GNS 216 REPRODUCTIVE HEALTH

UNIT 6 HIV AND ACQUIRED IMMUNE DEFICIENCY SYNDROME

DEFINITION OF HIV AND AIDS

HIV (Human Immunodeficiency Virus) is a virus that attacks the body's immune
system, specifically the CD4 cells (T cells), which are crucial for fighting off
infections.
AIDS (Acquired Immunodeficiency Syndrome) is the most advanced stage of HIV
infection. It occurs when the immune system is severely damaged, leading to life-
threatening opportunistic infections or cancers that take advantage of the body's
weakened defenses.
BASICS ABOUT HIV AND AIDS.

The first case of AIDs was recorded in America in 1981. The virus was discovered by
prof. Luc. Montagnier at pasteur institute in paris. There are two types of HIV

1. Througout the world

2. Limited to west africa

Transmission: HIV is transmitted through contact with certain body fluids, such as
blood, semen, vaginal fluids, rectal fluids, and breast milk.

The most common routes of transmission include:

 Unprotected sexual intercourse with an infected person (Vaginal, Rectum or Oral)

 Sharing needles or syringes with someone who is HIV-positive
 Transmission from mother to child during childbirth or breastfeeding

Stages of HIV:

 Acute HIV Infection: The initial stage, often accompanied by flu-like

symptoms.
 Chronic HIV Infection (Clinical Latency Stage): The virus is still active but
reproduces at lower levels. Without treatment, this stage can last for several
years.
 AIDS: The final and most severe stage of HIV infection.

Diagnosis:

HIV is diagnosed through blood or saliva tests that detect the virus or the antibodies
produced in response to it. Early detection is crucial for managing the virus
effectively.

Treatment:

Antiretroviral therapy (ART) is the primary treatment for HIV. ART can’t cure HIV
but can reduce the viral load in the body to undetectable levels, allowing individuals
to live longer, healthier lives and significantly reducing the risk of transmitting the
virus.

Symptoms of AIDS:

 Rapid weight loss

 Extreme tiredness
 Recurring fever or profuse night sweats
 Prolonged swelling of the lymph glands
 Chronic diarrhea
 Sores of the mouth, anus, or genitals
 Pneumonia
 Memory loss or other neurological disorders

Treatment:

Treatment for AIDS is the same as for HIV (ART). However, because the immune
system is already compromised, additional treatments may be necessary to address
opportunistic infections or cancers.

Prevention:

Safe Practices:

 Use condoms consistently and correctly during sex

 Get tested regularly for HIV and other sexually transmitted infections (STIs)
 Use pre-exposure prophylaxis (PrEP) if at high risk for HIV
 Avoid sharing needles or syringes
 Ensure that blood products are tested for HIV before transfusion

Mother-to-Child Transmission: Pregnant women with HIV can take ART to reduce
the risk of transmitting the virus to their baby.

Pathophysiology of HIV/AIDs and Natural Progressive of HIV/AIDs

(WHO Staging)

Pathophysiology of HIV/AIDS

HIV (Human Immunodeficiency Virus) primarily affects the immune system by

targeting CD4+ T cells, which are crucial for immune function. The normal CD4
court for a healthy adult is 500 to 1200 cell percubic milliliter (CLUSTER OF
DIFFERENTIATION 4) in molecular biology CD4 is a glycoprotein that serve as a
co-receptor for the T-cell.

T-cell are types of white blood cell in part of the immune system found in the bone
morrow it help in the protection of the body form the infection and may help fight
cancer. Another name for T-cell is LYMPHOCYTES

Here's a breakdown of the pathophysiology

1. Viral Entry: HIV enters the body through contact with infected bodily fluids. It
targets CD4+ T cells by binding to the CD4 receptor and a co-receptor (usually CCR5
or CXCR4) on the cell surface. CCR5 - is a protein on the surface of the white blood
cell that involved the immune system as it act as a receptor. (CYCTEINE CYCTEINE
RECEPTOR).
2. Reverse Transcription and Integration: After entering the cell, the virus releases
its RNA, which is converted into DNA by the viral enzyme reverse transcriptase. This
viral DNA is integrated into the host cell's genome by another enzyme, integrase.
3. Viral Replication: Once integrated into the host DNA, the virus uses the cell's
machinery to produce new viral RNA and proteins, which are assembled into new
HIV particles.
4. Destruction of CD4+ T Cells: The production of new virus particles eventually
leads to the death of the infected CD4+ T cells. Over time, the depletion of CD4+
cells weakens the immune system, leaving the body vulnerable to opportunistic
infections and cancers.
5. Immune Evasion: HIV evades the immune system by mutating rapidly, which
makes it difficult for the body to mount an effective immune response.
6. Progression to AIDS: AIDS (Acquired Immunodeficiency Syndrome) is the
advanced stage of HIV infection, characterized by severe immune system damage and
the presence of opportunistic infections or certain cancers.

