Acquired immunodeficiency
syndrome (AIDS)
is a chronic, potentially
life-threatening condition
caused by the
human immunodeficiency virus (HIV)
GP 120, GP41 essential for
binding CD4+, T lymphocyte
Envelop surrounds
essential structural component of a virion &
virus carry genetic
facilitates many crucial life cycle steps through
interactions with host cell factors material in
ribonucleic acid
RNA-dependent DNA
polymerase - enzyme that
transcribes single-
stranded RNA into DNA
genetic material
BINDING
▼
GP120, GP41bind CD4+ & chemokine
coreceptors
▼
Fusion of HIV CD4+Tcell membrane
reverse transcriptase - convert RNA sequences to cDNA
sequences that are capable of inserting into different
UNCOATING
areas of the genome.
CONTENTS OF HIV VIRAL CORE
(2 SINGLE STRANDS OF VIRAL RNA, 3 VIRAL
ENZYMES: REVERSE TRANSCRIPTASE, INTEGRASE,
PROTEASE) ARE EMPTIED INTO CD4+ TCELL
Integrase (IN) is a retroviral enzyme - catalyzes the insertion of viral DNA (vDNA) into
host chromosomal DNA - necessary for efficient viral replication
Proteolytic enzymes (proteases) break down protein
DNA SYNTHESIS
HIV CHANGES GENETIC
MATERIAL RNA
▼
REVERSE
TRANSCRIPTASE
▼
DOUBLE-STRANDED DNA
▼
CARRIES INSTRUCTION
FOR
▼
VIRAL REPLICATION
INTEGRATION
New viral DNA enters
nucleus CD4+ T cell
▼
Integrase
▼
Blended with CD4 Tcell
▼
Permanent lifelong
infection
TRANSCRIPTION
WHEN CD4+ T CELL IS
ACTIVATED
▼
DOUBLE-STRANDED DNA
FORMS
▼
SINGLE-STRANDED
MESSENGER RNA WHICH
BUILDS
▼
NEW VIRUSES
TRANSLATION
mRNA creates chains
of new proteins &
enzymes
▼
contain components
▼
Construction of new
viruses
CLEAVAGE
HIV ENZYME PROTEASE
▼
CUTS POLYPROTEIN
CHAIN
▼
INDIVIDUAL PROTEINS
THAT MAKE UP NEW
VIRUS
maturation of new
virions, which can then
infect new cells
During budding, immature
(noninfectious) HIV pushes itself out
BUDDING
of the host CD4 cell. (Noninfectious
NEW PROTEINS, VIRAL HIV can't infect another CD4 cell.)
RNA MIGRATE TO THE ▼
MEMBRANE OF Once outside the CD4 cell, the new
CD4+TCELL HIV releases protease
▼ ▼
EXIT FROM THE CELL breaks up the long protein chains in
▼
START THE PROCESS
the immature virus
ALL OVER ▼
creating mature (infectious) virus.
