HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED

IMMUNODEFICIENCY SYNDROME
ACQUIRED IMMUNE DEFICINECY
✓ Immune deficiency can be acquired due to medical treatment such as
chemotherapy or infection from agents such as human immune deficiency
virus (HIV).

HIV INFECTION AND AIDS

✓ Discovered more than 35 years ago
✓ Timeline:
➢ 1st Decade: Progress was associated with the recognition and
treatment of opportunistic diseases and introduction of
prophylaxis against opportunistic infections.
➢ 2nd Decade: Witnessed progress in the development of highly active
antiretroviral drug therapies (HAART) as well as continuing
progress in the treatment of opportunistic infections.
➢ 3rd 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, and continued need for an effective vaccine.
DIAGNOSTIC TESTS
✓ The HIV antibody test, an enzyme immunoassay (EIA; or a variant of
this test called enzyme-linked immunosorbent assay [ELISA]).
EPIDEMIOLOGY OF H.I.V
✓ Since the first cases of AIDS were reported in the United States in
1981, surveillance case definitions for HIV infection and AIDS have
undergone several revisions (in 1985, 1987, 1993, 2008, and 2014) in
response to diagnostic advances
✓ Criteria for a confirmed case of HIV infection can be met by either
laboratory evidence or clinical evidence but laboratory evidence,
usually obtained through blood tests, is preferred over clinical
evidence (e.g., patient signs and symptoms).
✓ About 1,218,400 persons aged 13 years and older are living with HIV
infections in the United States, including 156,300 (12.8%) that are
unaware that they are infected.
✓ Gay, bisexual, and other men who have sex with men (MSM) of all races
and ethnicities remain the population most profoundly affected by HIV.
✓ According to the World 2763 Health Organization (WHO) (2015a), there
were approximately 36.9 million people living with HIV at the end of
2014 with 2.0 million people becoming newly infected with HIV in 2014
globally.
TRANSMISSION OF H.I.V
✓ Human immune deficiency virus type 1 (HIV-1) is transmitted in body
fluids (blood, seminal fluid, vaginal secretions, amniotic fluid, and
breast milk) that contain infected cells.
 GERONTOLOGIC CONSIDERATIONS
✓ A growing number of adults aged 50 and older have HIV/AIDS (National
Institute on Aging [NIA], 2015). Many were diagnosed with HIV in their
younger years and are benefitting from effective treatment.
✓ Older adults are less likely than younger people to get tested. Signs
of HIV/AIDS can be mistaken for the aches and pains of normal aging.
✓ Older adults living with HIV/AIDS also experience the development of
other comorbidities such as cardiovascular disease and diabetes
occurring within that specific demographic population, and HIV/AIDS
becomes a contributing, but not necessarily primary, cause of mortality.
PREVENTION OF H.I.V
✓ Behavioral interventions such as encouraging the use of condoms are
highly effective in reducing the transmission of HIV, the HIV-negative
person must be motivated and have the freedom to choose to use the
method.
✓ Pre-exposure prophylaxis (PrEP) might be appropriate.
✓ HIV status should be checked every 3 months to be sure that the person
has not become infected.4

PREVENTIVE EDUCATION

✓ Prevention of HIV infection is achieved through: (a) behavioral

interventions have been effective in reducing the risk of acquiring or
transmitting HIV by ensuring that people have the information,
motivation, and skills necessary to reduce their risk; (b) HIV testing,
because most people change behaviors to protect their partners if they
know they are infected with HIV; and (c) linkage to treatment and care,
which enables individuals with HIV to live longer, healthier lives and
reduce their risk of transmitting HIV (CDC, 2015c).

PREVENTION IN LESBIAN, GAY, BISEXUAL, AND TRANSGENDER

✓ Many health care providers are insufficiently prepared to meet the

unique health needs of those who identify as lesbian, gay, bisexual,
and transgender (LGBT). LGBT youth, in particular, are at higher risk
for contracting HIV.
RECOMMENDATIONS FOR STANDARD PRECAUTIONS

✓ Hand hygiene
✓ Personal protective equipment
✓ Soiled patient care equipment
✓ Environmental control
✓ Textiles and laundry
✓ Needles and other sharps
✓ Patient resuscitation
✓ Patient placement
✓ Respiratory hygiene/cough etiquette

PATHOPHYSIOLOGY
✓ HIV is in the subfamily of lentiviruses and is a retrovirus because it
carries its genetic material in the form of ribonucleic acid (RNA)
rather than deoxyribonucleic acid (DNA)

✓ HIV consists of a viral core containing viral RNA, surrounded by an

envelope consisting of protruding glycoproteins
✓ All viruses target specific cells. HIV targets cells with CD4+
receptors, which are expressed on the surface of T lymphocytes,
monocytes, dendritic cells, and brain microglia.

THE HIV LIFE CYCLE IS COMPLEX AND CONSISTS OF THE FOLLOWING STEPS

✓ Attachment/Binding
✓ Uncoating/Fusion
✓ DNA synthesis
✓ Integration
✓ Transcription
✓ Translation
✓ Cleavage
✓ Budding
➢ HIV-1 mutates quickly, at a relatively constant rate, with about 1%
of the virus’s genetic material changing annually.
STAGES OF HIV INFECTION
✓ There are five stages of HIV infection based on clinical history,
physical examination, laboratory evidence, signs and symptoms, and
associated infections and malignancies.

1. Primary or acute infection is characterized by high levels of viral

replication, widespread dissemination of HIV throughout the body,
and destruction of CD4+ T cells, which leads to dramatic drops in
CD4+ T-cell counts (normally 500 to 1,500 cells/ mm3 of blood).
2. Stage 2 occurs when CD4+ T-lymphocyte cells are between 200 and 499,
stage 3 when the count drops below 200 cells/mm3 of blood and at this
point, the person is considered to have AIDS for surveillance
purposes.
3. A stage 3 diagnosis has implications for services (e.g., disability
benefits, housing, and food stamps), because these programs are often
linked to living with severe immune dysfunction.