MAMATA NURSING COLLEGE,

BACHUPALLY , HYDERABAD

SEMINAR ON:
HIV AND AIDS

Submitted to: Submitted by:

Mrs. Biva Sinha. Nikhitha A
Associate professor N Pranavi
Mamata Nursing College Bsc Nursing 4th semester
Bachupally , Hyderabad Mamata Nursing College
Bachupally , Hyderabad

Signature of guide: Signature of principal:

 INDEX

SL CONTENT PAGE NO
NO
1 INTRODUCTION
2 ANATOMY AND PHYSIOLOGY OF IMMUNE SYSTEM
3 DEFINITION
4 INCIDENCE
5 MODE OF TRANSMISSION
6 TYPES
7 STAGES
8 MYTHS AND FACTS
9 ETIOLOGY AND RISK FACTORS
10 PATHOPHYSIOLOGY
11 PATHOGENESIS
12 CLINICAL MANIFESTATIONS
13 DIAGNOSTIC EVALUATION
14 MEDICAL MANAGEMENT
15 NURSING MANAGEMENT
16 NURSING DIAGNOSIS
17 NURSING CARE PALN
18 COMPLICATIONS
19 PREVENTION
20 SUMMARY
21 CONCLUSION
22 BIBLIOGRAPHY

OBJECTIVES

GENERAL OBJECTIVES:
By the end of the seminar presentation the group will be able to gain in depth knowledge regarding HIV and
AIDS
SPECIFIC OBJECTIVES:
At the end of the seminar presentation group will be able to :
 Anatomy and physiology of immune system
 Define HIV and AIDS
 Discuss the incidence of HIV and AIDS
 Explain the mode of transmission of HIV and AIDS
 List out the types of HIV and AIDS
 Enlist the stages of HIV and AIDS
 Discuss the myths and facts of HIV and AIDS
 List out the etiology and risk factors of HIV and AIDS
 Elaborate the pathophysiology of HIV and AIDS
 Explain the pathogenesis of HIV and AIDS
 Enlist the clinical manifestations of HIV and AIDS
 Describe the diagnostic evaluation of HIV and AIDS
 Explain the management of HIV and AIDS
 Describe the nursing diagnosis and nursing care plan of HIV and AIDS
 Enlist the complications of HIV and AIDS
 Discuss the preventive measures of HIV and AIDS

INTRODUCTION
HIV is fatal illness that breaks down the immune system .It is a virus that attach the bodies immune system and
it weakens the immunity to the point where the body struggles to fight with infections and diseases. Mainly it
affects the immune system and cause immunosuppression. Human immunodeficiency virus is a retrovirus that
cause immunosuppression. Individuals with HIV are more susceptible to infections that are normally controlled
through immune response. HIV infection is an acquired infection in which it integrates itself into CD4 causing
severe immune dysfunction. HIV infected individuals are susceptible to other life threatening infections and
malignancy .
AIDS is the most serious form of HIV infection and the final stage of HIV infection. Individuals at this stage of
HIV infection have a badly damaged immune system which put them at the risk of opportunistic
infections .AIDS was first identified in almost 30 years ago. Remarkable progress has been made in improving
the quality and duration of life for people living with HIV and AIDS. It can be spread from the body fluids of an
infected person, including blood ,breast milk, semen, saliva and vaginal fluids. It will not spread by hugging
and kissing or by shaking hands. It is fatal illness that breakdown the body immune system leaving the patient
vulnerable to a host of life threatening opportunistic infection, neurological disorders or unusual malignancy.
HIV targets the CD4 cell of the body and if left untreated HIV infection can progress to AIDS often after many
years.
Their is no effective vaccine and no cure exist for HIV/AIDS . It can be prevented and can be treated with the
antiretroviral therapy and it is helpful in slowing down the disease or infection from further progress.

ANATOMY AND PHYSIOLOGY

IMMUNE SYSTEM
An immune system is a collection of biological processes with include the cells, tissues and organs which
provide non specific and specific protection against diseases by identifying and killing pathogens and tumour
cells.

CELLS OF IMMUNE SYSTEM

 LYMPHOCYTES
They are small around cells found in the peripheral blood, lymph and lymphoid organs and other
tissues .In peripheral blood they constitute of leukocyte population while in lymphoid organ they form
the main cell type.
Lymphocytes can be divided into two main groups : B lymphocyte and T lymphocytes.
1. B Lymphocytes :These are important in the production of the antibodies and they are linked with
humoral immunity. The b cell recognise any antigen and transform themselves into plasma cells. These
plasma cells secrete large quantities of antibody corresponding to the antigen found.
2. T Lymphocytes: It is a type of lymphocyte that plays a important role in cell mediated immunity. They
can be distinguished from other lymphocytes with the presence of t cell receptor on the cell surface and
they mature in thymus gland. T cell becomes activated when the receptor comes in contact with an
antigen.

