-
defining clinical conditions).

11 | Management of Patients with HIV Infection and AIDS

D. Assessment: v In general, while obtaining the initial history, theclinician
should obtain information from the client in an open,
Take a health history, especially noting any “high risk” nonjudgmental manner.
exposures.
o The initial encounter forms the encounter of the basis of
• Having unprotected anal or vaginal sex; the client - provider relationship and should be
informed by a patient - centered multidisciplinary
• Having another sexually transmitted infection (STI) such approach.
as syphilis, herpes, chlamydia, gonorrhea and
bacterial vaginitis Many STIs produce open sores on Comprehensive Patient History
genitals. These sores act as doorways for HIV to enter the
1. Date of diagnosis of HIV infection
body.
2. Identified risk factors related to HIV
• If client appears very uncomfortable andpauses for long acquisition
periods before answering the nurses questions- take your 3. Prior HIV-associated complications and
time. Realize thatthis is a very private topic to talk about. comorbidities
4. Past medical history
• OPD patient during interview give time to collect his or
5. Past surgical history
her thoughts and composure before answering questions
6. Psychiatric history
You must ask about esp IN PATIENT: 7. Residence and travel history

• Shared contaminated needles, syringes

8. Medication history
9. Allergies and intolerances to medications
• Received unsafe injections, blood transfusions and
A complete physical examination should be performed at the
tissue transplantation, and medical procedures that
involve unsterile cutting or piercing. initial encounter, with particular attention given to the oral,
integumentary, and lymphnode examinations.
• Accidental needle stick injuries
Patients with HIV/AIDS may develop
Risk reduction counseling can also often introduce or discuss opportunistic infections:
sexual history. The patient support network can be assess and Respiratory Manifestations
patients readiness to antiviral therapy.. During this time:
1. Pneumocystis Pneumonia (PCP) - most common infection
• The nurse should begin with an assessment of the clients in people with AIDS.
comfort level with the topic.
Without prophylactic therapy, 80% of allpeople with
• When completing a health history for a client and HIV will develop pneumocystispneumonia.
begins to obtain a sexual history. Nonspecific signs and symptoms - nonproductive cough,
fever, chills, shortness of breath, dyspnea,
• Opening question- How do you feel about answering hypoxemia, and occasionally chest pain.
questions about your sexual history? Respiratory failure can develop within 2 to
3 days after the initial appearance of symptoms.
v The initial evaluation and the focus of the first visit should
PCP can be diagnosed definitively by identifying the
take into account whether the clientis newly diagnosed with
organism in lung tissue or bronchial secretions.
HIV or has establishedHIV and is new to the clinic.
Procedures:
v In some instances, the client may have active related HIV o Sputum induction
tissue that needs immediately to beaddressed and these
tissues may need to take priority and dominate the o Bronchial-alveolar lavage
persuasive. o Transbronchial biopsy (fiberoptic
bronchoscopy)

12 | Management of Patients with HIV Infection and AIDS

 2. Mycobacterium avium complex (MAC) is a group of Place the patient on respiratory isolation and inform the
bacteria related to tuberculosis. These germs are very physician
common in food, water, and soil. When a person have a Gastrointestinal manifestations:
strong immunesystem, it don't cause problems. But they can
make people with weaker immune systems, likethose with • Loss of appetite, nausea, vomiting, oral andesophageal
HIV very sick. candidiasis characterized by creamy-white patches in the
S/S: oral cavity, difficult and painful swallowing and chronic
diarrhea - profound weight loss
Fever.
Sweating. Wasting syndrome - profound involuntary weight loss
Weight loss. exceeding 10% of baseline body weight and either chronic
Fatigue. diarrhea for more than 30 days
Diarrhea - loose, watery stools, which wouldincrease
the risk for perineal skin breakdown
Shortness of breath.
Abdominal pain.
Anemia.

3. Tuberculosis – s/s

A disease developed by a bacteria known

Mycobacterium tuberculosis. The bacteria usually
attacks the lungs but they can also attack different
parts of the body. The TB spreads through the air when
a person with TB of the lungs or throat coughs, sneezes
Oncologic Manifestations
ortalks.
S/s: Kaposi’s sarcoma (KS) - a type of cancer that can form masses
Loss of appetite and unintentional weightloss. in the skin, lymph nodes, or otherorgans. The skin lesions are
usually purple in color. They can occur singularly, in a limited
Fever.
area, or be widespread.
Chills.

Night sweats

A cough that lasts more than three weeks

o Sometimes when we admit the client particularly in

the old department and we assist the client, they
may say these things to you but if the client coughs
someblood and you notice it, it will call ourattention
and we have to place the client in an isolation and
we are going to inform the attending physician of
what we have observed. Neurologic Manifestations
Cough up some blood
1. HIV-associated dementia occurs when the HIV
Sputum exam and x-ray virus spreads to the brain. Symptoms of HIV-
associated dementia include loss of memory, difficulty
Meds – 4 drug combination: isoniazid, rifampin, thinking, concentrating, and or speaking clearly, lack of
pyrazinamine and ethambutol interest in activities and gradual loss of motor skills.