NATURAL PROGRESSION OF HIV/AIDS (WHO STAGING)

The World Health Organization (WHO) has developed a clinical staging system for
HIV/AIDS, which categorizes the disease into four stages based on the severity of
symptoms and the presence of opportunistic infections.

Stage 1: Primary HIV Infection

 Often asymptomatic or presents with mild flu-like symptoms.

 There may be persistent generalized lymphadenopathy (swollen lymph nodes).

Stage 2: Mild Disease

 Weight loss of less than 10% of body weight.

 Minor mucocutaneous manifestations (e.g., oral ulcers, seborrheic dermatitis).
 Recurrent upper respiratory tract infections (e.g., sinusitis, otitis media).
 Herpes zoster (shingles).

Stage 3: Advanced Disease

 Weight loss of more than 10% of body weight.

 Chronic diarrhea lasting more than a month.
 Persistent fever for more than a month.
 Oral candidiasis (thrush).
 Pulmonary tuberculosis.
 Severe bacterial infections (e.g., pneumonia, pyomyositis).

Stage 4: Severe or AIDS

 HIV wasting syndrome (unexplained weight loss with chronic diarrhea or chronic
weakness and fever).
 Pneumocystis pneumonia.
 Recurrent severe bacterial infections.
 Esophageal candidiasis.
 Kaposi's sarcoma.
 Central nervous system toxoplasmosis.
 Cytomegalovirus infection (retinitis or other organs).
 Progressive multifocal leukoencephalopathy (PML).

CLINICAL PICTURES OF HIV/AIDS

1. Acute HIV Infection (Primary HIV Infection)

1) Occurs 2-4 weeks after exposure.

2) Symptoms resemble those of influenza or mononucleosis (often called acute
retroviral syndrome).
3) Common Symptoms:

 Fever
 Fatigue
 Sore throat
 Rash (usually maculopapular)
 Muscle and joint pain
 Swollen lymph nodes
 Headache

2. Asymptomatic Stage (Chronic HIV Infection)

 This stage can last for years, during which the virus is actively replicating but at
lower levels.
 Many individuals remain symptom-free during this time, although the virus
continues to damage the immune system.

3. Symptomatic Stage (Progression to AIDS)

 When the CD4 count drops below 200 cells/µL, or when opportunistic
infections/cancers occur.
 Common Opportunistic Infections and Symptoms:

 Respiratory: Pneumocystis pneumonia (PCP), tuberculosis (TB), recurrent

bacterial pneumonia.
 Gastrointestinal: Chronic diarrhea, esophageal candidiasis.
 Neurological: HIV-associated dementia, toxoplasmosis, cryptococcal
meningitis.
 Skin: Kaposi's sarcoma, molluscum contagiosum, persistent herpes simplex
virus (HSV) infections.
 Systemic Symptoms: Persistent fever, weight loss, night sweats, chronic
fatigue.
 DIAGNOSTIC INVESTIGATIONS FOR HIV/AIDS

Screening Tests:

1. HIV Antibody Tests:

 Enzyme-Linked Immunosorbent Assay (ELISA) – Detects antibodies to HIV,

often used for initial screening.
 Rapid HIV Tests – Provide results in 20-30 minutes, commonly used in clinical
and community settings. If the test read positive another comfirmatory test should
be done to confirm before the person is inform. Where the person remains
infective but test read negative, (ELISA) is a simple rapid test which is also cheap
and sensitive.

2. Antigen/Antibody Combination Tests:

 Detect both HIV-1/2 antibodies and p24 antigen (a part of the virus itself), which
allows for earlier detection.

3. Nucleic Acid Tests (NATs):

 Detect HIV RNA (viral load) and are used for early diagnosis, especially in high-
risk exposures, and to monitor treatment response.

Confirmatory Tests:

1. Western Blot:

 Previously the gold standard for confirmation, though being phased out in favor
of more modern methods. Is ideal to confirm (ELISA) test which is 100%
specific.

2. Immunofluorescence Assay (IFA):

 Used in some settings as a confirmatory test for HIV infection.

Monitoring Tests:

1. CD4 Count:

 Measures the number of CD4 T lymphocytes in the blood, which indicates the
health of the immune system. A declining CD4 count suggests disease
progression.

2. Viral Load (HIV RNA Quantification):

 Measures the amount of virus in the blood. A high viral load indicates active
replication and a higher risk of progression to AIDS.