IMMUNITY
Immunity is the resistance of an organism to the infection, diseases or other pathogenic invasion.
 1. INNATE IMMUNITY
It is the resistance possessed by an individual by birth or it is inherited. They provide first line defence
against the infections.
MECHANISM OF INNATE IMMUNITY

 Epithelial surfaces
Skin : It act as a mechanical barrier to microorganisms and they provide bactericidal secretions.
Respiratory tract : Inhaled particles are arrested in the nasal passage on the moist mucus membrane surface .
Mucous membrane acts as a trapping mechanism and hair like cilia propels the particles towards pharynx where
it is coughed out. Cough reflex act as a defence mechanism.
Intestinal tract : Mouth passes saliva which has an inhibitory effect on microorganisms and other bacteria are
destroyed by the acidic pH of gastric juices.
Conjunctiva : Tears have major route by flushing away bacteria and other dusts.
Genitourinary tract : Flushing actions of urine eliminate the pathogens.

 Antibacterial substances in blood and tissues

 Cellular factors
 2. ACQUIRED IMMUNITY
The resistance that acquired by an individual during the lifetime is known as acquired immunity. They Provide
second line defence against the infections.
A. ACTIVE IMMUNITY
Active immunity is also known as adaptive immunity .The resistance developed by an individual as a result of
any and antigenic activities. There are two types of active immunity they are: Natural active immunity and
Artificial active immunity .
Natural active immunity results clinical or and in apparent infection by a microbe . They are usually
long lasting.
Artificial active immunity resistant that is induced by vaccinations. Vaccines prepared from live or
killed microorganism or from their product.
B. PASSIVE IMMUNITY
Resistance transmitted passively to a recipient in and readymade form. Immunity acquired from someone or
from animals. There are two types of passive immunity they are natural passive immunity and artificial passive
immunity.
Natural passive immunity are resistance passively transferred from mother to foetus or infant through placenta
or through the milk.
Artificial passive immunity are the resistance passively transferred to a recipient by administration of
antibodies.

FUNCTIONS OF IMMUNE SYSTEM

 Immune system defends and protects human body from infections caused by bacteria virus, fungi and
parasites.
 Immune system removes and destroys damaged or dead cells.
 Immune system identify sand destroys malignant cells and prevent the development of tumours.
 Recognition of the foreign substances.

DEFINITION
It is caused by human immunodeficiency virus, which attacks cells that help the body to fight against
infections. Making a person more vulnerable to other infections and diseases if left untreated it leads to the
advanced state of a infection AIDS .
- Vinod k Paul
HIV is a retrovirus that targets the CD4 cells of the immune system and turns them into viral factories of HIV
reproduction.
-Lewis
AIDS is a chronic life threatening condition caused by the human immunodeficiency virus by damaging the
immune system .HIV interferes with the body’s ability to fight off viruses, bacteria and fungi that cause
diseases. HIV makes the body more susceptible to certain types of malignance and opportunity infections.
 - World Health Organization (WHO)
AIDS is a disease of human immune system caused by the human immunodeficiency virus .This condition
progressively reduce the effectiveness of the immune system and leaves the individual susceptible to
opportunistic infections and other malignancy.

INCIDENCE
IN WORLD
 According to World Health organisation (WHO) HIV data and statistics, globally and estimated 39
million people living with HIV and AIDS at the end of 2023.
 Almost 630,000 number of people in the world have died of HIV illness.
 People acquiring HIV is 1.3 million and African region remain the most severely affected in the world
wide.
 In 39 million HIV infected people among the 1.4 million are children and 38.6 million are adults . In
addition women and girls are the most affected.

IN INDIA
 According to National AIDS Control Organisation (NACO) in 2023 HIV and AIDS prevalence rate in
India is lower than in many other countries.
 2.5 million people is living with HIV infection in India. As if in 2023 India reported estimated about
68000 cases of HIV infection in children across the country.
 The highest prevalence of HIV and AIDS in India is in Maharashtra, Andhra Pradesh and Karnataka
being in the top position in the country.

IN TELANGANA
 According to the Telangana State AIDS Control Society (TSACS) in 2023 adult prevalence rate of
HIV/AIDS in Telangana comes down 0.47%.
 It has reduced from 0.66% to 0.47%and there is an 71% of reduction in new HIV infection and 88% of
reduction in the death rate.