13 | Management of Patients with HIV Infection and AIDS

 nausea, vomiting, mental status changes, and
seizures.
• Ask the client to place his chin on hischest.
o If you suspect that the client might be having this
then you can ask the client to place his chin on
his chest, that is now to assess the presence of
nuchal rigidity.
• Diagnosis is confirmed by CSF analysis.
• Nuchal rigidity is an inability to flex the neck
forward due to rigidity of the neck muscles, if
present it confirms the diagnosis of Cryptococcal
Meningitis and also a CSF analysis will be
performed for this confirms now the diagnosis.
2. HIV-associated peripheral neuropathy
3. Distal Sensory Polyneuropathy (DSPN) occurs in
advanced HIV disease as a result of immunosuppression,
antiretroviral drug toxicity,and/or mitochondrial toxicity. It
can lead to significant pain and decreased function

4. HIV Encephalopathy - It is a clinical syndrome that is

characterized by a progressive decline in cognitive,
behavioral, and motor functions.
• Early manifestations include memory deficits,
headache, difficulty concentrating,
progressive confusion, psychomotor slowing,
apathy, and ataxia.
• Later stages include global cognitive impairments, Patients with Cryptococcal Meningitis will be placedin seizure
delay in verbal responses, avacant stare, spastic precautions. For this patients:
paraparesis, hyperreflexia, psychosis,
hallucinations, tremor, incontinence,seizures, mutism, • Side rails must be up
and DEATH.
• They may be placed in a side lying position.
5. Cryptococcal meningitis - A fungal infection that causes • Seizure pads against the side rails
neurologic disease. • Pillow under the head
• Suction will be available if the seizure starts
• It is characterized by symptoms such as fever,
headache, malaise, stiff neck, • Bed in a low position
• Observe privacy

14 | Management of Patients with HIV Infection and AIDS

6. Progressive multifocal Gynecologic Manifestations
leukoencephalopathy (PML) is a disease of the white
matter of the brain, caused by a virus infection that targets • Vaginal candidiasis can be seen
cells that make myelin. • Ulcerative sexually transmitted diseases (STDs) such as
• People may become clumsy, have troublespeaking, chancroid, syphilis, and herpes are more severe in
and become partially blind, and mental function women with HIV infection.
declines rapidly.

• Human papillomavirus (HPV) causes venereal warts

and is a risk factor for cervicalintraepithelial neoplasia,
a cellular change that is frequently a precursor to
cervical cancer.
Depressive Manifestations

• People with HIV/AIDS who are depressed may

experience irrational guilt and shame, loss of self-esteem,
feelings of helplessness and worthlessness, and suicidal
ideation.
• People with HIV Suffer from Depression Caused by
Shame, Trauma, Substance Abuse

Integumentary Manifestations

• Generalized folliculitis
• Seborrheic dermatitis
• Molluscum contagiosum is a viral infection
characterized by deforming plaque formation.
HOW HIV SPREADS
● Unprotected penetrative sex - have vaginal, anal or oral
sex with an infected partner whose blood, semen or
vaginal secretions, enter the body. The virus can enter the
body through mouth sores or small tears that sometimes
develop in the rectum or vagina during sexual activity.

In this picture, we have a patient with this disease ● By sharing needles - Sharing contaminated IV drug
paraphernalia (needles and syringes) putsyou at high risk
Lesions in the groin and thigh areas on presentationof a 25- of HIV and other infectious
year-old, HIV-seropositive man with molluscum contagiosum virus
infection. Extensive, ulcerating lesions were accompanied by
perinodularscarring.

