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HIV Infection and AIDS
Dr. Belal M. Hijji, RN. PhD
May 25 & 28, 2011
Learning Outcomes
By the end of this lecture, students will be able to:
• Describe the transmission and prevention of HIV
• Discuss the importance of preventive education
• Describe the standard precautions of infection
prevention, and measure that healthcare providers need
to take postexposure prophylaxis
• Identify the main stages of HIV
• Recognise some of the drugs used in HIV treatment
• Use the nursing process as a framework to address a
nursing problem related to HIV
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HIV Transmission
• HIV-1 is transmitted in body fluids containing HIV and/or
infected CD4+ (or CD4) T lymphocytes. These fluids
include blood, seminal fluid, vaginal secretions, amniotic
fluid, and breast milk. Breaks in the skin or mucosa
results in the increased probability of exposure to HIV.
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CD4 molecule
CD4 (cluster of differentiation 4) is a glycoprotein
expressed on the surface of T helper cells, regulatory T
cells, monocytes, macrophages, and dendritic cells.
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Prevention of HIV Infection
• Eliminating or reducing risk behaviors.
• Primary prevention efforts through effective educational
programs are vital for control and prevention.
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Preventive Education
• Public education regarding safer sexual practices.
• Latex condoms should be used during intercourse.
Nonlatex condoms for people with latex allergy.
• Avoiding sexual practices that might cut or tear the lining
of the rectum, penis, or vagina and avoiding sexual
contact with multiple partners.
• In the absence of needle exchange programs, injection
drug users should be instructed on methods to clean
their syringes and to avoid sharing cotton and other drug
use equipment.
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Transmission to Health Care Providers
• Standard precautions are guidelines that were
developed to prevent the transmission of infection during
patient care for all patients, regardless of known or
unknown infectious status. Attention needs to be given to
the following aspects:
– Hand washing after touching blood, body fluids,
secretions, excretions, and contaminated items. Wash
hands immediately after removing gloves, and between
patient contacts to avoid transfer of microorganisms to
other patients. Wash hands between tasks and procedures
on the same patient to prevent cross-contamination of
different body sites.
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– Gloves: Wear clean gloves when touching blood, body
fluids, secretions, excretions, contaminated items, and just
before touching mucous membranes and nonintact skin.
Change gloves between tasks and procedures on the
same patient after contact with materials that may contain
a high concentration of microorganisms. Remove gloves
promptly after use, before touching noncontaminated items
and environmental surfaces, and before going to another
patient.
– Mask, eye protection, face shield: Wear a mask and eye
protection or a face shield to protect mucous membranes
of the eyes, nose, and mouth during procedures and
patient care activities that are likely to generate splashes
or sprays of blood, body fluids, secretions, or excretions.
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– Patient care equipment: Handle used patient care
equipment soiled with blood or body fluids in a manner that
prevents skin and mucous membrane exposures,
contamination of clothing, and transfer of microorganisms
to other patients and environments. Ensure that reusable
equipment is not used for the care of another patient until it
has been cleaned and reprocessed appropriately. Ensure
that disposable items are discarded properly.
– Environmental control: Hospitals should have adequate
procedures for cleaning and disinfection of environmental
surfaces, beds, bed rails, and bedside equipment.
– Linen: Handle, transport, and process used linen soiled
with blood fluids in a manner that prevents skin and
mucous membrane exposures and contamination of
clothing and that avoids transfer of microorganisms to
other patients and environments.
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– Occupational health and blood-borne pathogens: Take
care to prevent injuries when using sharp instruments such
as needles and scalpels after procedures, when cleaning
used instruments, and when disposing of used needles.
Never recap used needles. Do not remove used needles
from disposable syringes by hand. Place used disposable
syringes and needles and scalpel blades in appropriate
containers close to the area in which the items were used.
Use mouthpieces or resuscitation bags as an alternative to
mouth-to-mouth resuscitation methods in areas where the
need for resuscitation is predictable.
– Patient placement: Place a patient who contaminates the
environment or who does not or cannot be expected to
assist in maintaining appropriate hygiene or environmental
control in a private room. Otherwise, consult with infection
control professionals regarding patient placement or other
alternatives.
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Postexposure Prophylaxis For Health Care
Providers
• If you sustain a needle stick injury, take the following
actions immediately:
– Wash the area with soap and water.
