HIV Infection and AIDS
● The cause of HIV infection is a virus – human immunodeficiency virus
○ Viral particles have an outer coat with special “docking proteins” (gp41 and gp120), which
assist in finding a host
○ Inside, HIV has RNA genetic material along with enzymes reverse transcriptase (RT),
HIV protease, and HIV integrase
○ Viral binding to the CD4 receptor and to either of the co-receptors is needed to enter the
cell (drug class → fusion inhibitors → works here to prevent the interaction needed for
entry of HIV into the CD4+ T-cell
○ Because HIV is a retrovirus → able to insert
its single-stranded ribonucleic acid
(ss-RNA) genetic material into the host’s
DNA
○ HIV particles are made within the infected
CD4+ T-cells – uses the host cell’s protein
synthesis processes
○ Effects of HIV infection are related to the
new genetic instructions that now direct
CD4+ T-cells to become an “HIV factory,”
making billions of new viral particles daily.
○ Early HIV → before the disease is evident
→ the immune system can still attack and
destroy most of the newly created virus
particles
● Everyone who has AIDS has HIV infection → not
everyone who had HIV has AIDS
○ Distinction is the number of CD4+ T-cells and whether any opportunistic infections have
occurred
■ Healthy adult has at least 800-1000 CD4+ T-cells mm^3 of blood
● Develop acute infection reaction within 4 weeks of first being infected
○ Fever, sore throat, rash, night sweats, chill, HA, and muscle aches → similar to any viral
infection
● Progression with transition to stage HIV-II is when infected adults are most often diagnosed with
HIV disease and management with drug therapy is started
○ Immune dysfunction drops
● A diagnosis of AIDS (HIV-III)
○ Adult be HIV positive
○ Have either:
■ CD4+ T-cell count of <200 cells/mm^3 or less than 14%
■ An opportunistic infection (decreased CD4 count = opportunistic infection)
● HIV Progression
○ When HIV results from a single sexual encounter → progression takes longer
○ Personal factors influencing time to progression include frequency of re-exposure to HIV,
presence of other STIs, nutrition status, and stress
● Health and Promotion
○ Found in blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces,
saliva, tears, CSF, lymph nodes, cervical cells, corneal tissue, and brain tissue
, ○ Transmitted:
■ Sexual → genital, anal, or oral
■ Parenteral → sharing needles or equipment contaminated with infected
blood
● Main occupation-related HIV infection means
■ Perinatal → from placenta, contact with maternal blood/body fluids during birth,
or from breast milk
○ Teach all adults about transmission routes and ways to reduce exposure
○ HIV is NOT transmitting by casual contact in the home, school, or workplace
■ Sharing household utensils, towels and linens, and toilet facilities does not
transmit HIV
○ Not spread by mosquitoes or other insects
Recommendations for Preventing HIV Transmission by Health Care Workers
● Adhere to Standard Precaution
● If you have exudative lesions or weeping dermatitis, do not perform direct pt. care or handle pt.
care equipment and devices used in invasive procedures
● Follow guidelines for disinfection and sterilization or reusable equipment used in invasive
procedures
● If you are infected with HIV, you may perform non-exposure-prone procedures, as long as you
comply with Standard Precautions and sterilization and disinfection recommendations
● Identify exposure-prone procedures by institutions where they are performed
● If you perform exposure-prone procedures, know you HIV antibody status
● If you are infected with HIV, check with an expert review panel before performing exposure-prone
procedures to determine under which circumstances you may continue to practice these
procedures with notification of prospective pt. of your HIV positivity
AIDS (HIV-III) → Opportunistic Infections
Protozoal-like Viral
Toxoplasmosis Cytomegalovirus
Cryptosporidiosis Herpes simplex zoster
Isosporiasis, microsporidiosis Varicella-zoster virus
Strongyloidiasis Malignancies
Giardiasis Kaposi’s sarcoma
Fungal Non-Hodgkin’s lymphoma
Candidiasis Hodgkin’s lymphoma
Pneumocystis jiroveci pneumonia Invasive cervical carcinoma
Cryptococcosis
Histoplasmosis
Coccidioidomycosis
Bacterial
Mycobacterium avium complex
Tuberculosis
Nocardiosis
● History
○ Ask about age, gender, occupation, and home environment
, ○ Assess current illness → when it started, the severity of symptoms, associated problems,
and any interventions to date
● Opportunistic Infections → Disease is taking over
○ Caused by overgrowth of the pt. microbiome (normal flora) — only when immunity is
depressed are such organisms capable of causing infection
○ May result from new infection or reactivation of a previous infection – usually protozoan,
fungal, bacterial, or viral
○ Usually indicate disease progression or a temporary further reduction of immunity and
can result in death if treatment is not started quickly
○ Rarely poses a threat to the health care worker who has normal immunity when caring for
a pt. with HIV disease at any stage
○ Protozoal and fungal infections are common among pt. with AIDS