15 | Management of Patients with HIV Infection and AIDS

 diseases, such as hepatitis (e.g. Injecting drug users who
share needles)
● From blood transfusions - In some cases, thevirus may be
transmitted through blood transfusions. (e.g. Recipients of
contaminated blood and blood products)
● During pregnancy or delivery or through breast-feeding
- Infected mothers can pass the virus on to their babies.
Mothers who are HIV- positive and get treatment for the
infection during pregnancy can significantly lower the riskto
their babies.
● Sharing razors – if blood is present
● Kissing – inflammation and breaks in the skin or mucosa,
if even the smallest amount of bloodis present (membranes
of mouth are thin enough for HIV to enter straight into the
body).
● Receiving organ transplants with HIV infected blood or
blood products
● Tattoos/body piercing – if equipment is not clean
PREVENTION FROM HIV INFECTION:
Advise all patients to:
1. Abstain from exchanging of sexual fluids
2. Have monogamous relationship - be faithful to onepartner
3. Always use latex condoms. If the patient is allergicto latex,
non-latex condoms should be used,however they will not protect
against HIV infection
4. Avoid reusing condoms.
* We need to educate the people on the proper useof
condoms.
5. Avoid using cervical caps or diaphragms without using a
condom as well.
6. Always use dental dams for oral– genital or anal stimulation.
• A dental dam is a thin, flexible piece of latex that
protects against direct mouth-to-genital ormouth-to-anus
contact during oral sex. This reduces your risk for sexually
transmitted infections (STIs) while still allowing for clitoral
or anal stimulation
7. Avoid anal intercourse because this practice may injure
tissues; if not possible, use lubricant- there arewater and silicone
based products designed for analsex.
8. Avoid manual–anal intercourse (“Fisting”).
9. Do not ingest urine or semen.
10. Educate patients about nonpenetrative sexual activities,
such as body massage, social kissing (dry), mutual masturbation,
fantasy, and sex films.
11. Advise patients to avoid sharing needles, razors,
toothbrushes, sex toys, or blood-contaminated articles.
12. Inform previous, present, and prospective sexualand drug-
using partners of their HIV positive status. If the patient is
concerned for his or her safety, advise the patient that many
states have established mechanisms through the public health
department in which professionals are available to notify
exposed contacts.
13. Avoid having unprotected sex with another HIV-seropositive
person. Cross-infection with that person’s HIV can increase the
severity of infection.
14. Advise HIV-seropositive patients to avoid donating blood,
plasma, body organs, or sperm.
16 | Management of Patients with HIV Infection and AIDS
Standard precautions to reduce the risk ofexposure to health care
workers to HIV:
1. Hand hygiene: Use after touching blood, body fluids,
secretions, excretions, or contaminated items;immediately after
removing gloves; and betweenpatient contacts.
2. Personal protective equipment (PPE) - the gloves, gown,
mask should be worn whenever takingcare of patients with HIV.
3. Soiled patient care equipment: Handle in a manner that
prevents transfer of microorganisms to others and to the
environment; wear gloves if visiblycontaminated; and perform
hand hygiene.
4. Environmental control: Develop procedures forroutine care,
cleaning, and disinfection of environmental surfaces, especially
frequently touched surfaces in patient care areas.
5. Textiles and laundry: Handle in a manner that prevents
transfer of microorganisms to others and tothe environment.
6. Needles and other sharps: Do not recap, bend, break, or
hand-manipulate used needles.
7. Patient resuscitation: Use mouthpiece, resuscitation bag,
and other ventilation devices to prevent contact with mouth and
oral secretions.
8. Patient placement: Prioritize for single-patient room if
patient is at increased risk of transmission, islikely to contaminate
the environment, does not maintain appropriate hygiene, or is at
increased risk of acquiring infection or developing adverse
outcome following infection
9. Respiratory hygiene/cough etiquette
Instruct symptomatic people to cover mouth andnose when
sneezing or coughing
• Use tissues and dispose in no-touch
receptacle
• Observe hand hygiene after soiling of handswith
respiratory secretions
• Wear a surgical mask if tolerated.
PRE-EXPOSURE PROPHYLAXIS (or PrEp)
• Is a way for people who do not have HIV but whoare at very
high risk of getting HIV to prevent HIV infection by taking
a pill every day.
• The pill (brand name Truvada) contains two medicines
(tenofovir and emtricitabine) that areused in combination
with other medicines totreat HIV.
• When someone was exposed to HIV through sex or injection
drug use, this medicine can work to keep the virus from
establishing a permanentinfection.
POST-EXPOSURE PROPHYLAXIS (PEP)
• Means taking HIV medicines within 72 hours after a
possible exposure to HIV to prevent HIVinfection
• After an unintended exposure to the blood or body fluids
of a person who either is HIV positiveor whose HIV status IS
UNKNOWN, the need for post-exposure prophylaxis (PEP)
must be assessed within 2 hours.
• Exposure can be – large bore needle stick, significant
mucosal contact with body fluids, contact with body fluids
via break in the skin.
Post Exposure Prophylaxis for Health CareProviders
● It includes taking antiretroviral medicines ASAP, but no
more than 72 hours(3 days) afterpossible HIV exposure;
2 or 3 drugs are usually prescribed which must be taken
for 28days.
● Retrovir (zidovudine) and Epivir (lamivudine) for 28
days
● Occupational exposures – needle stick injury
DIAGNOSTIC TESTS
1. HIV diagnostic tests:
Three types of HIV diagnostic tests:
1. Nucleic Acid Tests (NAT) a.k.a.RNA test
• Looks for the actual virus in the blood
• Test can either tell if a person has HIV or tellhow much
virus is present in the blood (known as an hiv viral load
test).
17 | Management of Patients with HIV Infection and AIDS
 test counseling is provided by telephonewhen
• Is very expensive and not routinely used for screening
results are obtained.
for individuals unless they recently had high risk or
possible exposure and have early symptoms of HIV b. OraQuick In-Home HIV
infection
§ Swab own mouth to collect an oral fluidsample
• Can usually tell you if you have HIV infection10 to 33 and use a kit to test it.
days after an exposure.

2. Antigen/Antibody Tests

• Looks for both HIV antibodies and antigens.

• If you have HIV, an antigen called p24 is produced

even before antibodies develop.

• Can usually detect HIV infection 18 to 45 days after

an exposure.

