Rotsen J.

Jambongana, RN, MN, CICN (PHICNA)

Faculty (Professor II) – University of St. La Salle, Bacolod
Former Nurse Supervisor, Infection Control & HACT, RMCI
Board of Director, Phil. Hospital Infection Control Society
DOH & St. Luke’s Medical Center - Certified IPC Professional
WHO and DOH - Certified Re-Emerging Diseases ICN, RITM
Lecturer, Province of Neg. Occ. EEDD-HOD

Prev. ICN Trained Trained Member Apointee Member Trained Reviewer

 General Formula:
Human Immuno-
Acquired Immune
deficiency Virus
Deficiency Syndrome

HIV AIDS
The Causative agent The Disease
A retrovirus type Caused by HIV
Genus Lentivirus Progressed HIVD
HIV – The Virus
HIVD – The disease CD4 of < 300 (PHL)
Type 1 and Type 2 Symptomatic
CD4 of > 300 (PHL) (+) AIDS Def. Con’s
Can be Asymptomatic
Blood-borne/STI Blood-borne/STI
Test: HIV Screening / Test: Western Blot
Western Blot (ELISA Test)
The virus attacks certain unit in the immune system called
CD4, which are cells that help the body to fight certain
diseases & infections—making the body weak and vulnerable
to opportunistic infections. HIV causes or may lead to AIDS.
Morbidity and Death among AIDS cases are not due to the
virus itself but on the opportunistic infections brought about
by lowered CD4 of immune compromised patients.
On HIV Testing/Screening – HIV Proficient Med Tech performs
it. Results are kept confidential.
A HACT Nurse/ HIV Proficient RMT performs the pre/post test
counseling for patients and/or folks.
– SCREENING is NOT a CONFIRMATORY HIV/AIDS test.
 R.A. 8504
Philippine AIDS Prevention
and Control Act of 1998

2 7 13 22 38

Q: Is the test mandatory?

Q: What to test? HIV-1 or HIV-2?
Q: Where do we avail free &
confidential testing?
The CD4 Cells are specific soldier cells for immune
related infections

WBC Visible in conventional

(White Blood Cells) CBC Test
(N) = 5 to 10 x10 9/L

Part of the Immune

Helper T-Cells System Complex; can be
quantified
by specific Ig Assays

Visible only thru

CD4 CD4 Count/Test
CD4 (N) = > 800 units
 The HIV virus can be spread in
different ways such as:

Unprotected sexual contact, congenital,

BT, injectables, organ donation, blood
exposure
 How does HIV screening works?
• Go to the accredited Treatment Hub (free) or private
hospital (Price at P250 to P350) or other public
facility (Price at P150 to P250).
• Request for HIV Screening
• Pre test counselling
• Confidential Blood Extraction and Analysis
• Post test counselling (after 1-2 hrs)
• If REACTIVE: referral to the HACT MD
• Re-extraction of serum sample for RITM-SACCL
• 7-10 days TAT for MNL to Region 6
• Send back of final confirmatory test
• Re evaluation, CD4 testing and referral
• Start of free ARV thru the Tx Hub based on CD4
• Monthly free checkups and CD4 count
General rule: There is NO specific S/Sx for HIV Infection, to
get tested is the BEST way to check occurrence

• Some people may experience a flu-like illness within 2 to 4

weeks after infection (Stage 1 HIV infection). But some people
may not feel sick during this stage. Flu-like
symptoms include fever, chills, rash, night sweats, muscle
aches, sore throat, fatigue, swollen lymph nodes, or mouth
ulcers (US-CDC, 2018).
• Most people infected with HIV experience a short, flu-like illness
that occurs 2-6 weeks after infection. After this, HIV may not
cause any symptoms for several years. It's estimated up to 80% of
people who are infected with HIV experience this flu-like illness
(CDC).
Tip: usually, all atypical infections may be suspected, if the patient has
underlying risky behaviors / predisposing acts
 HACT Protocols for
Government Hospitals
• SHAP Code Patients (HIV +)
– Patients who were tested or screened
within the same hospital and are
treated in the same institution where
the HACT is.
• PHAP Code Patients (HIV +)
– Patients who were tested from other
hospitals or referral clinics the same
hospital and are treated in the same
institution where the HACT is.
• Both are eligible for PHIC Z-Package 9
(devastating chronic illnesses)
DOH Study on Adolescent High Risk
Behavior

Male/ Transgenders
having Sex with Males

Female / Sex Workers

People Who Inject Drugs

HIV is the same as AIDS and now, has cure
MYTH
Piercings in the genitals will increase one’s FACT
likelihood of acquiring STIs/HIV
If you had STIs like gonorrhea, genital
herpes-2 or syphilis, the higher you are
suspected to also have HIV infection.
FACT
If you had an HIV reactive result taken from
a hospital, it is definite you have HIV(+). MYTH
The anatomy of the rectum (rectal tissue) is
more susceptible/prone to HIV infection
FACT
Condom usage should be paired with
Lubrication (e.g. generous amount of KY Jelly) FACT
TIPS ON PREVENTION AND MANAGEMENT OF HIV
 ELISA/
Screening Western Blot
(hosp/RHU): (SACCL/RITM)

NON-REACTIVE NEGATIVE
Start ARV/ART
asap.
Atrophic candidiasis

Pseudomembranous
candidiasis

Kaposi’s Sarcoma
(below)