MODE OF TRANSMISSION
HIV fragile virus it can only be transmitted under specific conditions that allow contact with infected bloody
fluid such as blood, seminal fluid, vaginal secretions, amniotic fluids and breast milk.

 SEXUAL TRANSMISSION

Unprotected sexual contact with an HIV infected partner is the most common mode of transmission . It
can be transmitted through sexual intercourse with an infected partner.
 CONTACT WITH THE BLOOD AND BLOOD PRODUCTS
Blood and blood products can transmit HIV to recipient and HIV can be transmitted during exposure to
blood through blood transfusions ,needle stick exposure ,puncture wounds.

 PERINATAL OR MATERNAL EXPOSURE

Transmission from an infected mother to her infant can occur during pregnancy , at the time of delivery or
during breastfeeding.

TYPES
HIV can be mainly classified into two main groups they are HIV 1 and HIV2.

HIV1
HIV1 is the most common type and they found worldwide .They can be transmitted easily from mother to
child and the progression to AIDS is faster . These are more virulent in nature and easily transmitted. The
plasma viral load are higher and the average level of immune system activation is very high. During
progression HIV 1 has lower CD4 cell count.

HIV2
HIV2 is the less common as compared to HIV 1 and they are confined in west Africa. They are less easily
transmitted from mother to child and the progression to AIDS is slower than HIV [Link] are less virulent
and the plasma viral load are lower. There is a average level of immune system activation.

MYTHS AND FACTS ABOUT HIV AND AIDS

MYTHS : HIV can be transmitted through casual contact, such as hugging , shaking hands or sharing
dishes.
FACT : HIV is not spread through a casual contact, it is transmitted through contact with certain body fluids
such as blood, semen, vaginal fluids and breast milk .
MYTHS : HIV can be transmitted from mosquito , tick bites.
FACT : HIV cannot be transmitted by mosquito or other insects ,it requires direct contact with the infected
body fluids.
MYTHS : There is cure for HIV and AIDS.
FACT : where is currently no cure for HIV and AIDS but can be managed effectively with an the
antiretroviral therapy.
 MYTH : HIV always leads to AIDS.
FACT : people with HIV won’t necessarily progress to AIDS especially if they keep up with their treatment.

STAGES OF HIV INFECTION

HIV has four main clinical stage .People may progress through these stages at different rates, depending on a
variety of factors .
Stages of HIV infections are:
 Early stage / Acute infection stage
 Clinical latency stage/ Asymptomatic disease (clinical stage 1)
 Mild signs and symptoms of HIV (clinical stage 2)
 Advanced signs and symptoms of HIV (clinical stage 3)
 AIDS or clinical stage 4.

Acute Infectious stage

within 2-4 weeks after HIV infection, people develop flu-like symptoms. Often called as the worst flue .The
symptoms include fever, swollen glands, sore throat, rash’s, muscle and Joint aches this stage is also called
acute retroviral syndrome.

Clinical Latency I Asymptomatic Disease a clinical stage 1

HIV infected individual experience a clinically latent period. If the immune system produces antibodies in
attempt to protect itself from HIV. During latency HIV infected may or may not have signs and symptoms . A
persistent lymphadenopathy occurs.

Mild signs and symptoms of HIV / Clinical stage 2

Minor signs and symptoms of HIV infection begin. They may develop candidiasis lymphadenopathy , herpes
zoster. The viral load increases, and the CD4 count falls between 350-499 in children. During this stage HIV
virus reproduce at very low levels still active.

Advanced Signs symptoms of HIV /Clinical stage 3

The development of , pulmonary and lymph node TB, wasting, persistent fever, candidiasis, bacterial
pneumonia a other opportunistic infections. In this stage patients may be wasting or losing weight. The viral
load increases.

AIDS (acquired Immunodeficiency syndrome) clinical stage 4

In this stage the immune system is badly damaged and become vulnerable to infections and other opportunistic
infection. When the number of CD4 cells fall below 200 cells are considered to have progressed to AIDS.

ETIOLOGY
 Human immunodeficiency virus (HIV)
 Retrovirus
  Sexual practices, including vaginal or anal penetration without a condom and oral sexual practices are
associated with high risk of infection .
 The use of contaminated needles for subcutaneous, intramuscular or Iv injection is another source of
infection.
 Women who are infected may pass the virus into their new-born via three potential routes: gestation,
delivery and through breastfeeding.
 Blood, semen and vaginal secretions are primary sources for infections, and via saliva, tears and
breastmilk .
 Blood transfusions are not mainly significant source of HIV infection.
 contact with blood and blood products containing HIV infection.
 HIV is also transmitted through bodily fluids by high risk behaviour such as heterosexual intercourse
with an HIV infected partner, injection drugs use and male homosexual relations.