3. Antibody Tests

• HIV antibody tests only look for antibodies to HIV in

the blood or oral fluid.
• Can take 23 to 90 days to detect HIV infection after
an exposure.
i. Rapid HIV testing
§ Offer highly accurate information within as little as
20 minutes. These tests look for ANTIBODIES to HIV
using either:
§ A sample of blood, drawn from a vein or a finger 1. HIV antibodies from oral fluids are collected through the
prick swab
§ Fluids collected on a treated pad that is rubbed on
your upper and lower gums 2. Once the device is inserted into the test tube, theoral fluid
§ A positive reaction on a rapid test requires an mixes with the liquid and travels up the teststick.
additional blood test to confirm the results. 3. If C-line turns dark it confirms the test is working properly. If
§ REMIND THE PATIENT ABOUT THE NEED TO no C-line appears, the test is not working.If only C-line appears,
RETURN FOR RETESTING TOVERIFY THE RESULTS. the test is negative.
ii. FDA Approved Home Testing Kits 4. HIV antibodies collecting at the T-line indicate thetest positive
a. Home Access HIV 1 Test system The results can be read in 20-40 minutes

§ The Home Access HIV-1 Test System is a laboratory

test sold over-the-counter (OTC)that uses fingerstick
blood mailed to the testing laboratory.

§ Test results are obtained through a toll freetelephone

number using the PIN, and post-
There is a phone number included with a HIV self- test for anyone
to call to get help with conducting thetest.

18 | Management of Patients with HIV Infection and AIDS


4. EI/ELISA test, formerly referred to as the ELISA(enzyme-
linked immunosorbent assay)
• Identifies antibodies directed specificallyagainst HIV.
• Can use, blood, saliva or urine.
• Antibody assays do not detect HIV antibody in the
earliest stages of the infection.(HIV antibody may be
detected normally from 2weeks to 6 mos. After the acute
infection.)
• False positives and false negatives can occur.
• A false-positive result indicates you have acondition
when you actually don’t.
• A false-negative result indicates you don’thave a
condition when you actually do.
• Because of this, patient may be asked torepeat the
EIA again in a few weeks
• If positive = the enzyme immunoassay test willneed to
be repeated to verify the results.
o = must be confirmed by Western Blot (WB) test.
o The Western blot test detects antibodies to HIV and
is used to confirmthe EIA test results
Additional Diagnostic and Laboratory Findings
Western blot
• The Western blot test separates the blood
proteins and detects the specific proteins (called HIV
antibodies) that indicatean HIV infection. The Western
blot is used toconfirm a positive EIA, and the combined
tests are 99.9% accurate.
• Can take up to 2 weeks to obtain results.
• Normal value – negative
Polymerase Chain Reaction (PCR)
• Used to detect HIV's genetic material, called RNA.
These tests can be used to screen thedonated blood
supply and to detect very early infections before
antibodies have beendeveloped.
Immunofluorescent antibody assay
• Normal value= negative
• HIV infected cells are fixed onto a clean glassslides and
then reacted with serum followed by fluorescein
conjugate anti human gammaglobulin
• Apple green fluorescence appear in the positive test
under fluorescent microscope.
CD4 Cell Count with Percentage
• Helps to establish the risk of specific HIV- associated
complications and the need for prophylaxis against
opportunistic infections.
• For persons with HIV infection, measurement of CD4 cell
count serves as the best laboratoryindicator of immune
function.
o Identifies what stage of HIV infection patient may
be in.
o Determines when to start antiretroviral therapy
(ART) and prophylactic therapy for Opportunistic
Infections (OIs).
• Should be obtained every 3 to 6 months thereafter to
assess immune and/or therapeutic response and evaluate
need for starting ART.
Quantitative Plasma HIV RNA Level (viral load):
• The plasma HIV RNA level defines a baselineviral load,
which can predict rapidity of disease, with higher HIV
RNA levels clearly correlating with more rapid
progression of disease and greater risk of developing
AIDS.
• Every 3 to 4 months thereafter in the untreatedperson
HIV Drug-Resistance Testing
• Two types of HIV drug-resistance tests are widely
available: genotypic and phenotypic tests Baseline HIV
drug-resistance testing assesses transmitted drug
resistance.
Screening for sexually transmitted diseases
a) Syphilis: All persons with HIV should undergo screening for
syphilis at the initial visit and periodically thereafter if
ongoing risk factors exist.
• High rates of syphilis in person with HIV especially
among men with HIV who have sex with other men.
This phenomenon maylink to methamphetamine used
and changing patterns of sexual network.
b) Routine STD Screening in Women: All women should be
screened for Neisseria
19 | Management of Patients with HIV Infection and AIDS
 gonorrhoeae, Chlamydia trachomatis, NURSING DIAGNOSES
and Trichomonas vaginalis at baseline.
1. Ineffective airway clearance
• Depending on the risk and the prevalence of Sexually 2. Impaired skin integrity
Transmitted Disease (STD) in the community. 3. Imbalanced nutrition less than body
requirements
• Retesting in 3 months is indicated for men found to be
4. Diarrhea
positive for gonorrhea and chlamydial infections
because of high reinfection rates 5. Risk for infection
6. Social isolation
c) Routine STD Screening in Men: All men should be 7. Deficient knowledge
screened for gonorrhea andchlamydia at baseline.
8. Activity intolerance
• annually after and depending on this and the 9. Acute and chronic pain
prevalence Sexually Transmitted Disease (STD) in the 10. Chronic confusion
community.
11. Grieving
• Retesting in 3 months is indicated for men found to be
positive for gonorrhea and chlamydial infections
because of high reinfection rates MEDICAL MANAGEMENT

Pregnancy Test • ART is usually a combination of three or more medications

• Pregnancy testing should be performed in women at from several different drug classes.This approach has the
initiation or modification of antiretroviral therapy, since best chance of lowering the amount of HIV in the blood
certain medications may be teratogenic, such as
efavirenz and possibly dolutegravir.