3. Drug Resistance Testing:

 Identifies mutations in the virus that make it resistant to specific antiretroviral

medications.

INCUBATION PERIOD

1. 6 - 12 weeks for antibodies to appear against HIV

2. It is variable usually 5 - 10 years to developed AIDs

MANAGEMENT OF HIV INFECTION IN DRUG THERAPY (ANTIRETROVIRAL

THERAPY - ART)

1. Purpose: ART is the cornerstone of HIV treatment. It helps control the virus,
improving the quality of life and extending lifespan by reducing viral load to
undetectable levels, preventing the progression to AIDS, and minimizing the risk of
transmission.
2. Common Classes of ART:

 Nucleoside Reverse Transcriptase Inhibitors (NRTIs): E.g., Tenofovir,

Zidovudine
 Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): E.g., Efavirenz,
Nevirapine
 Protease Inhibitors (PIs): E.g., Lopinavir/Ritonavir, Atazanavir
 Integrase Strand Transfer Inhibitors (INSTIs): E.g., Dolutegravir, Raltegravir
 Entry Inhibitors: E.g., Maraviroc (CCR5 antagonist)
 Fixed-Dose Combinations: Multiple drugs combined into one pill for
convenience and adherence, such as Triumeq and Atripla.

CHALLENGES:

1. Adherence: Strict adherence is crucial to prevent drug resistance.

2. Side Effects: Managing adverse effects such as nausea, fatigue, and long-term
metabolic complications.
3. Drug Resistance: Occurs when the virus mutates, reducing the effectiveness of
ART, requiring a change in the regimen.

MANAGEMENT OF HIV INFECTION IN NUTRITION

1. Role of Nutrition: Good nutrition supports the immune system, enhances the
efficacy of ART, and improves overall well-being. Malnutrition can worsen the
progression of HIV and reduce the body’s ability to fight infections.
2. Key Nutritional Strategies:

 Balanced Diet: Emphasize fruits, vegetables, whole grains, lean protein, and
healthy fats.
 Micronutrients: Adequate intake of vitamins and minerals, such as Vitamin A,
Vitamin D, Zinc, and Selenium, which are essential for immune function.
 Caloric Intake: Increased energy needs may be necessary to combat the effects
of the virus and maintain body weight, particularly in those with advanced
disease.
 Hydration: Staying well-hydrated is essential, particularly for managing side
effects like diarrhea.
 Avoidance of Alcohol and Certain Foods: Excessive alcohol can weaken the
immune system, and foods that can increase the risk of foodborne illnesses should
be avoided.

3. Supplementation: In cases of deficiencies, supplementation with vitamins and

minerals may be required, especially in areas with food insecurity.

MANAGEMENT OF HIV INFECTION IN SUPPORT GROUPS

1. Purpose: Psychosocial support is critical for people living with HIV. Support
groups provide emotional support, help with stigma reduction, and encourage
adherence to treatment regimens.
2. Benefits:

 Emotional Well-being: Reduces feelings of isolation, depression, and anxiety

that can accompany an HIV diagnosis.
 Peer Education: Group members can share experiences, provide advice on
managing side effects, and discuss coping strategies.
 Adherence Support: Regular meetings can encourage members to remain
consistent with ART and follow-up appointments.
 Social Support: Family and community-based support systems can provide
practical assistance, such as help with transportation to clinic appointments or
financial aid.

3. Online and Physical Groups: Support can be provided through face-to-face

meetings or online platforms, which can be particularly beneficial in regions with
stigma or limited physical support services. (National Association of People Living
with HIV/AIDs)

COUNSELLING AND DISCLOSUR OF HIV/AIDS

Counseling and disclosure of HIV/AIDS are critical components of managing the

condition both on a personal and public health level. They help individuals and
communities cope with the challenges of living with HIV/AIDS, support treatment
adherence, and reduce the stigma associated with the condition.

1. Counseling for HIV/AIDS:

 Pre-test Counseling: Before an HIV test is conducted, pre-test counseling helps

prepare the individual for the outcome, ensuring they understand the process, the
implications of both positive and negative results, and the importance of consent.
 Post-test Counseling: After the test results are received, post-test counseling
provides emotional support and helps the individual understand their status. If the
 result is positive, the counselor discusses treatment options, prevention strategies,
and how to manage the condition.
 Ongoing Counseling: For those living with HIV/AIDS, ongoing counseling is
essential. It focuses on adherence to antiretroviral therapy (ART), coping
strategies, mental health support, and dealing with stigma or discrimination.