■ Pneumocystis jiroveci pneumonia (PCP)
● SOB, tachypnea, persistent dry cough, persistent low-grade fever,
fatigue, weight loss → assess for crackles
■ Toxoplasmosis encephalitis → caused by toxoplasma gondii → acquired through
contact with contaminated cat feces/ingesting infected undercooked meat
● Subtle changes in mental status, neurologic deficits, HA, fever, difficulties
with speech, gait, and vision, seizures, lethargy, and confusion
● Perform a comprehensive mental status exam and MT the pt. to detect
subtle changes
■ Cryptosporidiosis → intestinal infection caused by Cryptosporidium organisms
● Diarrhea with significant fluid loss
● Ask about diarrhea and whether they
have had an unplanned weight loss of 5
lbs or more
○ Fungal → most often an overgrowth of normal body flora
■ Candida albicans → intestinal tract’s natural flora
● Food tasting “funny,” mouth pain,
difficulty swallowing, pain behind the
sternum
● Cottage-cheese-like, yellow-ish white
plaques and inflammation upon
examination of the mouth and throat
(thrush) → zero taste, quickly dehydrated
■ Cryptococcosis → cryptococcus neoformans → debilitating meningitis → widely
spread infection in AIDS
● Fever, HA, blurred vision, nausea, vomiting, neck stiffness, confusion,
other mental changes, seizures and other neurological problems, mild
malaise, fever
■ Histoplasmosis → histoplasma capsulatum → begins as a respiratory infection
and progresses to widespread infection in AIDS
● Dyspnea, fever, cough, weight loss
● Assess for enlargement of the lymph nodes, spleen, or liver
○ Bacterial → acquired from other people or sources and as overgrowth of skin flora
■ Tuberculosis (TB) → Mycobacterium tuberculosis → occurs in 2-10% of adults
with AIDS
○ Viral → from a virus other than HIV → common among adults with HIV that has
progressed to AIDS
, ■ Cytomegalovirus (CMV) → can infect many sites → eye, respiratory, GI tracts,
CNS
● Fever, malaise, weight loss, fatigue, swollen lymph nodes, diarrhea, abd.
bloating, discomfort, weight loss
● CMV retinitis (eyes) → impairs vision (slight to total blindness)
■ Herpes simplex virus (HSV) → occurs in perirectal, oral, and genital areas
● Numbness or tingling at the site for up to 24 hours before blisters form,
lesions are painful, chronic open areas
after blisters rupture
● Fever, HA, pain, enlarged lymph nodes
in the affected area, and malaise
■ Varicella-zoster virus (VZV) → not a new
infection for adults with AIDS
● Chicken pox with rash and fever
● Malignancies
○ Kaposi sarcoma, lymphomas, invasive cervical cancer,
lung cancer, GI cancer, and anal cancer
○ Kaposi sarcoma → most common AIDS-related
■ Small, purplish-brown, raised lesions on skin
and mucous membranes that are usually not
painful or itchy
● Lab Assessment
○ Lymphocyte counts in addition to CBC with differential
→ often leukopenic with AIDS → WBC less than 3500 cells/mm^3
○ Antibody-Antigen tests → pt. response to the virus (the antigen) and are indirect tests for
HIV
■ HIV antibodies can be measured by enzyme-linked immunosorbent assay
(ELISA) and Western blot analysis, which is an older testing algorithm
■ Positive → confirmatory Western blot test is done → more sensitive and specific
for HIV
● HIV antibodies are not detected for at least 14-21 days after exposure →
Western blot requires an additional 7 days for a confirmation
● If the pt. had sex with an HIV-positive adult one night and comes in for a
test a week later, the ELISA will be negative even though they may have
HIV
■ CDC recommends the use of a fourth-generation HIV assay that detects HIV-IgM
and IgG antibodies (positive in 21 days) and detects the presence of the p24
antigen (an HIV capsid protein) in serum (positive in 14 days)
○ Viral Load Testing
■ HIV home screening tests → blood or oral transmucosal exudate (not saliva)
■ Some with specimens collected at home can be performed at home
● NANDA
○ Potential for infection due to reduced immunity
■ MT daily CBC with differential WBC count and absolute neutrophil count (ANC)
■ Inspect mouth q8h for lesions and mucosa breakdown
■ Assess the lungs q8h for crackles, wheezes, and reduced breath sounds
■ Drug therapy
● Approved antiretroviral drugs → excellent activity against HIV replication
● The cause of HIV infection is a virus – human immunodeficiency virus
○ Viral particles have an outer coat with special “docking proteins” (gp41 and gp120), which
assist in finding a host
○ Inside, HIV has RNA genetic material along with enzymes reverse transcriptase (RT),
HIV protease, and HIV integrase
○ Viral binding to the CD4 receptor and to either of the co-receptors is needed to enter the
cell (drug class → fusion inhibitors → works here to prevent the interaction needed for
entry of HIV into the CD4+ T-cell
○ Because HIV is a retrovirus → able to insert
its single-stranded ribonucleic acid
(ss-RNA) genetic material into the host’s
DNA
○ HIV particles are made within the infected
CD4+ T-cells – uses the host cell’s protein
synthesis processes
○ Effects of HIV infection are related to the
new genetic instructions that now direct
CD4+ T-cells to become an “HIV factory,”
making billions of new viral particles daily.