Cervical Cancer Screening

• Sexually active women with HIV infection should
undergo cervical cancer screening atinitial entry to HIV
care and again 12 monthslater if the initial test was
normal.

ROUTINE LABORATORY TESTS

§ Complete Blood Count (CBC) with Differential:
§ Basic Chemistry Panel and Calculated Creatinine
Clearance:
§ Hepatic Aminotransferase Levels- assesses theliver functions
§ Urinalysis- to detect any presence of infection
§ Fasting Lipid Panel (Total cholesterol, HDL, LDL,
Triglycerides):
THERAPEUTIC MANAGEMENT
§ Fasting Plasma Glucose or Hemoglobin A1c- to detect
blood sugar The goals of treatment include:
§ Serum Testosterone- Because Men with HIV infection, • Maximal and sustained suppression of viralload to a
particularly those with advanced immunosuppression, have nondetectable level
increased risk of developing hypogonadism
• Restoration or preservation of immunologicfunction
• Improved quality of life of patient
• Reduction of HIV-related morbidity and
mortality.

The classes of antiretroviral drugs include:

1. Nucleoside or nucleotide reverse transcriptase inhibitors

(NRTIs) are faulty versions of the building block that HIV
needs to make copies of itself.

20 | Management of Patients with HIV Infection and AIDS

Examples

• Abacavir (Ziagen)
• Tenofovir (Viread)
• Emtricitabine (Emtriva)
• Lamivudine (Epivir)
• Zidovudine (Retrovir).

Combination drugs also are available, such as

Emtricitabine/Tenofovir (Truvada) and Emtricitabine/
Tenofovir Alafenamide (Descovy).

4. Integrase inhibitors work by disabling a protein called

integrase. It prevents viral DNA from integrating into hosts
DNA

Examples

- Bictegravir Sodium/
Emtricitabine/Tenofovir Alafenamide Fumar
(Biktarvy)
- Raltegravir (Isentress)
• As we see in the picture yung pinag-aralan natin yung
- Dolutegravir (Tivicay).
HIV cycle life, what will the drug do? It will now stop,
so NNRTIs and NRTIs now block the conversion of HIV 5. Entry or fusion inhibitors block HIV's entry intoCD4 T cells.
RNA to HIVDNA.
Examples
2. Non-nucleoside reverse transcriptaseinhibitors (NNRTIs)
turn off a protein needed by HIV to make copies of itself. - Maraviroc (Selzentry).
- Enfuvirtide (Fuzeon)
Examples

- Efavirenz (Sustiva) • Fuzeon is available only as a subcutaneous injection

and can cause injection site reactions and nodules.
- Rilpivirine (Edurant)
The client should be taught the subcutaneous
- Doravirine (Pifeltro). technique, including rotation of sites

• So it does also what your NRTI do, so we have your

NNRTIs it will now block the conversion of HIV RNA to
HIV DNA.

3. Protease inhibitors (PIs) inactivate HIV protease, another

protein that HIV needs to make copies of itself.

Examples:

- Atazanavir (Reyataz)
- Darunavir (Prezista)
- Lopinavir/ritonavir (Kaletra)

21 | Management of Patients with HIV Infection and AIDS

Adherence to ART is defined as a patient's ability tofollow a • Lipohypertrophy – central visceral fat accumulation
treatment plan, take medications at prescribed times and in the abdomen, possibly in the breast, dorsocervical
frequencies, and follow restrictions regarding food and other region [buffalo hump] and within the muscle and liver.
medications.

Factors associated with nonadherence include

- Active substance abuse
- Depression
- Lack of social support

BEFORE THE INITIATION OF ANTIRETROVIRALTHERAPY (ART)

ASSESS PATIENT'S ABILITY TO COMPLY WITH ART SCHEDULE

Results of therapy are evaluated with viral loadtests:

● Viral load levels should be measured immediately before

• Facial wasting – sinking of the cheeks, eyes and
initiation of antiretroviral therapy and again after 2 to 8
temples caused by the loss of fat tissue under the skin,
weeks, because inmost patient’s adherence to a regimen of
may be treated by injectable filters such as poly-l-
potentantiretroviral agents should result in a large decrease
lactic acid (Sculptura)
in the viral load by 2 to 8 weeks.
o can disturb body image, → patient declines/stops
● The viral load should continue to decline over thefollowing
ART
weeks, and in most individuals, it will drop below detectable
levels (currently defined as less than 50 RNA copies/mL) by
16 to 20 weeks.
Adverse effects associated with all HIV
treatments:

1. Hepatotoxicity
2. Nephrotoxicity
3. Osteopenia
4. Increase risk of CVD and MI
TREATMENT OF OPPORTUNISTICINFECTIONS
5. Fat redistribution syndrome
Pneumocystis Pneumonia
6. Metabolic alterations – dyslipidemia, insulin resistance
7. Fat redistribution syndrome • Trimethrophim – sulfamethoxazole (TMP- SMZ) is the
(LIPODYSTROPHY) treatment of choice.
• Adjunctive corticosteroids should be started as early as
• Lipoatrophy – localized subcutaneousfat loss in possible and certainly within 72 hours after starting
the face, arms, legs andbuttocks. specific PCP therapy.