2. Disclosure of HIV/AIDS Status:

 Voluntary Disclosure: Individuals have the right to disclose their HIV status to
whomever they choose. Voluntary disclosure, especially to sexual partners, family
members, and healthcare providers, is encouraged for the sake of treatment and
preventing transmission.
 Challenges of Disclosure: Many people face challenges in disclosing their HIV
status due to fear of stigma, discrimination, or even violence. Counseling plays a
vital role in helping individuals navigate these challenges.
 Legal and Ethical Considerations: Different countries have laws regarding the
disclosure of HIV status. Ethically, healthcare providers must balance
confidentiality with the need to prevent the spread of the virus, and they should
provide guidance on legal obligations around disclosure.
 Partner Notification: Some programs encourage or require partner notification to
inform sexual partners of possible exposure to HIV. This can be done with the
individual's consent, either by themselves or through a healthcare provider.

3. Confidentiality in HIV Counseling and Disclosure:

 Confidentiality is a key principle in HIV counseling. Healthcare professionals are

bound to keep an individual's status private unless disclosure is legally mandated,
or the individual consents to sharing the information.
 Ensuring confidentiality builds trust, encourages individuals to seek care, and
reduces fear of discrimination.

HIV/AIDS TESTING

HIV/AIDS Testing is a critical component of HIV prevention, care, and treatment

programs.

1. Testing: This involves taking a sample of blood or oral fluid and testing it for HIV.
Testing can be done at health facilities, community-based testing centers, or through
self-testing kits. Rapid tests can give results within minutes, while some tests may
need to be sent to a laboratory for processing.

Test aims to encourage early diagnosis of HIV to ensure timely treatment, reduce the
spread of the virus, and support people living with HIV/AIDS to maintain their health
and well-being. Additionally, it helps reduce stigma and discrimination by providing
education and raising awareness about HIV/AIDS.

PREVENTION OF HIV/AIDS INFECTION IN ABCDE METHODS OF HIV/AIDS

PREVENTION, UNIVERSAL PRECAUTION, AND POST-EXPOSURE
PROPHYLAXIS (PEP)
ABCDE Methods: The ABCD approach to HIV prevention involves a set of
strategies aimed at reducing the risk of HIV transmission. These include:

 A - Abstinence: Refraining from sexual activity is the most effective way to

prevent sexual transmission of HIV.
 B - Be Faithful: Limiting sexual partners and being faithful to one uninfected
partner can reduce the risk of HIV infection.
 C - Condom Use: Consistent and correct use of condoms significantly reduces the
risk of HIV transmission during sexual intercourse.
 D - Don't Share Needles: Avoiding the sharing of needles and other injection
equipment helps prevent the transmission of HIV through blood contact.
 E - Educational about HIV/AIDs

Universal Precautions: Universal precautions are infection control measures

designed to reduce the risk of transmission of HIV and other bloodborne pathogens in
healthcare settings. Key practices include:

 Using protective barriers such as gloves, masks, eye wear and gowns when dealing
with blood or bodily fluids.
 Proper disposal of needles and other sharp instruments.
 Hand hygiene practices after contact with potentially infectious materials.

Post-Exposure Prophylaxis (PEP): PEP involves taking antiretroviral medications

after potential exposure to HIV to prevent infection. It is most effective when started
within 72 hours of exposure and involves taking HIV medications for 28 days. PEP is
recommended for individuals who may have been exposed to HIV through:

 Occupational exposure (e.g., needlestick injury).

 Sexual exposure (e.g., unprotected sex with an HIV-positive partner).
 Other high-risk exposures (e.g., sharing needles).

PREVENTION OF HIV/AIDS INFECTION OF MOTHER-TO-CHILD

TRANSMISSION OF HIV/AIDS (PMTCT)

PMTCT focuses on preventing the transmission of HIV from an HIV-positive mother

to her child during pregnancy, childbirth, or breastfeeding.

1. Antenatal Care and HIV Testing: Early HIV testing and diagnosis during
pregnancy allow for timely intervention. Pregnant women who test positive for HIV
are provided with antiretroviral therapy (ART) to reduce the viral load.
2. Antiretroviral Therapy (ART): Administering ART to HIV-positive pregnant
women significantly reduces the risk of transmitting the virus to their babies. ART is
usually continued throughout pregnancy, delivery, and breastfeeding.
3. Safe Delivery Practices: Healthcare providers may recommend a caesarean
section for delivery in some cases to reduce the risk of HIV transmission during
childbirth. However, with effective ART, many HIV-positive women can safely
deliver vaginally.
4. Infant Feeding Practices: Exclusive breastfeeding with ART is encouraged for
HIV-positive mothers in low-resource settings to reduce the risk of HIV transmission,
as mixed feeding increases the risk of transmission. In settings where safe alternatives
(such as formula feeding) are available, these may be recommended.
5. Postnatal Care: Continued monitoring of both mother and child for HIV, as well
as providing ART for the baby if needed, are critical in reducing mother-to-child
transmission.