○ Early HIV → before the disease is evident
→ the immune system can still attack and
destroy most of the newly created virus
particles
● Everyone who has AIDS has HIV infection → not
everyone who had HIV has AIDS
○ Distinction is the number of CD4+ T-cells and whether any opportunistic infections have
occurred
■ Healthy adult has at least 800-1000 CD4+ T-cells mm^3 of blood
● Develop acute infection reaction within 4 weeks of first being infected
○ Fever, sore throat, rash, night sweats, chill, HA, and muscle aches → similar to any viral
infection
● Progression with transition to stage HIV-II is when infected adults are most often diagnosed with
HIV disease and management with drug therapy is started
○ Immune dysfunction drops
● A diagnosis of AIDS (HIV-III)
○ Adult be HIV positive
○ Have either:
■ CD4+ T-cell count of <200 cells/mm^3 or less than 14%
■ An opportunistic infection (decreased CD4 count = opportunistic infection)
● HIV Progression
○ When HIV results from a single sexual encounter → progression takes longer
○ Personal factors influencing time to progression include frequency of re-exposure to HIV,
presence of other STIs, nutrition status, and stress
● Health and Promotion
○ Found in blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces,
saliva, tears, CSF, lymph nodes, cervical cells, corneal tissue, and brain tissue
, ○ Transmitted:
■ Sexual → genital, anal, or oral
■ Parenteral → sharing needles or equipment contaminated with infected
blood
● Main occupation-related HIV infection means
■ Perinatal → from placenta, contact with maternal blood/body fluids during birth,
or from breast milk
○ Teach all adults about transmission routes and ways to reduce exposure
○ HIV is NOT transmitting by casual contact in the home, school, or workplace
■ Sharing household utensils, towels and linens, and toilet facilities does not
transmit HIV
○ Not spread by mosquitoes or other insects
Recommendations for Preventing HIV Transmission by Health Care Workers
● Adhere to Standard Precaution
● If you have exudative lesions or weeping dermatitis, do not perform direct pt. care or handle pt.
care equipment and devices used in invasive procedures
● Follow guidelines for disinfection and sterilization or reusable equipment used in invasive
procedures
● If you are infected with HIV, you may perform non-exposure-prone procedures, as long as you
comply with Standard Precautions and sterilization and disinfection recommendations
● Identify exposure-prone procedures by institutions where they are performed
● If you perform exposure-prone procedures, know you HIV antibody status
● If you are infected with HIV, check with an expert review panel before performing exposure-prone
procedures to determine under which circumstances you may continue to practice these
procedures with notification of prospective pt. of your HIV positivity
AIDS (HIV-III) → Opportunistic Infections
Protozoal-like Viral
Toxoplasmosis Cytomegalovirus
Cryptosporidiosis Herpes simplex zoster
Isosporiasis, microsporidiosis Varicella-zoster virus
Strongyloidiasis Malignancies
Giardiasis Kaposi’s sarcoma
Fungal Non-Hodgkin’s lymphoma
Candidiasis Hodgkin’s lymphoma
Pneumocystis jiroveci pneumonia Invasive cervical carcinoma
Cryptococcosis
Histoplasmosis
Coccidioidomycosis
Bacterial
Mycobacterium avium complex
Tuberculosis
Nocardiosis
● History
○ Ask about age, gender, occupation, and home environment
, ○ Assess current illness → when it started, the severity of symptoms, associated problems,
and any interventions to date
● Opportunistic Infections → Disease is taking over
○ Caused by overgrowth of the pt. microbiome (normal flora) — only when immunity is
depressed are such organisms capable of causing infection
○ May result from new infection or reactivation of a previous infection – usually protozoan,
fungal, bacterial, or viral
○ Usually indicate disease progression or a temporary further reduction of immunity and
can result in death if treatment is not started quickly
○ Rarely poses a threat to the health care worker who has normal immunity when caring for
a pt. with HIV disease at any stage
○ Protozoal and fungal infections are common among pt. with AIDS
■ Pneumocystis jiroveci pneumonia (PCP)
