HIV/AIDS

AGE & GENDER

Productive years [25-44]

Men > Women

 RACE

African-American
Hispanic-American
American Indian/Alaska natives
Asian-American/Pacific Islanders
 MODES OF TRANSMISSION
• Presence of another • Amniotic fluid
STD • CSF
– Chlamydia • Pleural fluid
– Genital herpes
• Peritoneal fluid
– Syphillis
– Gonorrhea
• Pericardial fluid
 MODES OF TRANSMISSION

• Unprotected1 sexual intercourse

– Anal, oral, vaginal
• Multiple sex partners
• Failure to disclose HIV status
• Trading sex for money or drugs
• Sharing needles or syringes2
• Mother to fetus [pregnancy or birth]
Medical-Surgical Management
Polymerase chain reaction (PCR)
MEDICAL
Viral load test
Measures copies of HIV RNA

Uses:
PCR can
1. Assess risk for getting sick
measure as few
2. Check effects of drugs
as 50 copies/mL
3. Distinguish between actual
of HIV RNA HIV infection in a NB and
maternally-acquired
antibodies
Medical-Surgical Management Nucleoside analogue reverse
PHARMACOLOGICAL transcriptase inhibitor
(NRTIs)

Zidovudine (Retrovir) • Interrupt the life cycle of

Zalcitabine (Hivid) HIV at an early stage
Didanosine (Videx)
• Delay onset of oppotunistic
Stavudine (Zerit)
Lamivudine (Epivir)
infections
Abacavir (Ziagen) • Do not prevent HIV
transmission in individuals
Medical-Surgical Management Nucleoside analogue reverse
PHARMACOLOGICAL transcriptase inhibitor
(NRTIs)

Zidovudine + Lamivudine
(Combivir)

• Depletes RBC & WBC

• Didanosine (Videx)
– Painful nerve damage
– Pancreatitis
Medical-Surgical Management Non-nucleoside analogue
PHARMACOLOGICAL reverse transcriptase
inhibitor (NNRTIs)

• Used in combination with

Delavirdine other anti-retrovirals
(Rescriptor)
Nevirapine (Viramune)
Efavirenz (Sustiva)
Medical-Surgical Management Protease inhibitor
PHARMACOLOGICAL

• Interrupt HIV life cycle at a

later stage
Ritonavir (Norvir)
• SE
Saquinavir mesylate
(Fortovase, Invirase) – Nausea
Indinavir sulfate – Diarrhea
(Crixivan) – GI symptoms
Nelfinavir mesylate
– Abnormal redistribution of
(Viracept)
body fats
Medical-Surgical Management

PHARMACOLOGICAL For asymptomtic HIV-positive

clients, drug therapy is
recommended if:

• Viral load test results are

>500 copies/mL, or
• The client’s CD4 T-cell
count is under 500
cells/mm3
Medical-Surgical Management

HEALTH PROMOTION

• Standard precautions

– Personal protective
equipment
DIAGNOSTIC TEST • CD4 T-cells

• Enzyme-linked
immunosorbent assay
(ELISA)

• Polymerace chain reaction

(PCR)

• Western blot
COMMON INFECTIONS
 • The most common opportunistic
RESPIRATORY infection

• Initiation of treatment when the

CD4 T-cell count is 200 or less/mm3

• Found primarily in the lungs

Pneumocystis carinii – Adrenal glands
pneumonia (PCP) – Bone marrow
– Skin
– Thyroid
– Kidneys
– Spleen
 • Clinical manifestations
RESPIRATORY – Fever
– SOB
– Nonproductive cough
– Crackles

Pneumocystis carinii • Initial Dx

pneumonia (PCP)
– X-ray: diffuse infiltrates
– Fiberoptic bronchoscopy:
obtain definitive dx
• Sputum for culture
 • Management
RESPIRATORY – sulfamethoxazole-
trimethoprim (Bactrim,
Septra) PO or I.V.
• TOC
– I.V. pentamidine
isoethionate
Pneumocystis carinii (Pneumopotent, Pentam
pneumonia (PCP)
300)
 • Management
RESPIRATORY – Prophylaxis: a therapeutic
necessity for all persons
infected with HIV when CD4
count is <200 copies or less