– Alert your supervisor and initiate the injury-reporting
system used in the setting.
– Identify the source patient for possible testing.
– Have your blood tested for HIV, hepatitis B, and
hepatitis C.
– Start the prophylaxis medications for HIV within 2
hours after exposure.
– Practice safer sex until follow-up testing is complete.
– Follow up with postexposure testing at 6 weeks, and
at 3, 6, and 12 months.
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Stages of HIV Disease
• Primary Infection
– The period from infection with HIV to the development
of antibodies to HIV.
– There is intense viral replication and widespread
dissemination of HIV throughout the body. Symptoms
range from none to severe flu-like symptoms.
– The person is infected with HIV but tests negative on
the HIV antibody blood test.
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• HIV Asymptomatic
– By about 6 months, the rate of viral replication
reaches a lower but relatively steady state.
– 8 to 10 years pass before a major HIV-related
complication develops.
– In this prolonged, chronic stage, patients feel well and
show few symptoms.
– Apparent good health continues because CD4 T-cell
levels remain high enough to preserve defensive
responses to other pathogens.
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• HIV Symptomatic
– Over time, the number of CD4 T cells gradually falls.
– This stage consists of symptomatic conditions in HIVinfected patients including, but not limited to,
candidiasis, cervical carcinoma, fever, diarrhea
exceeding 1 month in duration, oral herpes zoster,
idiopathic thrombocytopenic purpura, pelvic
inflammatory disease, and peripheral neuropathy.
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• AIDS
– When CD4 T-cell levels drop below 200 cells/mm3 of
blood, patients are said to have AIDS.
– One complication of advanced HIV infection is
anemia, which may be caused by HIV, opportunistic
diseases, and medications.
– Complex conditions are present such as candidiasis
of bronchi, trachea, or lungs, cervical cancer,
cytomegalovirus retinitis (with loss of vision),
encephalopathy, HIV-related herpes simplex,
bronchitis, pneumonitis, or esophagitis, lymphoma,
mycobacterium tuberculosis, pneumocystis carinii
pneumonia, recurrent Salmonella septicemia,
recurrent toxoplasmosis of brain
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Assessment and Diagnostic Findings
• Obtain patient history in relation to his/ her sexual
practices, injection drug use, and receipt of blood
transfusions.
• Assess exposure to body fluids containing infected blood
while providing care to others with HIV infection, such as
through needle sticks.
• Patients who are in later stages of HIV infection may have
a variety of symptoms related to their immuno-suppressed
state.
• Several screening tests are used to diagnose HIV
infection. These are EIA (enzyme immunoassay),
Western blot, viral load, and CD4/CD8 ratio.
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Treatment of HIV Infection
• Treatment is carried out using antiretroviral drugs. These
include:
– Zidovudine (AZT, Retrovir), lamivudine (3TC, Epivir),
d4t (Zerit, stavudine), ddc (Hivid, zalcitabine),
abacavir (Ziagen).
– Nevirapine (Viramune), delavirdine (Rescriptor),
efavirenz (Sustiva), tenofovir (Viread).
– Nelfinavir (Viracept), ritonavir (Norvir), saquinavir
(Invirase,Fortovase)
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Applying the Nursing Process to Manage a
Nursing Problem Related to HIV
• Nursing Diagnosis: Deficient knowledge related to
means of preventing HIV transmission
• Goal: Increased knowledge concerning means of
preventing disease transmission
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Nursing Interventions
• Instruct patient and family about routes of HIV
transmission.
• Instruct patient and family about means of preventing
transmission of HIV:
– Avoid sexual contact with multiple partners. Use
condoms during sexual intercourse.
– Avoid sex with prostitutes.
– Do not use injection drugs; if addicted and unable or
unwilling to change behavior, use clean needles and
syringes.
– Women at risk of exposure to AIDS through sexual or
drug practices should consult with a physician before
becoming pregnant.
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Outcomes
• Patient and family state means of transmission.
• Reports and demonstrates practices to reduce exposure
of others to HIV
• Avoids intravenous drug use
• Demonstrates knowledge of safer sexual practices
• Identifies means of preventing disease transmission
• States that sexual partners are informed about positive
HIV antibodies in blood
• Avoids IV/injection drug use and sharing of drug
equipment with others
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