RISK FACTORS
The main risk factor for HIV/AIDS core :-
Sexual practices
 Unprotected sex: Engaging in vaginal, anal sex without using condom or other barrier methods with
someone who have HIV infection.
 Multiple sexual partners: Having multiple sexual partners increases the likelihood of encountering an
HIV positive individual.
 Sexual partners with unknown HIV status.
 Improper condom usage or condom breakage.
 Presence of other sexually transmitted diseases, open sores, lesions or irritation in the genital area.
 High risk sexual behaviour.
Contaminated blood and blood products
 Receiving blood transfusion or organ transplant from an HIV positive donor.
 Through the use of contaminated needles and by sharing needles or syringes for drug use, tattoos or by
piercing.
 Blood transfusion: receiving blood transfusion from an HIV infected person.

Occupational exposure
 All healthcare workers: acute , long term and home care.
 Needle stick injury
  Dental workers and other healthcare workers.

Inadequate medical procedures

 Receiving medical procedures with improperly sterilized equipment, particularly in areas with limited
healthcare recourses.
 Inadequate sterilization

Mother to child transmission or perinatal exposure

 During pregnancy
Through the mother’s blood can cross the placenta and it will infect the foetus.

 During delivery
The mother’s blood or cervical secretions can infect the foetus during childbirth.

 During breastfeeding
The mother’s breastmilk or blood can infect the baby.
Injection drug use
Through injection drug use HIV can transmitted by sharing needles and other equipment.
PATHOPHYSIOLOGY
Due to etiological factors

Virus enter the immune system and attack the CD4 cell (T cell)

Viral RNA enters the cell

RNA transcribes DNA by enzyme reverse transcriptase

Integrase inserts viral DNA into host DNA

Destroying the T cell and person was immunocompromised

Multiple infections and progression to AIDS

PATHOGENISIS
 Viral entry and Infection
The primarily targets the CD4 cells, which are crucial for immune system. The virus enters the body through
the mucosal surfaces, by unprotected sexual contact and through blood exposure .HIV binds to the CD4
receptor on T cells and co-receptors facilitating the entry to cell.

 Viral replication
Once inside the CD4 cell , HIV releases its RNA genome into the cell cytoplasm. The enzyme reverse
transcriptase converts viral RNA to DNA. This viral DNA is then integrated into the host cell’s DNA by the
enzyme integrase and produced new viral proteins.

 Cell destruction and Immune system Decline

 Newly formed HIV particles bud from the host cell, which will destroy the T cell, which will destroy the T
cells .The continuous cycle of infection and cell destruction leads to a decline in CD4 cell and compromising
the immune system.

 Progression to AIDS
If the infections left untreated the immune system is severely weakened. In this stage the CD4 cell count
becomes 200 cells / mm3 or the occurrence of cancers , opportunistic infections, and other infections.

 Clinical manifestation and complication

Progression to AIDS can lead to occurrence of susceptible opportunistic infections and other complications.

CLINICAL MANIFESTATIONS
Symptoms are widespread and may affect the organ systems. Manifestations range from mild abnormalities in
the immune response without overt signs and symptoms .

RESPIRATORY
 Shortness of breathing
 Dyspnoea ,cough, chest-pain, fever

 Opportunistic infections including pneumonia , pneumocystis jiroveci.

 HIV associated tuberculosis

GASTROINTESTINAL
 Loss of appetite
 Nausea and vomiting

 Oral and oesophageal candidiasis

  Chronic diarrhoea with weight loss and electrolyte imbalance

WASTING SYNDROME
 Multifactorial protein energy malnutrition
 Profound involuntary weight loss , chronic weakness and anorexia

NEUROLOGICAL SYSTEM
 HIV encephalopathy
 HIV related peripheral neuropathy
 Other neurologic disorders including TB
INTEGUMENTARY SYSTEM
 Kaposi’s sarcoma
 Herpes simplex
 Herpes zoster virus
 Dermatitis

REPRODUCTIVE SYSTEM
 Vaginal candidiasis
 Pelvic inflammatory disease
 Menstrual abnormalities
 Vaginal warts and cervical cancer