Mycobacterium Avium Complex

• Clarithromycin (Biaxin) is the preferred first agents

• Azithromycin (Zithromax) can be substituted when there is
drug interaction / intolerance to clarithromycin
• Ethambutol is the recommended 2nd drug

22 | Management of Patients with HIV Infection and AIDS

Cryptococcal Meningitis
• Current primary therapy is IV lipid formulation of
amphotericin B in combination with fluconazole
(Diflucan).
o Serious potential adverse effects of this will include
anaphylaxis, renal and hepatic impairment,
electrolyte imbalances, anemia, fever and severe
chills.
• 2 weeks therapy
• Lumbar puncture - CSF negative
Cytomegalovirus Retinitis
• Leading cause of blindness in patients with AIDS.
• Oral valganciclovir, IV ganciclovir,IV ganciclovir
followed by Oral Valganciclovir
o The reaction to Ganciclovir is severe neutropenia.
• Cytomegalovirus retinitis, also knownas CMV
retinitis, is an inflammation of the retina of the eye that
can lead to blindnesscaused by human cytomegalovirus.
o It occurs predominantly in people whose immune
system has been compromised 40-50% of those
with AIDS.
Antidiarrheal Therapy
• Therapy with Octreotide Acetate (Sandostatin), a synthetic
analogue of somatostatin, has been shown to be effective
inmanaging chronic severe diarrhea
• A stool culture should be obtained to determinethe possible
presence of microorganisms that cause diarrhea
Chemotherapy
Kaposi’s Sarcoma
Management of KS is usually difficult because of the
variability of symptoms and the organ systems involved.
The treatment goals are
o To reduce symptoms by decreasing the size of the
skin lesions
o To reduce discomfort associated with edema and
ulcerations
o Radiation therapy is effective as a palliative
measure to relieve localized paindue to tumor mass.
Lymphoma
Successful treatment of AIDS-related lymphomas has
been limited because of therapid progression of these
malignancies.
Combination chemotherapy and radiation therapy
regimens may produce an initial response, but it is
usually short-lived.
Antidepressant Therapy
Involves psychotherapy integrated with
pharmacotherapy.
If depressive symptoms are severe and of sufficient
duration, treatment with antidepressants may be
initiated.
Imipramine (Tofranil)
Desipramine (Norpramin)
Fluoxetine (Prozac)
These medications also allegate the fatigue andlethargy that
are associated with depression then wehave a psychostimulant
like Ritalin may be used in low doses in patients with
neuropsychiatricimpairment.
Nutrition Therapy
Malnutrition increases the risk of infection and the
incidence of opportunistic infections.
Nutrition therapy should be tailored to meet thenutritional
needs of the patient whether oral diet, enteral tube
feeding or parenteral nutritional support if needed.
For patients with diarrhea a diet low in fat, lactose,
insoluble fiber and caffeine is helpful
The goal is to maintain the ideal weight and, when
necessary, to increase weight.
Appetite stimulants have been used successfully with
AIDs related anorexia
Megestrol acetate (Megace), a synthetic oralpreparation
promotes significant weight gain. It inhibits cytokine
synthesis and in patients with HIV infection, it increases
body weight primarily by increasing body fat stores.
Dronabinol (Marinol) a synthetic tetra hydro carbinol
the active ingredient in marijuana relieves nausea and
vomiting associated with cancer chemotherapy.
Oral supplements may be used to supplementdiets that
are deficient in calories and protein..
Advera is a nutritional supplement that has been
developed
23 | Management of Patients with HIV Infection and AIDS
 ● Parenteral nutrition is the final option because of its
prohibitive cost and associated risk including risk of
infection
NURSING INTERVENTIONS
1. Improving Airway Clearance
• Provide respiratory support
• Pulmonary therapy (coughing, deep
breathing, postural drainage, percussion, and
vibration) is provided as often as every 2hours to
prevent stasis of secretions and topromote airway
clearance.
• Any cough and the quantity and characteristics of
sputum are documented. Sputum specimens are
analyzed for infectious organisms.
• High Fowler’s or semi-Fowler’s position that facilitates
breathing and airway clearance.
• Administer oxygen and respiratory treatments as
prescribed.
• Humidified oxygen may be prescribed, and
nasopharyngeal or tracheal suctioning,intubation, and
mechanical ventilation may be necessary to maintain
adequate ventilation
2. Prevent the spread of infection
• Monitors laboratory test results that indicate infection,
such as the white blood cell count and differential.
• Culture of specimen from wound drainage, skin lesions,
stools, urine, sputum, mouthand blood are obtained to
identify pathogenic microorganism and the most
appropropriate anti-microbial therapy.
• The patient is instructed to avoid others with active
infections such as upper respiratory infections
3. Improving Activity Tolerance
• Monitor ability to ambulate and perform activities of
daily living.
• Patients may be unable to maintain their usual levels of
activity because of weakness, fatigue, shortness of
breath, dizziness, and neurologic involvement measures
such asrelaxation, guided imagery may be beneficial
