Transcript Transmission of HIV

Megan McClintock, MS, RN
Fall 2011
“HIV has no cure, continues for life, causes
increasing physical disability, contributes to
impaired health and ultimately ends in death.”
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Sexual intercourse
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Exposure to infected blood
◦ Drug-using equipment
◦ Blood products
◦ Needle stick
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Perinatal transmission during pregnancy,
delivery, or breastfeeding
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Safe sex – masturbation, insertive sex only if
neither person infected or at risk of being
infected
Barriers – condoms, dental dams, plastic food
wrap
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No alcohol or tobacco
Don’t share drug equipment
Utilize needle/syringe exchange
programs
Clean equipment (least effective)
If exposed through a needle stick
at work, get post-exposure
prophylaxis with ART
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Prevent HIV in women
Treat HIV during pregnancy with ART
Offer HIV testing to all women
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Acute Infection
◦ Occurs within 2-4 weeks of infection and lasts 1-2
weeks (often mistaken for the flu)
◦ Mono-like symptoms
◦ Neuro symptoms
◦ High viral load, decreased CD4+ T cells
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Chronic Early Infection
◦ Generally asymptomatic but spreading the disease
b/c they don’t know they are infected
◦ May have night sweats, fatigue, headache, low
grade temp, lymphadenopathy
◦ Low viral load, CD4+ T cells fairly normal (>500)
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Chronic Intermediate Infection
◦ Symptoms worsen – localized infections, nervous
system symptoms
◦ Thrush is common, also shingles, vaginal candida,
oral/genital herpes, bacterial infection, Kaposi’s
sarcoma, oral hairy leukoplakia
◦ Increased viral load, CD4+ T cells 200-500
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Late Chronic Infection – AIDS
◦ Can only make this diagnosis when
specific criteria is met (pg 245, Table 15-9)
◦ Opportunistic disease (pg 245, Table 15-10),
wasting, dementia, malignancies
◦ High viral load
◦ Low CD4+ T cells (<200)
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HIV antibodies and/or antigens in the blood
◦ May not appear for 2 months after infxn, but can still
transmit the virus during this time (window period)
◦ Rapid HIV test (EIA) – looks for antibodies
◦ Western blot test of IFA must be done to confirm
diagnosis
CD4+ Tcell counts (measure of immune function)
– normal 800-1200
Viral load (measure of disease progression) – can
be undetectable (but still have the virus and can
transmit it)
 WBC, neutropenia, thrombocytopenia, anemia,
liver function abnormalities, can also test for ART
drug resistance, Hep B, Hep C
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No cure, just decreased disease progression
Goals – decrease viral load, increase CD4+ T
cell count, delay onset of opportunistic
disease
Must use at least 3 drugs from 2 different
drug classes
Critical for the patient to adhere to the drug
regimen
Drugs interact with many other drugs and
herbs
Vaccinations are important
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Assess for risky behaviors
◦ Blood transfusion before 1985
◦ Sharing drug-using equipment
◦ Any sexual experience (yes, this covers lots of
folks)
◦ STDs
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CDC recommends HIV testing for everyone
ages 13-64
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Drug therapy
◦ Must take right dose at right time every day
◦ Encourage use of electronic reminders, calendars,
timers, group support
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Promote a healthy immune system
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Good nutrition to keep lean body mass
Decrease alcohol/tobacco/drug use
Vaccinate for infectious diseases
Good rest and exercise
Decrease stress
Avoid exposure to illnesses
Mental health counseling and support groups
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Metabolic disorders that cause fat deposits in
abdomen, upper back, breasts and fat loss in
arms, legs, face (lipodystrophy)
Hyperlipidemia
Insulin resistance
Hyperglycemia
Bone disease
CV disease