CD4+, T lymphocyte
< 200 mcl or
< 14 %
LAB confirmation of HIV CD4+, T lymphocyte
CD4+, T lymphocyte 200 – 499 mcl or
count percentage 14 - 28
> 500 mcl or
Percentage >29
Diagnostic Examination:
Test Normal Result Abnormality with Condition Explanation
Enzyme-linked Positive ELISA
immunosorbent test is confirmed
assay (ELISA) and Negative for by a Western
Western blot HIV antibodies Positive for HIV antibodies blot
B and T cell values decreased. CD4
counts less than 500/mL are
B cells: 65– generally associated with symptoms;
T lymphocyte and 4785/mL; CD4 CD4 counts less than 200/mL are
B lymphocyte T cells: 450– associated with severe immune
subsets; CD4 1400/mL; CD4 suppression. Any HIVinfected HIV infects cells
counts, CD4 to CD8 T cell person with a CD4 level less than with the CD4
percentages ratio: 1:3.5 200/mL is considered to have AIDS protein marker
Detects number of copies/mL; test
has a lower limit of 400 copies/mL Quantitative
but can reach levels at 30,000 assay that
Viral load: copies/mL and higher; ultrasensitive measures amount
polymerase chain assay has a lower limit of 40 of HIV-1 RNA
reaction (PCR) Negative copies/mL in plasma
▪ Other Tests: Complete blood count; HIV p24 antigen, viral culture, indirect
entry
nucleoside inhibitors
reverse
transcriptase
prevent HIV
inhibitors from entering
NRTIs or nukes a cell
block HIV Enfuvirtide
replication (Fuzeon, T-20)
Zidovudine
(Retrovir, AZT
non-nucleoside
reverse transcriptase
inhibitors
a non-nukes
or NNRTIs
Disrupt enzyme
activity
Nevirapine
(Viramune, NVP)
protease
inhibitors or PIs
Inhibits & prevents
maturation of virus
Saquinavir
(Invirase, SQV)
NURSING MANAGEMENT
Health education – The healthcare worker must:
• Know the patient
• Avoid fear tactics
• Avoid judgmental and moralistic messages
• Be consistent and concise
• Use positive statement
• Give practical advice
Practice universal/standard precaution
• a thorough medical handwashing after every contact with patient & after
removing the gown & gloves, & before leaving the room of an AIDS suspect
or known AIDS patient.
• Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap,
mask, gloves, CD gown, face shield/goggles are very necessary.
HEALTH TEACHINGS
Prevention
• Care should be taken to avoid accidental pricks from sharp
instruments contaminated with potentially infectious materials
form AIDS patient.
• Gloves should be worn when handling blood specimens and other
body secretions as well as surfaces, materials and objects
exposed to them.
• Blood and other specimens should be labeled with special
warning “AIDS Precaution”.
• Blood spills should be cleaned immediately using common
household disinfectants, like “chlorox”.
• Needles should not be bent after use, but should be disposed into
a puncture-resistant container.
• Personal articles like razor or razor blades, toothbrush should not
be shared with other members of the family. Razor blades may be
disposed in the same manner as needles are disposed.
• Patients with active AIDS should be isolated.
The Four Cs in the Management of HIV/AIDS
Compliance Counseling/education
giving of information and Giving instruction about the
counseling the client which treatment
results to the client’s Disseminating information
successful treatment, about the disease
prevention and Providing guidance on how to
recommendation avoid contracting STD again
Sharing facts about HIV and
AIDS
Contact tracing
Tracing out and providing
treatment or partners Condoms
[Link] HIV Infection
[Link] HIV infection is the earliest stage of HIV infection, and it
generally develops within 2 to 4 weeks after infection with HIV.
During this time, some people have flu-like symptoms, such as
fever, headache, and rash. In the acute stage of infection, HIV
multiplies rapidly and spreads throughout the body. The virus
attacks and destroys the infection-fighting CD4 cells (CD4 T
lymphocyte) of the immune system. During the acute HIV
infection stage, the level of HIV in the blood is very high, which
greatly increases the risk of HIV transmission. A person may
experience significant health benefits if they start ART during
this stage.
[Link] HIV Infection
[Link] second stage of HIV infection is chronic HIV
infection (also called asymptomatic HIV infection or clinical
latency). During this stage, HIV continues to multiply in the
body but at very low levels. People with chronic HIV
infection may not have any HIV-related symptoms. Without
ART, chronic HIV infection usually advances to AIDS in 10
years or longer, though in some people it may advance
faster. People who are taking ART may be in this stage for
several decades. While it is still possible to transmit HIV to
others during this stage, people who take ART exactly as
prescribed and maintain an undetectable viral load have
effectively no risk of transmitting HIV to an HIV-negative
partner through sex.