HEMATOLOGIC SYSTEM
 B cell lymphoma
OTHERS
 Their will be a persistent diarrhoea is very common in HIV infections.
 Profuse weight loss and muscle weakness
 shortness of breath
 Other depressive symptoms include neuropsychiatric symptoms , loss of self esteem
 Dry cough and other infections
  Flue like symptoms

 Lymphadenopathy

DIAGNOSTIC FINDINGS
 History collection and physical examination
 Antibody assay
  ELISA
 Western blot test
 Rapid test
 Viral load
 CD4 cell count test
 Other tests

HISTORY COLLECTION
 Personal history or demographic data
 Medical history
Any previous illness comorbidities and any prior treatment for HIV or other infections.
 Present illness
Allergy reactions altered immune system ask the patient for this manifestations. Flue like illness
consistency of fever, chills , night sweats, malaise and generalized rashes
Ask about the onset of symptoms duration and a progression and severity of symptoms like rash a
weight loss of a current infections and location of the swollen lymph nodes.
 Progression how the symptoms evolved over time
 Past medical history
Any previous opportunity infections or complication like a tuberculosis, pneumonia.
Ask for the status of vaccinations like influenza vaccine and HBV and know drug allergy or other.
 Risk factor : ask the patient about any exposure to the risk factors of HIV
 Social history: lifestyle, living situations and social support
 Any family history of HIV or relevant other illness ,diet and nutrition.

PHYSICAL EXAMINATION
 Inspection : inspect the patients skin and mucus membrane for lesions ,dermatitis ,purpora and
also inspect for any chills , night sweats , rashes and oral thrush.
 Inspect the surfaces overlaying lymph nodes of neck, head ,axilla, inguinal and popliteal fossa.
 Palpation : Palpate the lymph nodes for swelling, enlargement, tenderness, warmth and
temperature. Abnormal lymph nodes are larger than 1 cm diameter hard and tender. Identify
these characteristics thoroughly.

ANTIBODY ASSAYS
Antibody assay measure the immune system's response from exposure to a specific antigens. when an antigen
enters the host, The immune system recognize the antigen and produce specific against it .Antibody assay test
depend on antibody formation, but a patient's serum may not have detectable levels of antibody during the
initial Stage of infection .The production of detectable antibodies is known as “The windows period".
Antibody testing is unreliable until the infant is 18 months of age.

ELISA ( Enzyme linked immunosorbant assay)

The ELISA is highly specific test that is close to 99.6% sensitive for HIV 1 antibodies. If the
patients serum is reactive, the patient is considered seropositive for HIV antibodies. False
positive are possible and may occurs from recent influenza, or hepatitis of vaccines; in
multiparous women's after multiple blood transfusion, or with multiple myeloma, hepatitis of
biliary rashes.
WESTERN BLOT TEST
If a patient has a positive ELISA as it confirmed by the western blot technique , another more sensitive test for
HIV 1 antibodies. The western blot test for antibodies to four major HIV antigens , two of which must be
present for a positive result .The Western bloat test relies on the production of antibodies and their for may not
detect antibodies during the early stages of infection.

RAPID TESTS
Rapid HIV antibody tests are being more widely used today because of ease of use and convenience. Many have
comparable sensitivities to the ELISA and western blood test.

VIRAL LOAD TEST

Plasma HIV RNA levels indicate the amount of virus in the person serum which is a reflection of active viral
replication or viral load. The stepper the rate e of increase in plasma HIV RNA the greater the risk of disease
progression unless and antiretroviral therapy is started. HIV RNA viral load is measured by one of the three
assay quality RNA PCR, branch DNA assay or nucleic acid sequence based amplification. Viral load is
measured periodically in HIV positive person to assess their disease progression and monitor the effectiveness
of antiretroviral therapy. The therapy is aimed at reducing plasma HIV RNA levels of below the limit of
dictation by assay.

CD4 CELL COUNT

CD for cell counts are used to measure the extent of immune damage that has occurred as a result of HIV
infection at its complications and to monitor the immunological benefit of an electron viral therapy. CD4 cell
counts are obtained on all newly diagnostic patients to establish a baseline and every 3 to 4 months there after
counts are above 350 and the patient is a asymptomatic. The CD4 cell counts are used in conjunction with viral
load to predict the possibility of disease progression, determine when to start and antiretroviral therapy and to
monitor the effectiveness of treatment .

OTHER TESTS
Other diagnostic studies are obtained to established baseline to monitor patient progress and identify positive co
infections.

