CARE OF CLIENTS WITH

HIV INFECTION
CARE OF CLIENTS WITH
HIV INFECTION
 Human immunodeficiency virus
(HIV) is a retrovirus that causes a
gradual deterioration of the
immune function of the body.

 HIV infection results in an

“acquired” immunologic defect.
 HISTORY OF HIV
 1981 – groups of predominantly
homosexual men were diagnosed with
diseases that reflected impaired immune
systems.

 1985 – causative agent was identified as

a retro virus (HIV) resulting in antibody
tests being developed
HISTORY OF HIV
 Epidemiological studies offered
clues as to modes of transmission.

 1987 – release of drugs for

treatment (ZDV, AZT, Retrovir)
HIV STATISTICS
 UN/WHO December, 2006:
 Adults = 37.2 million
 Children = 2.3 million
 Total worldwide = 39.5 million
 25.7 million live in Sub-Saharan Africa.
 7.8 million live in Asia and the Pacific
nations.
 4.3 million new cases of HIV occur
worldwide each year
HIV STATISTICS
 In 2005 the CDC estimates that
433,700 U.S. residents are living
with HIV.
What about the HIV virus?
 HIV is fragile virus
 Only transmitted via
infected body fluids
 Not transmitted by
hugging, dry kissing,
shaking hands, toilet seats,
tears, saliva, urine, sweat,
feces, or sputum
What about the HIV virus?
 Studies have failed to demonstrate
transmission by droplets, enteric
routes or casual encounters.
 Virus transmission requires a large
enough amount of virus must enter
the body of a susceptible host.
 RISK TO HEALTH CARE
WORKERS IN THE US
 Approximately 600,000
accidental needle sticks
each year
 High risk injuries:
 blood from client with high
viral load
 deep puncture wound, hollow
bore needle with visible blood
 device used to access vein or
artery.
 Pathophysiology
 HIV enters the cell (viruses can
only replicate inside a living cell).
 Once inside the cell, HIV RNA is
transcribed onto a strand of the
cells DNA.
 The enzyme made by the virus,
reverse transciptase, helps attach
the HIV RNA onto the host cell.
 Pathophysiology
 The HIV virus splices itself into the
genome of the host.
 Results:
 All genetic material is replicated
during cellular division = all daughter
cells are infected.
 The cell’s genetic code can direct the
cell to make HIV.
 Pathophysiology
 Production of the virus by the cell
requires the enzyme protease.
 Once infected with HIV, crucial immune
cells calld CD4+T cells are disabled and
killed.
 CD4+T cells play a critical role in the
immune response, signaling other cells
in the immune system to perform their
specialized functions.
 LABORATORY AND
DIAGNOSTIC TESTS
 Screening for HIV infection by
detection of antibodies (EIA, Western
blot). Table 15-12; page 256
 Testing for antibodies means there is
a “window period” during which
someone infected with HIV will not
test HIV-antibody positive.
 LABORATORY STUDIES
 Once infection is confirmed, progression
of the infection is monitored by CD4+T
cell counts.
 Normal CD4 count = 800-1200 per cc of
blood.
 Viral load = the number of viral
particles in a sample.
 Other labs: CBC (especially WBC,
neutrophil count, platelet count)
 Acute infection (1-3 weeks after
initial infection.
 Chronic infection (average of 10
years from infection to AIDS)
 Early chronic infection
 Intermediate chronic infection
 Late chronic infection or AIDS
 Stages of HIV Infection
Acute Early Intermediat Late
infectio chronic e chronic Chronic
n
Flue-like CD4+T CD4+T Meet
Swollen >500 200-500 case
nodes, Vague Fever, criteria of
fever, sympto night CDC pg.
sore ms sweats, 268
throat, diarrhea,
etc. H/A,
fatigue,
 OPPORTUNISTIC
INFECTIONS
 Pneumocystis
pneumonia (fungal)
 Herpes (viral)
 Candida (fungal)
 CMV (viral)
 Toxoplasmosis
(protozoal)
 Tuberculosis
(bacterial)
 Cancer (cervical,
lymphoma, etc.)
PREVENTING THE SPREAD
OF HIV INFECTION
 Treatment does not cure HIV.
 Infection is for life.
 Education and behavior change
are the most effective prevention
tools.
 PREVENTION OF HIV
INFECTION
 Decreasing risk related to sexual
intercourse.
 Decreasing risks from drug use
(sharing needles).
 Decreasing risks of perinatal
transmission.
 Decreasing risks at work.
 NURSING ASSESSMENT
SUBJECTIVE DATA
 Past health history: (STD’s, TB, foreign
travel, infections, alcohol/drug use.
 Perception/knowledge of illness and
treatment regimen (“How do you take
the pills?”)
 Nutrition: weight loss, anorexia, mouth
lesions/soreness, difficulty swallowing.
 Elimination: persistent diarrhea, change
in bowel habit or stool, painful urination.
 NURSING ASSESSMENT
SUBJECTIVE DATA
 Activity-exercise
 Sleep-rest
 Cognitive-perceptual
 Social support (“Who do you
consider to be your family?”)
 Sexuality-reproductive
 OBJECTIVE DATA
 Look at the client – wasting? Demeanor?
Affect?
 Skin – turgor, lesions, excoriation, delayed
wound healing
 Respiratory – rate, retractions, breath sounds,
dyspnea (rest or with exhertion)
 Cardiac
 GI – inspect oral cavity/rectal area for lesions;
bowel sounds, inspect and palpate
 Muscle wasting?
 Neurological – LOC, tremors, coordination,
speech, paralysis, etc.
 Genital lesions, discharge, PID in women.
What Nursing Diagnoses?
 NURSING DIAGNOSES
 ANTICIPATORY  ACUTE PAIN
GRIEVING  DIARRHEA
 ANXIETY  FATIGUE
 CHRONIC LOW  HYPERTHERMIA
SELF ESTEEM  IMBALANCED
 CAREGIVER NUTRITION
STRAIN  IMPAIRED ORAL
 FEAR MUCOUS
 SPIRITUAL MEMBRANE
DISTRESS
 NURSING DIAGNOSIS
 RISK FOR INFECTION, RELATED TO
IMMUNODEFICIENCY
 KNOWLEDGE DEFICIT RELATED TO
SELF CARE REQUIREMENTS
NURSING INTERVENTIONS
FOR CLIENT WITH HIV
Specific interventions address
specific problems.
Nursing care of clients with HIV
and their family requires sensitivity
and skill.
The nurse should strive to provide
emotional and spiritual support as
well as competent physical care.
Interventions for Clients
Having HIV Infections
 Early intervention after diagnosis:
 Psychosocial support – “grief
reaction”
 Nutritional support
 Stress reduction
 Avoid infections (crowds, sick people,
STD’s)
 Moderation/elimination:

alcohol, smoking, recreational drug use
Interventions for Clients
Having HIV Infections
 Rest and exercise
 Antiretroviral therapy:
 “hit it early – hit it hard” vs delay until
immune suppression observed
 Use of at least 3 antiretroviral drugs
 Take full dose
 Goal: get viral load to undetectable levels

Note: even if viral load is undetectable,
HIV is present in body and can be
transmitted
 Categories of
Antiretroviral Drugs
 Reverse Transcriptase Inhibitors:
 Interferes with HIV replication by
inhibiting an enzyme (RNA-directed
DNA polymerase)
 Missing a dose can lead to viral
mutations that allow HIV to become
resistant to the drugs
 Categories of
Antiretroviral Drugs
 Protease Inhibitors:
 Renders enzyme (protease) incapable
of processing the polyprotein
precursor to generate functional
proteins in the HIV-infected cells
 Slows HIV replication, reducing
progression of HIV infection
 Categories of
Antiretroviral Drugs
 Fusion Inhibitor:
 enfuvirtide (Fuzeon)
 Interferes with the entry of HIV into
CD4 cells by inhibiting fusion of viral
and cellular membranes
 Slows HIV replication, reducing
progression of HIV
 Administered subcutaneously – rotate
injection sites
See lecture supplement for
specific medications in each
category.