18
 Pneumocystis Pneumonia
• Pneumocystis pneumonia (PCP) is a
serious illness caused by the
fungus Pneumocystis jiroveci. PCP is
one of the most frequent and severe
opportunistic infections in people with
weakened immune systems, particularly
people with HIV/AIDS.
• The symptoms of PCP are fever, dry
cough, shortness of breath, and fatigue.
• Dx: Bronchial lavage, Sputum C/S,
CXR, Polymerase chain reaction
(PCR) is also used to detect P.
jirovecii DNA in clinical specimens
 Pneumocystis Pneumonia
PCP requires treatment that must be
taken for 3 weeks. The best form of
treatment for PCP is trimethoprim
sulfamethoxazole (TMP-SMX) via IV

Smicroscopic mear of
bronchoalveolar lavage material
Aka Pneumocystis carinii.
 Other common opportunistic
Infections in HIV/AIDS patients

• Candida specie (yeast)

– Thrush, vaginitis, esophagitis
– Can be detected on C/S
• Cryptococcus neoformans (yeast)
– Fungal Inf, Meningitis, Pneumonia
– Can be detected on C/S (yeast)
• Cytomegalovirus (CMV)
– Retinitis, pneumonia
– Can be detected on C/S 21
Epstein-Barr or Infectious
Mononucleosis
Common S/Sx of EBV on HIV cases
(transmitted via droplet of saliva)
• sore throat (tonsillopharyngitis) – most
common and poses much discomfort
• extreme fatigue
• Fever, Rash, head ache and body aches
• swollen lymph nodes in the neck &
armpits
• ↑ white blood cells (lymphocytes) with
atypical presentation
• fewer than normal neutrophils or Plt.
 PrEP (Pre- Exposure
Prophylaxis)
• PrEP is when people at very high risk
for HIV take HIV medicines daily to
lower their chances of getting
infected., PrEP is approved for daily
use to help prevent an HIV-negative
person from getting HIV from a
sexual or injection-drug-using
partner who’s positive.
• Usually, by CDC guidelines, a
combination of two HIV medicines
(tenofovir and emtricitabine), or
depending on the case, as prescribed
• Common reported PEP Side effects:
upset stomach, loss of apetite
 PEP (Post Exposure Prophylaxis)

• PEP must be started within 72

hours after a possible exposure.
The sooner you start PEP, the
better; every hour counts.
• Starting PEP as soon as possible after
a potential HIV exposure is important.
• If you’re prescribed PEP, you’ll need
to take it once or twice daily for 28
days.
• Usually: Lamivudine, Tonofivir,
Efavirenz depending on the case,
add emtricitabine per CDC
guidelines.
 RECURSIVE
• A subtype of pneumonia most likely
present in immune compromised
AIDS host patients:
• Pneumocystis jiroveci or
Pneumocystis carinii pneumonia
• A process or test to accompany N95
mask or respirator usage to ensure
proper size choice and effective
filtration of aerosol.
• N95 Fit Testing / Fit Test
 PEP If you’re HIV-negative or
don’t know your HIV status, and
in the last 72 hours you:
• think you may have been
exposed to HIV during sex (for
example, if the condom broke),
• shared needles and works to
prepare drugs (for example,
cotton, cookers, water), or
• were sexually assaulted,
• talk to your health care provider
or an emergency room doctor
about PEP right away.
 Brief review on PEP for HCWs
• Consult to an ID Specialist is recommended
• PEP to start immediately within 72H from injury
• The HCW should be advised to report and seek
medical evaluation for any acute febrile illness
that occurs within 12 weeks after the exposure.
• Seronegative HCWs should be retested 6 weeks
post-exposure and on a periodic basis thereafter
(e.g., 12 weeks and 6 months after exposure)
– the first 6-12 weeks (1 ½ to 3 months)
after exposure, when most HIV infected
persons are expected to
seroconvert (may yield negative HIV
test result)
 Relationship goals:
TB and HIV
• Per CDC, People living with HIV are more
likely than others to become sick with TB.
Worldwide, TB is one of the leading
causes of death among PLHIV.
• PLHIV or newly Dx HIV cases are to be
tested for PTB mandatorily (CXR, AFB)
• HACT prophylaxis includes AZT + INH
• A person who has both HIV infection and
TB disease has an AIDS-defining
condition together with correlated CD4
 Simple Formulas applied in
empiric clinical practice
• PNM + HIV reactive test = AIDS
• PNM + HIV non-reactive test = PNM
• TB + HIV reactive test = AIDS
• TB + HIV non-reactive test = TB
2015 data
from WHO
and AIDS
research
organizations

30
 NURSING DIAGNOSIS
FOR HIV/AIDS
• Imbalanced Nutrition: Less Than Body
Requirements r/t Inability or altered ability
to ingest, digest and/or metabolize
nutrients: nausea/vomiting
• Risk for Infection r/t Inadequate primary
defenses: broken skin, traumatized tissue
• Fatigue r/t Decreased metabolic energy
production, increased energy requirements
• Anxiety r/t Threat to self-concept, threat of
death, change in health/socioeconomic
status & role functioning
NURSING DIAGNOSIS FOR STIs/STDs
• Sexual dysfunction
• Sexuality patterns, ineffective
• Body image, disturbed
• Sexual dysfunction:
• “The state in which a person experiences a
change in sexual function that is viewed as
unsatisfying, unrewarding, inadequate”
• Sexuality patterns, ineffective: “Expressions of
concern regarding own sexuality” (NANDA)
• Body image, disturbed: “confusion in mental
picture of one’s physical self” (Ackley)
• r/t physical, psychological, cognitive/perceptual ,
32
cultural, spiritual changes
 THANKS FOR
LISTENING!

Rotsen J. Jambongana, MN
0998 4299939 | rotsenRN@gmail.com
r.jambongana@usls.edu.ph
Rotsen.jambongana@concentrix.com