 PCR ( polymerase is chain reaction)

 CBC (complete blood count)
PCR TEST: PCR test is mainly used to detect the presence of HIV genetic material. They
are used for the early detection and it is also used to detect and monitor the viral load in
blood and can be sometimes used as an confirmatory test.
CBC TEST: It is used to access and monitor the immune system health, assessing the
complication and treatment monitoring. It is helpful in the management and monitoring of
the HIV infection.
CBC test can also access and reveal:
 Anaemia :low red blood cell count, which can be associated with chronic HIV
infections.
 Leukopenia: low white blood cells count, particularly a reduced count of CD4 cells
which can indicate immune suppression.
 Thrombocytopenia :low platelet count which may be seen in advanced HIV diseases.
MANAGEMENT
 Currently there is no cure for HIV or AIDS , although researchers continue to work
on developing a vaccine.
 Treatment decisions for an individual patient are based on three factors; HIV, RNA
(Viral load ),CD4 T-cell counts, and the clinical conditions of the patient ( severity
to symptoms and patients commitment to participate in lifelong therapy).
 To determine and evaluate the treatment plan, viral load resting is recommended at
diagnosis and then every 3 to 4 months thereafter in the untreated person.
 CD4+ T-cell counts should be measured at diagnosis and generally every 3 to 6
months thereafter.

MEDICAL MANAGEMENT
 Antiretroviral therapy ( ART ) :
Anti-retroviral therapy ( ART ) is a medical treatment that involves the use of a
combination of antiretroviral drugs to suppress the replication of the human
immunodeficiency virus ( HIV ) in the body. This therapy helps to slow down the
progression of HIV; improve immune function, and reduce the risk of HIV.

o Anti-retroviral therapy include :

1. Nucleoside / Nucleotide Reverse Transcriptase Inhibitors ( NRTI )

2. Non-Nucleoside Reverse Transcriptase Inhibitors ( NNRTI )
3. Protease Inhibitors
4. Fusion Inhibitors
5. Combination Therapy.

o Nucleoside Reverse Transcriptase Inhibitors ( NRTI ) :

o These drugs interrupt the virus from duplicating, which may show the spread
of HIV in the body.

o They include :

 Zidovudine
 Stavudine d4T
 Lamivudine
 Tenofovir
 Abacavir
o Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) :

o Non-Nucleoside Reverse Transcriptase Inhibitors ( NNRTI ) block the

infection of new cells by HIV.
o These drugs may be prescribed in combination with other anti-retroviral drugs.
It is used mainly to prevent HIV from mother to child.

o NNRTI include :

 Zevikapine
 Delavirdine
 Efravirenz ( Sustiva )
 Nevirapine

o Protease Inhibitors :

o These FDA- approved drugs interrupt virus replications at a later step in the
virus life cycle.

o Protease Inhibitors include :

 Indiavir
 Ritonavir
 Lopinavir
 Fosamprenavir
 Atazanavir
 Amprenavir
 Saquinavir ( Fortovase, invirase )

o Fusion inhibitors :

o Fusion inhibitors drugs are act against HIV by preventing the virus
from fusing with the inside of cell , preventing it from replicating .
o Fusion Inhibitors include :

 Enfuvirtide
 Fuzeon
 T-20

o Combination therapy :

o Combination therapy is defined as a regimen containing at least

two anti retroviral agent ; Highly active anti retroviral therapy
(HAART ) includes at least one Nucleoside reverse transcriptase
inhibitors plus various other drug combinations.
o As new medications are developed ,the number of combination
continues to increase.
o High cost of medication difficulties with adherence to the
regimen ,drug resistance ,and drug toxicities present problems in
drug therapy.
o Intermittent therapy is under investigations as an alternative
regimen.
NURSING MANAGEMENT

o Educate the patient to use the safe sexual practice to prevent

infection to the partner.
o Instruct the patient to use safety disposal of blood and body
fluids.
o Educated the patient to avoid exposure to crowded area to
prevent the spread of infection.
o Instruct the patient to take balanced diet.
o Educate the patient to maintain and monitor the body weight.
o Provide a support and encouragement to mother and child .
o Give health education to patient and family members on
national AIDS program.

NURSING ASSESSMENT

o Nursing assessment for individuals not known to be infected

with HIV should focus on behavior that could put the person at
risk for HIV infection and other sexually transmitted and blood
borne disease.
o All Patients should be assessed for risky behaviors on a regular
basis.
o Assess the patients physical status and psychological status.
o Nursing assessment includes identification of potential risk
factors ; including a history of risky sexual practice or IV
injection drug use.
NUTRITIONAL STATUS

o Nutritional status is assessed by obtaining a dietary history and identifying factors

that may interferes with oral intake, such as Anorexia , nausea, vomiting, oral pain
or difficulty swallowing . In addition the patient ability to purchase prepare and
store food safely is assessed . Weight history ( i.e., changes over time),
anthropometric measurements, and blood urea nitrogen ( BUN ) ,serum protein,
albumin , and transferrin levels provide objective measurements of nutritional
status.