COMPLICATION OF HIV/AIDS

HIV/AIDS can lead to several complications due to the weakening of the immune
system. Some of the most common complications associated with HIV/AIDS include:

1. Opportunistic Infections

 Tuberculosis (TB): The most common opportunistic infection associated with

HIV, especially in developing countries.
 Pneumocystis Pneumonia (PCP): A type of fungal pneumonia common in people
with advanced HIV.
 Candidiasis: Often occurs in the mouth, throat, or vagina.
 Cytomegalovirus (CMV): Can cause eye, lung, liver, and digestive tract
infections.
 Toxoplasmosis: A parasitic infection that can affect the brain and other organs.
 Cryptococcal Meningitis: A fungal infection of the brain.

2. Cancers

 Kaposi's Sarcoma: A cancer of the blood vessel walls that is more common in
HIV-positive individuals.
 Lymphomas: Cancers of the lymphatic system, particularly non-Hodgkin
lymphoma, are more common in people with HIV.
 Cervical Cancer: Women with HIV are at higher risk of developing cervical
cancer.

3. Neurological Complications

 HIV-associated Neurocognitive Disorder (HAND): This can range from mild

memory problems to severe dementia (AIDS dementia complex).
 Peripheral Neuropathy: Damage to the nerves in the hands and feet, causing
pain, tingling, or numbness.

4. Wasting Syndrome

 Significant involuntary weight loss often associated with diarrhea, chronic

weakness, and fever.

5. Kidney Disease

 HIV-associated nephropathy (HIVAN) is a type of kidney disease that occurs in

people with HIV, particularly affecting individuals of African descent.

6. Cardiovascular Disease
 HIV increases the risk of heart disease, stroke, and other cardiovascular conditions
due to chronic inflammation.

7. Liver Disease

 Co-infection with hepatitis B or C viruses is common and can lead to serious liver
damage, including cirrhosis and liver cancer.

8. Bone Disorders

 People with HIV are at higher risk for bone conditions like osteoporosis and
osteopenia, leading to an increased risk of fractures.

9. Chronic Inflammation

 Persistent inflammation due to HIV can contribute to a variety of conditions,

including cardiovascular disease, cancer, and other age-related illnesses.

THE ROLE OF A NURSE IN HIV/AIDS PREVENTION AND

MANAGEMENT

1. Education and Counseling:

 Prevention Education: Nurses educate individuals and communities about HIV

transmission, prevention methods, and the importance of safe practices, such as
condom use and harm reduction.
 Counseling: They provide emotional support and counseling for individuals
living with HIV/AIDS, helping them understand their condition, cope with the
diagnosis, and adhere to treatment regimens.

2. Testing and Screening:

 HIV Testing: Nurses perform HIV tests and provide pre-test and post-test
counseling. They ensure that individuals understand the importance of knowing
their HIV status and the implications of test results.
 Screening for Related Conditions: They screen for and manage other sexually
transmitted infections (STIs) and conditions that may complicate HIV
management.

3. Treatment and Care:

 Antiretroviral Therapy (ART): Nurses assist in the administration of ART,

monitor for side effects, and help patients manage their medication regimens.
 Adherence Support: They work to ensure that patients adhere to their treatment
plans, providing reminders and support to overcome barriers to adherence.

4. Preventing Transmission:

 Infection Control: Nurses implement and follow strict infection control practices
to prevent the transmission of HIV in healthcare settings.
 Needle Exchange Programs: In some settings, nurses may be involved in needle
exchange programs and other harm reduction strategies, a place where you can
get new clean injection equipment and advice for staying safe and return any used
equipment so that it can be destroyed.

5. Advocacy and Coordination:

 Advocacy: Nurses advocate for patients' rights, ensuring they have access to
necessary services and support.
 Coordination: They coordinate care with other healthcare professionals,
including doctors, social workers, and community organizations, to provide
comprehensive care.

6. Community Engagement:

 Community Outreach: Nurses participate in community outreach programs to

raise awareness about HIV/AIDS and promote testing and prevention.
 Support Groups: They may facilitate or support peer support groups for
individuals living with HIV/AIDS.

7. Research and Training:

 Research: Some nurses are involved in research related to HIV/AIDS,

contributing to the development of new treatments and strategies.
 Training: They train other healthcare providers and community members on best
practices for HIV prevention and management.