Pneumocystis carinii – Primary prophylaxis

pneumonia (PCP) • At risk for PCP based on CD4
count
– Secondary prophylaxis
• Prevent recurrences for those
who have had PCP
 • Management
RESPIRATORY – Oral sulfamethoxazole-
trimethoprim, or
– Aerosolized pentamidine

– If allergic to
Pneumocystis carinii sulfomethoxazole-
pneumonia (PCP) trimethoprim
• Pentamidine diluted in sterile
water
– Administred by Respigard II
nebulizer
 Histoplasma capsulatum
RESPIRATORY

• Fungus from
– Bird droppings
Histoplasmosis – Dirt chicken coops
– Caves
Suspected if:
•Fever of uncertain origin
•Cough
• Introduced through
•Malaise inhalation
• Not specific to the lung
 Diagnosis
RESPIRATORY
• C&S
• Biopsy
– BM
– Blood
– Lymph nodes
Histoplasmosis – Lungs
– Skin
 Treatment
RESPIRATORY

• Initial treatment
– I.V. Amphotericin B
– Oral ketoconazole (Nizoral)
• Maintenance therapy

Histoplasmosis
– Prophylaxis
• Itraconazole (Sporanox)
 Mycobacterium tuberculosis
RESPIRATORY
• Acid-fast aerobic bacterium
• Lodge in the apex of the
lungs

• Clinical manifestations
TUBERCULOSIS – Fever
– Night sweats
– Cough; productive
– Weight loss
– Pleuritic pain
 Diagnosis
RESPIRATORY
• Skin test with PPD
– Mantoux test
• Inject 0.1 mL ID
• Culture of sputum, urine,
TUBERCULOSIS
and other fluids
– Smeared & stained with acid-
•Use particulate
fast stain (AFB)
respirator x 2-3 weeks
•Cover mouth when • X-rays
coughing – Middle & lower lobe infiltrates
• IVP
 2 PHASES OF TREATMENT
RESPIRATORY
1. Initial phase
– Isoniazid (Laniazid)
– Rifampin (Rifadin)
– Pyrazinamide
– Ethambutol HCl
(Myambutol)
TUBERCULOSIS – Streptomycin sulfate x 2-6
mos
2. Continuation phase
– Treatment with 2-4 meds x 4
to 6 mos or longer
 GASTROINTESTINAL

• Mycobacterium avium complex

 GASTROINTESTINAL

• Cytomegalovirus
 GASTROINTESTINAL

• CRYPTOSPORIDIOSIS
 GASTROINTESTINAL

• HEPATITIS
 GASTROINTESTINAL

• HIV-WASTING SYNDROME
ORAL OPPORTUNISTIC INFECTIONS

• HIV-WASTING SYNDROME
 ORAL OPPORTUNISTIC INFECTIONS

• ORAL & ESOPHAGEAL CANDIDIASIS

ORAL OPPORTUNISTIC INFECTIONS

• ORAL HAIRY LEUKOPLAKIA

GYNECOLOGICAL OPPORTUNITIC INFECTION

• VAGINAL CANDIDIASIS
 GYNECOLOGICAL OPPORTUNITIC INFECTION

• CERVICAL INTRAEPITHELIAL NEOPLASIA

CENTRAL NERVOUS SYSTEM INFECTION

• AIDS DEMENTIA COMPLEX

CENTRAL NERVOUS SYSTEM INFECTION

• TOXOPLASMOSIS
CENTRAL NERVOUS SYSTEM INFECTION

• CRYPTOCOCCOSIS
OPPORTUNISTIC MALIGNANCIES

• KAPOSI’S SARCOMA
 OPPORTUNISTIC MALIGNANCIES

• NON-HODGKIN’S LYMPHOMA