Acquired Immune
Deficiency Syndrome
and HIV
• HIV infection leads to profound pathology and
resultant immunosupression.
• Infectious disease characterized by severe deficits
in cellular function
• Manifested clinically by opportunistic infections
and or unusual neoplasms
• Long incubation period (up to 10 years or more)
• Manifestations may not appear until late in the
infection.
• Caused by HIV
• Both cellular and humoral responses are
compromised
THE GOALS OF THERAPY
• Slow the growth of virus.
• Prevent and treat opportunistic illness.
• Provide nutritional support.
• Provide symptomatic treatment.
PATHOPHYSIOLOGY
• HIV strikes helper T cells bearing CD4 antigen
• The antigen serves as a receptor for the retrovirus,
letting it enter the cell.
• After invading a cell, HIV replicates (leading to cell
death)
STAGES
Stage 1: Primary HIV Infection
• Flu like symptoms
• Last a few weeks
• Body produces HIV antibodies and cytotoxic
lymphocytes – Seroconversion
• If test is done before seroconversion is complete, test
might become negative
Stage 2: Clinically Asymptomatic Stage
• Lasts an average of 10 years
• Free from major symptoms but there might be swollen
glands – HIV attacks the lymph nodes
Stage 3: Symptomatic HIV infection
• Immune system becomes severly damaged: Lymph
nodes becomes damaged, HIV mutates and body fails to
replace T-cells
• Opportunistic infections emerges
Stage 4: AIDS
• CD4 is less than 200 cells/mm3 . CD4 percentage less
than 20% (children aged 12-35 months) and a CD4
percentage less than 25% (children less than 12 months)
• Normal=?
DIAGNOSTIC TESTS
• Enzyme linked immunosorbent assay (ELISA)
determines the response of the antibodies to the HIV
virus
• WESTERN BLOT and INDIRECT FLUORESCENT
ANTIBODY confirms the presence of HIV antibodies
• Positive western blot and IFA is considered confirmatory
for HIV
• A positive ELISA that fails to be confirmed by WB or IFA
should not be considered negative, and repeat testing
should be done in 3 to 6 months.
HIGH RISK GROUPS
• Male homosexuals or bisexuals
• Intravenous drug users
• Persons receiving BTs (hemophiliacs, surgical
patients)—horizontal transmission
• Those client with frequent exposure to blood and body
fluids
• Heterosexual contact with high risk individuals
• Babies born to infected mothers—vertical transmission
(perinatal)
ASSESSMENT
• Malaise, weight loss, fatigue
• Lymphadenopathy of at least 3 months
• Diarrhea
• Night sweats
• Opportunistic infections: Pneumocytis carinii, pneumonia
(major source of mortality)
• Kaposi’s sarcoma: purplish red lesions on internal
organs and skin
• Candidiasis
• Fungal infections
TREATMENT
• Disease specific therapy for a variety of neoplastic and
premalignant diseases and organ specific syndromes
• Symptom management (palliative care)
• Well balanced diet
• Regular exercise as tolerated
• Immunodulatory agents, antibacterial, antineoplastics,
antiretrovirals
•
MANAGEMENT
• H- Health Education
• I -Infection Protection
• V -Ventilator Support
• D -Drug Regimen
• I -Increase Caloric Requirement (Wasting Syndrome,
No fresh Fruits and Vegetables)
• S -Support Groups
• E -Ensure Adequate bed rest
• A-Assure Skin Care
• S -Sensory and Motor Checks
• E -Establish grieving support measures
Anti-Retroviral Drug Abbreviati How they attack Examples
class ons
Nucleoside/Nucleotide NRTI Interfere with action of protein reverse Zidovudine
Reverse Transcriptase transcriptase Stavudine
Inhibitors Abacavir
Lamivudine
Combivir
Non-Nucleoside NNRTI’s, Interfere with action of protein reverse Delavirdine
Reverse Transcriptase Non- transcriptase Efavirenz
Inhibitors nucleoside Rilpivirine
s, non-
nukes
Protease Inhibitors P’s Inhibit protease, involved in replication Amprenavir
process Indinavir
Saquinavir
Fosamprenavir
Fusion or Entry Prevents binding or entering immune Enfuvirtide
Inhibitors cells Maraviroc
Integrase Inhibitors Interfere with integrase enzyme needed Raltegravir
to insert its genetic material into human
cells