because it decrease anxiety which contributes to the
weakness and fatigue
• Assist in planning daily routines
• Instruct about energy conservation technique
o Sitting while washing and even preparingmeals.
o Items must be kept within the patient’sreach.
4. Maintaining Thought Processes
• Instruct the family members to speak to the patient in
simple, clear language and give the patient sufficient
time to respond to questions.
• Orient the patient to the daily routine by talkingabout
what is taking place during daily activities. Provide
patients a daily regular schedule for medication
administration, grooming/hygiene, meal time, bed time,
and the time they wake up.
• Post a schedule in a prominent area (e.g. on the
refrigerator), provide night lights for the bedroom and
bathroom. Also, planning safely to ensure activities
allowing the patient to maintain a regular routine in a
safe manner.
• Activities that the patient previously enjoyed are
encouraged.
• Around-the-clock supervision may be necessary and
strategies can be implemented to prevent the patient
from engaging inpotentially dangerous activities such as;
driving, using the stove, or mowing the lawn.
5. Relieving Pain and Discomfort
• Assess quality and severity of pain associated with
impaired perianal skin integrity, the lesions of kaposi's
sarcoma and including peripheral neuropathy. In
addition, the effects of pain on the elimination, nutrition,
sleep affects and communication are explored alongwith
exacerbating and relieving factors.
• Cleaning the perianal area especially if the patient has
a chronic diarrhea - promote comfort.
• Topical anesthetic medications or ointments may be
prescribed.
• Use of soft cushions or foam pads may increase comfort
while sitting
• Avoid foods that act as bowel irritants.
• Antispasmodic and Anti-diarrhealmedications may be
prescribed to reduce the discomfort and frequency of
bowel movements.
• Pain management – NSAIDs and opioids plus
nonpharmacologic approaches such as relaxation
techniques.
24 | Management of Patients with HIV Infection and AIDS
 • Adequate rest is essential to minimize energy
expenditure and prevent excessivefatigue.
6. Promote Skin Integrity
• Medicated lotions, ointments, and dressings are
applied to affected skin surfaces as prescribed.
• Applying DNCB lotion to an hiv/aids patient with
kaposi's sarcoma
• Immobile - assist to change position every
2 hours. Devices such as alternating mattresses and
low air loss beds are used to prevent skin breakdown.
• Encourage to avoid scratching; to use non-abrasive,
non drying soaps; and to apply non-perfumed skin
moisturizers to dry skin.
• Adhesive tape is avoided.
• Keep bed linens free of wrinkles and avoiding tight
or restrictive clothing.
• If with foot lesions advise to wear cotton socks and
shoes that do not cause the feet to perspire.
(antipruritic, antibiotic, and analgesic agents are
administered as prescribed)
• Perianal area is cleaned after each bowel movement
with non abrasive soap and water to prevent any
excoriation and breakdown of the skin causing an
infection.If the areas are very painful, soft cloth or
cotton sponges may be more less irritating than
washed clothes.
• Sitz baths or gentle irrigation may facilitate
cleaning and promote comfort. The area must be
dried after cleaning.
• Topical lotions or ointments may be prescribed to
promote healing.
• Wounds are cultured if infection issuspected so that
the appropriate antimicrobial treatment can be
initiated.
7. Improving Nutritional Status
• Monitor weight, dietary intake, and serum albumin,
BUN, protein, and transferrinlevels.
• Assess for factors that interfere with oral intake such
as; anorexia, oral-esophageal candida, nausea,
pain, weakness, fatigue, and lactose intolerance.
• The dietician is consulted to determine the patient’s
nutritional requirements.
8. Promote Usual Bowel Patterns
• Bowel patterns are assessed for diarrhea.
• Monitor the frequency and consistency of stools and
patient’s reports of abdominal pain or cramping
associated with bowel movements.
• Factors that exacerbate diarrhea are also assessed.
The quantity and volume of liquidstools are measured
to document fluid volume losses.
• Stool cultures are obtained to identify pathogenic
organisms.
9. Coping with Grief
• Provide psychosocial support as needed.
• Help the patient verbalize feelings and explore and
identify resources for support and mechanisms for
coping
• Encourage to maintain contact with family, friends,
and coworkers and to use local or national AIDS
support groups and hotlines
• If possible, losses are identified and addressed.
Patients are encouraged to continue social activities
whenever possible. Consultations with mental health
counselors are useful for many patients.
10. Improving Nutritional Status
• Encourage the patient to rest before meals iffatigue
and weakness interfere with intake.
• Avoid foods that stimulate intestinal motility and
abdominal distention - with diarrhea and abdominal
cramping such as fiber rich foods and lactose if the
patient is intolerant.
• Patients who cannot maintain their nutritional status
through oral intake may require enteral feedings or
parenteral nutrition
25 | Management of Patients with HIV Infection and AIDS