[Link]
[Link] is the final, most severe stage of HIV infection. Because
HIV has severely damaged the immune system, the body cannot
fight off opportunistic infections. (Opportunistic infections are
infections and infection-related cancers that occur more
frequently or are more severe in people with weakened immune
systems than in people with healthy immune systems.) People
with HIV are diagnosed with AIDS if they have a CD4 count of less
than 200 cells/mm3 or if they have certain opportunistic
infections. Once a person is diagnosed with AIDS, they can have a
high viral load and are able to transmit HIV to others very easily.
Without treatment, people with AIDS typically survive about 3
years.
CD4 + help coordinate the immune response by stimulating other
immune cells, such as macrophages, B lymphocytes (B cells), and
CD8 T lymphocytes (CD8 cells), to fight infection
PAH-zih-tiv … LIM-foh-site) A type of immune cell that stimulates killer T cells,
macrophages, and B cells to make immune responses. A CD4-positive T lymphocyte
is a type of white blood cell and a type of lymphocyte. Also called helper T ce
DESCRIPTION
• HIV is the virus that causes AIDS.
• Also known by the names
1. Human T cell lymphotrophic virus (HTLV-III)
2. Lymphadenopathy associated virus (LAV)
3. AIDS associated retrovirus (ARV)
H=Human-Can live only in humans
I= Immunodeficiency: Damages the immune system of people it infects
V= Virus: ◦ Retrovirus (Nucleic material as RNA).
• The time from the onset of HIV transmission to the development of AIDS varies
from a few months to years. The median incubation period is 10 years
• Invades the helper T cells (CD4 cells) in the body of the
DESCRIPTION host (defense mechanism of a person)
MECHANISM OF HIV INFECTION
.
❖ Acquired (not born with)
❖ Immune (body’s defense system)
❖ Deficiency (not working properly)
D
❖ Syndrome (a group of signs and symptoms.
E
F
I • AIDS (acquired immune deficiency syndrome) is the final stage of HIV
N born disease.
I • Disease limits the body’s ability to fight infection due to markedly reduced
T helper T cells, hence, patients have a very weak immune system
I (defence mechanism).
O • Patients predisposed to multiple opportunistic infections leading to
N death.
RISK FACTORS
1. The presence of sexually transmitted infections (STIs) with open lesions, such as herpes
and syphilis, may increase the patient’s susceptibility to viral entry.
2. Sexual contact with HIV infected individual(male to male, male to female, female to
male, and female to female)
3. Blood to blood or transfusion contact
4. Through the use of needles contaminated by an HIV-infected person; by blood or other
HIV-infected fluids coming in contact with open lesions or mucous membranes
5. by mother to child during the in utero period, during delivery, or by breastfeeding.
SIGNS AND SYMPTOMS
There are three main stages of HIV infection:
1. acute infection,
2. clinical latency
3. AIDS.
As early as 2-4 weeks after exposure to HIV
(but up to 3 months later), people can experience
an acute illness, often described as “the worst flu
ever.” This is called acute retroviral syndrome
(ARS), or primary HIV infection, and it’s the body’s
natural response to HIV infection. During primary
HIV infection, there are higher levels of virus
circulating in the blood, which means that people
can more easily transmit the virus to others.
SIGNS AND SYMPTOMS
Symptoms can include:
•Fever
•Chills
•Rash
•Night sweats
•Muscle aches
•Sore throat
•Fatigue
•Swollen lymph nodes
•Ulcers in the mouth
SIGNS AND SYMPTOMS
Clinical latency
After the initial infection and
seroconversion , the virus becomes less
active in the body, although it is still
present. During this period, many
people do not have any symptoms of
HIV infection. This period is called the
“chronic” or “latency” phase. This
period can last up to 10 years—
sometimes longer.
SIGNS AND SYMPTOMS
AIDS
When HIV infection progresses
to AIDS, many people begin to
suffer from fatigue, diarrhea,
nausea, vomiting, fever, chills,
night sweats, and even wasting
syndrome at late stages. Many
of the signs and symptoms of
AIDS come from opportunistic
infections which occur in
patients with a damaged
immune system.