SKIN INTEGRITY AND MUCOUS MEMBRANE

o The skin and mucus membrane are inspected daily for evidence of breakdown ,
ulceration or infection. The oral cavity is monitored for redness, ulceration and
the presence of creamy white patches indicative of candidiasis. Assessment of the
perennial area for excoriation and infection in patients with profuse diarrhea is
important. Wounds are cultured to identify infectious organisms.

RESPIRATORY STATUS

o Respiratory status is assessed by monitoring the patient for cough , sputum

production ( i.e., amount and color ), shortness of breath , orthopnea , tachypnea
and chest pain. The presence and quality of breath sounds are investigated. Other
measures of pulmonary function include chest x-ray results , arterial blood gas
valves, pulse oximetry and pulmonary function test result.

NEUROLOGIC STATUS

o Neurologic status is determined by assessing level of consciousness,

orientation to person, place, and time and memory lapses. Mental status is
assessed as early as possible to provide a baseline. The patient is also assessed
 (visual changes ,headache or numbness and tingling in the extremities ),motor
involvement ( altered gait paresis or paralysis and seizure activity.

FLUID AND ELECTROLYTE STATUS

o Assess for dehydration by observing for increased thirst, decreased urine output
low blood pressure ,weak rapid pulse, or urine specific gravity.
o Monitor electrolyte imbalance ( laboratory studies show low serum sodium
potassium calcium magnesium and chloride ).
o Assess for signs and symptoms of electrolyte depletion, including decreasing
mental status , muscle twitching , muscle cramps , irregular pulse, nausea and
vomiting and swallow respirations.

NURSING DIAGNOSIS

o Risk for infection related to immunodeficiency as evidenced by recurrent

occurrence of skin infection.
o Deficit fluid volume related to pathogens or HIV infection as evidenced by
diarrhea.
o Imbalanced nutrition less than body requirements related to decreased oral intake
as evidenced by weight loss.
o Impaired oral mucous membrane related to repeated fungal infection as evidenced
by stomatitis.
o Activity intolerance related to disease progress as evidenced by physical activity
and weakness, fatigue and malnutrition.
o Anxiety related to recurrent bacterial infection as evidenced by weakness,
verbalization.
COMPLICATIONS

o Tuberculosis
o Cytomegalovirus
o Candidiasis
o Cryptococcal meningitis
o Toxoplasmosis
o Cryptosporidiosis
o Wasting syndrome
o Neurological compilations
o Kidney disease
o Kaposi’s sarcoma
o Lymphomas

TUBERCULOSIS
  In resources -poor nations, tuberculosis is the most common opportunistic infection
associated with HIV and a leading cause of death among people with AIDS.

CYTOMEGALOVIRUS

 This is common herpes virus is transmitted in body fluids such as , saliva, blood,
urine, semen and breast milk.
 If your immune system is weakness the virus resurface the causing damage to eye,
digestive system tract, lungs or other body organs.

CANDIDIASIS
  Candidiasis is a common HIV – related infection .
 It causes inflammation and a thick white coating on the mucous membrane of
your mouth, tongue, esophagus or vagina .

CRYPTOCOCCAL MENINGITIS

 Meningitis is an inflammation of the membrane and fluid surrounding your brain and
spinal cord ( meninges ).
 Cryptococcal meningitis is a common central nervous system infection associated
with HIV , caused by a fungus found in soil.
TOXOPLASMOSIS

 This infection is caused by an intestinal parasite that’s commonly found in animals.

 The parasite grows in your intestines and bile ducts, leading to severe, chronic
diarrhea in people with AIDS.

WASTING SYNDROME

 Aggressive treatment regimens have reduced the number of cause of wasting

syndrome, but it still affects many people with AIDS.
  It’s defined as a loss of at least 10% of body weight, often accompanied by diarrhea,
weakness and fever.

NEUROLOGICAL COMPILATIONS

 Although AIDS doesn’t appear to infection the nerve cells, it can cause neurological
symptoms such as, confusion, forgetfulness, depression, anxiety and difficulty
walking.
 One of the most common neurological compilations is AIDS dementia complex,
which leads to behavioral changes and diminished mental functioning.

KIDNEY DISEASE

 HIV- associated nephrology ( HIV ) is an inflammation of the tiney filters in your

kidneys that removes excess fluid and waste from your blood stream and pass them
to your urine.