● SOB, tachypnea, persistent dry cough, persistent low-grade fever,
fatigue, weight loss → assess for crackles
■ Toxoplasmosis encephalitis → caused by toxoplasma gondii → acquired through
contact with contaminated cat feces/ingesting infected undercooked meat
● Subtle changes in mental status, neurologic deficits, HA, fever, difficulties
with speech, gait, and vision, seizures, lethargy, and confusion
● Perform a comprehensive mental status exam and MT the pt. to detect
subtle changes
■ Cryptosporidiosis → intestinal infection caused by Cryptosporidium organisms
● Diarrhea with significant fluid loss
● Ask about diarrhea and whether they
have had an unplanned weight loss of 5
lbs or more
○ Fungal → most often an overgrowth of normal body flora
■ Candida albicans → intestinal tract’s natural flora
● Food tasting “funny,” mouth pain,
difficulty swallowing, pain behind the
sternum
● Cottage-cheese-like, yellow-ish white
plaques and inflammation upon
examination of the mouth and throat
(thrush) → zero taste, quickly dehydrated
■ Cryptococcosis → cryptococcus neoformans → debilitating meningitis → widely
spread infection in AIDS
● Fever, HA, blurred vision, nausea, vomiting, neck stiffness, confusion,
other mental changes, seizures and other neurological problems, mild
malaise, fever
■ Histoplasmosis → histoplasma capsulatum → begins as a respiratory infection
and progresses to widespread infection in AIDS
● Dyspnea, fever, cough, weight loss
● Assess for enlargement of the lymph nodes, spleen, or liver
○ Bacterial → acquired from other people or sources and as overgrowth of skin flora
■ Tuberculosis (TB) → Mycobacterium tuberculosis → occurs in 2-10% of adults
with AIDS
○ Viral → from a virus other than HIV → common among adults with HIV that has
progressed to AIDS
, ■ Cytomegalovirus (CMV) → can infect many sites → eye, respiratory, GI tracts,
CNS
● Fever, malaise, weight loss, fatigue, swollen lymph nodes, diarrhea, abd.
bloating, discomfort, weight loss
● CMV retinitis (eyes) → impairs vision (slight to total blindness)
■ Herpes simplex virus (HSV) → occurs in perirectal, oral, and genital areas
● Numbness or tingling at the site for up to 24 hours before blisters form,
lesions are painful, chronic open areas
after blisters rupture
● Fever, HA, pain, enlarged lymph nodes
in the affected area, and malaise
■ Varicella-zoster virus (VZV) → not a new
infection for adults with AIDS
● Chicken pox with rash and fever
● Malignancies
○ Kaposi sarcoma, lymphomas, invasive cervical cancer,
lung cancer, GI cancer, and anal cancer
○ Kaposi sarcoma → most common AIDS-related
■ Small, purplish-brown, raised lesions on skin
and mucous membranes that are usually not
painful or itchy
● Lab Assessment
○ Lymphocyte counts in addition to CBC with differential
→ often leukopenic with AIDS → WBC less than 3500 cells/mm^3
○ Antibody-Antigen tests → pt. response to the virus (the antigen) and are indirect tests for
HIV
■ HIV antibodies can be measured by enzyme-linked immunosorbent assay
(ELISA) and Western blot analysis, which is an older testing algorithm
■ Positive → confirmatory Western blot test is done → more sensitive and specific
for HIV
● HIV antibodies are not detected for at least 14-21 days after exposure →
Western blot requires an additional 7 days for a confirmation
● If the pt. had sex with an HIV-positive adult one night and comes in for a
test a week later, the ELISA will be negative even though they may have
HIV
■ CDC recommends the use of a fourth-generation HIV assay that detects HIV-IgM
and IgG antibodies (positive in 21 days) and detects the presence of the p24
antigen (an HIV capsid protein) in serum (positive in 14 days)
○ Viral Load Testing
■ HIV home screening tests → blood or oral transmucosal exudate (not saliva)
■ Some with specimens collected at home can be performed at home
● NANDA
○ Potential for infection due to reduced immunity
■ MT daily CBC with differential WBC count and absolute neutrophil count (ANC)
■ Inspect mouth q8h for lesions and mucosa breakdown
■ Assess the lungs q8h for crackles, wheezes, and reduced breath sounds
■ Drug therapy
● Approved antiretroviral drugs → excellent activity against HIV replication