SIGNS AND SYMPTOMS
Common Opportunistic Infections
•Pneumocystis carinii pneumonia
•Oral candidiasisopportunistic infection
•Toxoplasmosis of the CNS
•Chronic diarrhea/wasting syndrome
•Cancers
•Kaposi’s sarcoma – affects small blood
vessels and internal organs
•Pulmonary/extra-pulmonary tuberculosis
•Cervical dysplasia and cancer.
Researchers found out that women with HIV
have higher rates of this type of cancer.
• Cervial carcinoma is associated with Human
Papilloma Virus (HPV).
•Non-Hodgkin’s lymphoma – cancerous tumor
of the lymph nodes. This is usually a late
manifestation of HIV infection.
PATHOPHYSIOLOGY
1. When HIV infection takes place, anti-HIV antibodies are produced but they do not
appear immediately. This is called the “window effect”.
2. In some cases, antibodies to HIV become detectable 4 to 6 weeks after infection.
3. When HIV is in circulation, it invades several types of cells – the lymphocytes,
macrophages, the Langerhans cells, and neurons within the CNS.
4. HIV attacks the body’s immune system.
5. The organism attaches to a protein molecule called CD4 which is found in the
surface of T4 cells.
6. Once the virus enters the T4, it inserts its genetic materials into the T4 cell’s
nucleus taking over the cell to replicate itself.
7. Eventually the T4 cell dies after having been used to replicate HIV.
PATHOPHYSIOLOGY
8. The virus mutates rapidly making it more difficult for the body’s immune system to
‘recognize” the invaders.
1. HIV infection progresses through several stages.
2. The clinical course of HIV infection begins when a person becomes infected with
HIV through:
• sexual contact with infected person
• injection of infected blood or blood products
ICS
DIAGNOSTICS
Diagnostic Examination:
Test Normal Result Abnormality with Condition Explanation
Enzyme-linked Positive ELISA
immunosorbent test is confirmed
assay (ELISA) and Negative for by a Western
Western blot HIV antibodies Positive for HIV antibodies blot
B and T cell values decreased. CD4
counts less than 500/mL are
B cells: 65– generally associated with symptoms;
T lymphocyte and 4785/mL; CD4 CD4 counts less than 200/mL are
B lymphocyte T cells: 450– associated with severe immune
subsets; CD4 1400/mL; CD4 suppression. Any HIVinfected HIV infects cells
counts, CD4 to CD8 T cell person with a CD4 level less than with the CD4
percentages ratio: 1:3.5 200/mL is considered to have AIDS protein marker
Detects number of copies/mL; test
has a lower limit of 400 copies/mL Quantitative
but can reach levels at 30,000 assay that
Viral load: copies/mL and higher; ultrasensitive measures amount
polymerase chain assay has a lower limit of 40 of HIV-1 RNA
reaction (PCR) Negative copies/mL in plasma
▪ Other Tests: Complete blood count; HIV p24 antigen, viral culture, indirect
fluorescent antibody
ICS
MEDICAL MANAGEMENT
Pharmacologic Treatment
“AIDS Drugs” are medicines used to treat but not to cure HIV infection.
These drugs are sometimes referred to as “anteroviral drugs.”
These work by inhibiting the reproduction of the virus. There are two groups of anteroviral drugs:
1. Reverse trancriptase inhibitors – they inhibit the enzyme called reverse transcriptase which is needed
to “copy” information for the virus to replicate. These drugs are:
Zedovudine (ZDV) – Retirvir
Zalcitabine – Havid
Stavudine – Zerit
Lamivudine – Epivir
2. Protease inhibitors. They work by inhibiting the enzyme protease which are needed for the assembly
of viral particles.
These drugs are:
Saquinavir – Invarase
Ritonavir – Norvir
Indinavir – Crixivan