13. Promoting
Teaching patients self-care:
11. Decreasing the Sense of Isolation
• Provide an atmosphere of acceptance and
understanding for people with AIDS and theirfamilies
and partners.
• Encouraged to express feelings of isolation and
loneliness, with the assurance that thesefeelings are not
unique or abnormal
• May harbor feelings of guilt because of their lifestyle
or because they may have infected others in current or
previous relationships.
• May feel anger toward sexual partners who
transmitted the virus to them.
• Providing information about how to protect themselves
and others may help patients to avoid social isolation.
Patients, family and friends must be reassured that
AIDS is not spread through casual contact
Continuing care:
12. Improving knowledge of HIV
• Educate about HIV infection, means of preventing HIV
transmission, ART andappropriate self-care measures.
• Information on medications is important to avoid
people w/ infections such as upper respiratory tract
infections.
Home and Community-BasedCare
• Patients and their families or caregivers must receive
instructions about how to prevent disease transmission.
➔ Handwashing techniques and
methods for safely handling or
disposing items soiled w/ body fluids.
➔ Clear guidelines about avoiding and
controlling infection, regular healthcare
appointments, symptom management,
nutrition, rest and exercise are necessary. The
importance of personal and environmental
hygiene is
emphasized.
• Kitchen and bathroom surfaces should be cleaned
regularly with disinfectants to prevent growth of fungi
and bacteria.
• Patients with pets are encouraged to have another
person to clean the area soiled by animals, such as bird
cages and litter boxes.If this is not possible, patients
should use gloves and should wash their hands after
they clean the area.
• Patients are advised to avoid exposure to others who
are sick or who have been recently vaccinated
• Avoid smoking, excessive alcohol, and over the counter
and street drugs is emphasized.
• Instruct not to donate blood
• IV injection drug users who are unwilling to stop using
drugs are advised to avoid sharingdrug equipment with
others.
• Caregivers in the home are taught how to administer
medications, including IV preparations.
• Community based organizations that providea variety
of services for people living with HIVinfection and AIDS-
nurses can help to assess these services
• During home visits, the nurse assesses the patient’s
physical and emotional status and home environment.
Patient’s adherence to
26 | Management of Patients with HIV Infection and AIDS
 the therapeutic regimen is assessed and strategies are
suggested to assist withadherence.
• Assess for progression of disease and for adverse side
effects of medications. DEvious teaching is reinforced
and the importance of keeping follow-up appointments
is stressed.
• Remind that food handlers must maintain good hand
washing and hygiene practices. Discard food that has
passed the expiration date or dented and swollen cans.
Ensure adequate refrigeration and cooking. Control
insects and rodents to prevent foodcontamination.
• Drink purified bottled water if living in areas with
unsafe drinking water. Use a safe watersupply or boil
water for 1 min when unsure. Avoid unpasteurized milk,
other dairyproducts, fruit juice and raw seed sprouts.
Avoid undercooked eggs, meat, and seafood. HIV/AIDS SUPPORT GROUPS

HIV and AIDS in the Philippines 1. Pinoy Plus Association (PPA+)

What is the situation of HIV and AIDS in thePhilippines?

2. The Positive Action Foundation Philippines, Inc.
3. Action for Health Initiatives, Inc.
● The Philippines is a low-HIV-prevalence country with 4. B-Change Group
0.1% of the adult population estimated to be HIV
5. The Red Whistle (TRW)
positive- rate of increase in infections is one of the
highest. 6. AIDS Society of the Philippines
● As of August 2019, the Department of Health (DOH) 7. The Love Yourself Group (TLY)
AIDS Registry in the Philippines reported 69,629
cumulative cases since 1984.

Government agencies responsible for educatingthe public about

HIV AIDS in the Philippines:

✔ Department of Interior and Local

Government (DILG)
✔ Philippine National AIDS Council (PNAC)
✔ Research Institute for Tropical Medicine(RITM)
✔ STI/AIDS Cooperative Central Laboratory
• World AIDS Day, observe December 1 each year, is
(SCCL) dedicated to raising awareness of the AIDS pandemic
caused by the spread of HIV infection. It is common to hold
a memorial to honor persons who have died from HIV/AIDS
onthis day. Government and officials also observe an event
which speeches and forum on the AIDStopic.

27 | Management of Patients with HIV Infection and AIDS

 CORONAVIRUS (COVID-19) AND HIV

• Coronavirus lockdown could spark rise in HIV infections.

• If lockdowns and stay at home orders -problems getting
tested for sexually transmitteddiseases, because thousands
of centers that used to provide them have closed down.
Thesepeople still having sex and have no idea of their
status is a potential ticking BOMB.

28 | Management of Patients with HIV Infection and AIDS