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Human Immunodeficiency Virus
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Human Immunodeficiency virus (HIV)
- Alisha Pongratz
- Amanda Charron
- Robyn Glab
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Human Immunodeficiency virus (HIV)
What is HIV?
Human immunodeficiency virus infection is a retrovirus that causes immunosuppression.
People who have been diagnosed with HIV are more sensitive to infections that would normally be controlled through the immune response.
HIV infections are interchangeable with the HIV disease term. Due to treatment that has been advancing, HIV is now managed as a chronic disease, since now people who are diagnosed with it are able to live longer.
What is HIV?
How is hiv spread ?
The transmission of HIV can be contacted through infected blood, semen, vaginal secretions, or breast milk. It can also be transmitted through sexual intercourse with an infected partner; exposure to HIV-infected blood or blood products; and perinatal transmission during pregnancy, at delivery, or through breastfeeding. HIV is not spread casually, which means that the virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting. It is also not spread by tears, saliva, urine, emesis, sputum, feces, sweat, respiratory droplets, or enteric routes. Health care personnel have a low risk of acquiring HIV at work, even after a needle-stick injury.
Statistics
Currently there is more than 1 million people who are living with HIV in the United States, with approximately 50,000 new infections occurring each year. There has been a dramatic drop in the number of deaths due to the availability of effective HIV treatment.
There have been increasingly effective treatments for people diagnosed with HIV. People are living longer, healthier, and more productive lives. The death rate for HIV infections have greatly declined in the United States since the 1990s.
Who’s at risk?
HIV is more prevalent among men who have intercourse with other men (MSM) in North America. There is however, increasing numbers of new HIV infections that are occurring in women, people of color, people who live in poverty, and young adults.
There are disparities amongst gender, race, and ethnicity in new HIV diagnoses.
In 2015:
• 81% of annual HIV diagnoses occurred in men.
• Regardless of race or ethnicity, more than half occurred in gay and bisexual men.
• 27% of annual HIV diagnoses occurred in whites, 45% in African Americans, and 24% in Hispanics/ Latinos.
Signs and Symptoms
Signs and Symptoms
In the early stages of infection, HIV exists without symptoms - which is one of the major reasons it can be easily spread. The first symptoms (fever, fatigue, chills, enlarged lymph nodes, a rash that doesn't itch) occur within a month. Most who become infected will exhibit flu like symptoms.
In the second stage, individuals may be asymptomatic for up to 10 years as the virus attacks the immune system's CD4 T-cells.
Symptoms common in the third stage include; unexplained weight loss, ulcers of the mouth, yeast infections, or diarrhea. Suppressed immunity and infections are likely to occur as the infection progresses. This damage to the immune system over time can lead to the development of AIDS.
How is HIV Diagnosed?
How is HIV Diagnosed?
HIV is initially diagnosed when an individual has a positive result on an ELISA test then a positive Western blot test. At home HIV test kits that use samples of blood or saliva are another option. However, you must see your doctor in order to confirm a positive at home test
There are several tests to determine the current stage of the infection, such as, CD4 T cell count, HIV RNA, and drug resistance. Labs to test for other infections (UTI's, STI's, tuberculosis, hepatitis), and liver and kidney function may be ordered to determine potential complications.
Treatment Options
Treatment
Currently, there is no cure for HIV, only medications to slow down and control the virus. Non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, entry or fusion inhibitors, or integrase inhibitors are all options for antiretroviral therapy. Those receiving treatment should avoid garlic and St. John's wort as they inhibit the effectiveness of these medications.
Someone with severe symptoms, an opportunistic infection, who is pregnant, has kidney disease related to HIV, is being treated for hepatitis B or C, or has a CD4-T cell count below 350, should especially consider participating in HIV therapy.
HIV treatment/therapy is lifelong. People can improve their chances of staying healthy by eating healthy foods, avoiding foods that carry a risk for food borne illnesses (raw meats, egg, etc.), stay up to date on immunizations, and avoid animals known to carry parasites (birds, rodents).
Goals of drug therapy for hiv infection
- To decrease the viral load
- Maintain or increase CD4 T cell counts
to prevent HIV-related symptoms and opportunistic diseases
- Delay disease progression
- Prevent HIV transmission
goal of drug therapy
Community teaching
Health promotion WITH community teaching
Nurses play a large role in promoting health especially public health nurses. Education can make a huge impact on preventing HIV transmission and can be done through many settings such as schools, outpatient clinics, voluntary organizations, government organizations and community clinics.
- Health promotion should start early in school aged children. In 2017 21% of new HIV infected patients in the US were between 13-24 years of age.
- Out patient clinics can provide HIV education, brochures and pamphlets to patients.
- Voluntary organizations allow nurses to provide sexual health education to the community especially in areas where individuals do not have access to healthcare because they are not insured or under-insured. Peace corps and Red Cross are examples of organizations that provide voluntary sexual education.
- Nurses who work for government organizations such as the department of health work to create ideas that improve health and put these plans into action.
- Community clinic nurses will work to create programs to present to the community and are often available at community fairs to educate and counsel individuals.
What's included in HIV Education?
HIV EDUCATION
- What is HIV and how is HIV is spread?
- HIV signs, symptoms and outcomes.
- The use of condoms or the practice of abstinence.
- The use of prophylactic HIV medications for clients at high risk of acquiring HIV.
- The importance of prompt antiviral treatment to reduce the risk of HIV once a needle stick or sexual contact with a HIV infected person has occurred.
- Needle stick prevention.
- Significance of not sharing needles. Needle sharing may be done for drug use, piercings or for tattooing.
- Education of syringe exchange programs. (there are 13 organizations in Wisconsin that will take in used needles and give free sterile needles out).
- When to be tested for HIV: Testing should be done at least once a year if you are a homosexual male, are having multiple sexual partners or are sharing needles.
Nursing Interventions
for individuals who have HIV
nursing interventions
- Educate the patient about their disease, testing and available treatment to slow the disease down.
- Educate the client on how to prevent opportunistic infections by hand washing and disinfecting.
- Assess for dysphagia and mastication difficulties as HIV infected patients may acquire candidiasis or sores in the mouth.
- Check vitals for possible signs of inadequate circulation, dehydration and infection.
- Check that mucous membranes are moist and check skin turgor for hydration status.
- Offer fluids frequently to keep the client hydrated.
- Monitor fluid intake, urine and diarrheal output for hydration status.
- Help the client reposition as needed to reduce the risk of pressure ulcers.
- Change bed linens and patient gowns frequently to keep the client dry. This is important due to the diaphoresis, vomiting and diarrhea the patient may be having. Wet skin can lead to breakdown.
nursing interventions
Nursing Intervention's Cont.
- Encourage healthy eating such as a diet high in protein and with well cleaned fruits and vegetables. This will help with energy, healing and maintaining skin integrity.
- Discourage eating any raw meats, sushi and unpasteurized milk as they can harbor bacteria.
- Keep the environment quiet and relaxed when it's time to rest. Clients with HIV may feel lethargic and fatigued due to having increased metabolic activity.
- Administer pain medications or antipyretics as needed and as ordered.
- Administer antiemetics, antidiarrheals, antibiotics or appetite stimulators as needed and as ordered.
- Apply oxygen as ordered. This may be necessary in HIV infected clients with anemia.
- Encourage daily exercises to build strength and tone of muscles.
- Verbalize with and support clients.
- Determine support systems important to the client to prevent social isolation. Online support groups are also an option.