KAPOSI’S SARCOMA
  A tumor of the blood vessel walls, this cancer is rare in people not infected with HIV,
but common in HIV- positive people.
 Kaposi’s sarcoma can also affect the internal organs, including the digestive tract and
lungs.

LYMPHOMAS

 This type of cancer originates in your white blood cells and usually first appears in
your lymph nodes.
 The most common early sign in painless swelling of the lymph nodes in your neck ,
armpit or groin.

PREVENTION
 Levels of prevention:

1. Primary
2. Secondary
3. Tertiary

 PRIMARY PREVENTION
 Avoid multiple partners.
 Aims to reduce the transmission and acquisition of HIV.
 This can be done by targeting uninfected individuals, such as through condoms.
 Education relating to sexual and reproductive health.
 E.g.: School Educational programme.
 Public campaigns.
  Biomedical interventions
 Pre-exposure prophylaxis ( PrEP)
 Post-exposure prophylaxis ( PEP )

 Pre-exposure prophylaxis (PrEP) :

 Pre-exposure prophylaxis( PrEP) is a medicine that can help prevent HIV

infection.
 It’s taken by people who are at high risk of getting HIV but don’t have HIV
themselves.
 Post-exposure prophylaxis (PEP) :

 Post – exposure prophylaxis(PEP) is a combination of HIV drugs that can

prevent HIV infection if taken within 72 hours of possible exposure, it’s an
emergency measure that’s not meant for regular use.

 SECONDARY PREVENTION

 Secondary HIV prevention aimed at enabling people with HIV to stay well.
 Aims to diagnosis people living with HIV so they can receive treatment to
prevent complications and reduce the risk of transmission.
 Eg : Testing to allow people to know their status; welfare rights
advice ; lifestyle behavior; anti – discriminatory lobbying.

 TERTIARY PREVENTION

 Rehabilitation of HIV / AIDS patients :

o Rehabilitation centers in country dedicated to hospitalizing and rehabilitation

patients with severe AIDS and palliative supporting terminal AIDS patients.

o They provide medical, social and psychological services.

o Patients are treated with sympathetic attitude and advices to take adequate rest and
diet rich in proteins and vitamins.

o In these homes patients learn new strategies for an improved quality of life.
SUMMARY
 Human immunodeficiency virus( HIV ) is a virus that attacks the body’s immune
system, specifically the CD4 cells which are crucial for immune defense. HIV is
transmitted by contact with certain body fluids, including blood, semen, vaginal,
rectal fluids and breast milk and the common routes including unprotected sexual
contact by sharing needles, perinatal exposure and the clinical manifestations include
fever, sore throat, swollen lymph nodes, candidiasis, Nausea and vomiting. The
diagnose of HIV infection include antibody assays, ELISA test, western blot test, viral
load and CD4 cell count test.

 The HIV can treated and prevented by the anti retro viral therapy( ART) can
effectively manage the virus helping the individual to improve the life quality. If left
untreated HIV can progress to its advantage stage AIDS( acquired immunodeficiency
syndrome) characterized by a significantly weakened immune system and the onset of
the opportunistic infections or malignancies. Preventive measures and health
education can reduce the transmission of the HIV infection to uninfected individuals.

CONCLUSION
 In conclusion, HIV / AIDS is a worldwide epidemic and is a major threat to human
health worldwide. It is a contagious s and complicated disease which require critical
assessment by the multi disciplinary team.
 HIV can be effectively managed and prevented by the (anti retro viral therapy )
preventing its transmission through education, self sex practice and through the
regular testing is crucial. Early diagnosis can reduce the risk of progression to AIDS.
Their is no vaccine for HIV / AIDS. Early detection and treatment are key in
managing HIV and preventing its progression to does not make people dangerous so
you can shake hands and give hugs but should not should take preventive measures.

BIBLIOGRAPHY

 B. Venkateshan’s “a textbook of medical surgical nursing 1st edition, volume 2

EMMESS medical publisher page no: 669 - 680.
 Brunner and Siddharth’s “ a textbook of medical surgical nursing South Asian edition
volume 2 published by Wolters Kluwer’s page no : 1432 -1455.
 B-T vasavanthappa “ a textbook of medical surgical nursing 1st edition, volume 2
Kluwer’s publisher page no: 178-187.
 Lewis’s “ a textbook of medical surgical nursing 3rd edition, volume -1 Elsevier
publishers page no : 168-177.
 The Indian journal of medical research, volume page no: 158, Kluwer’s publisher’s .