Overview of HIV/AIDS
HIV stands for human immunodeficiency virus, which is the virus that causes HIV infection. The abbreviation “HIV” can refer to the virus or HIV infection. AIDS stands for acquired immunodeficiency syndrome. AIDS is the most advanced stage of HIV infection. HIV attacks and destroys the infection-fighting CD4 cells of the immune system. The loss of CD4 cells makes it difficult for the body to fight infections and certain cancers. Without treatment, HIV can gradually destroy the immune system and advance to AIDS.
The incidence of HIV/AIDS
As defined by the U.S. Census Bureau, the South region includes: Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia, has the highest incidences of HIV/AIDS cases, 45% of all people living with HIV diagnosis lives in the South.
Reported cases of HIV, in the decades since the first AIDS cases in Los Angeles and New York City in 1981, the epicenter of the nation’s HIV epidemic has shifted from urban centers along the coasts to the 16 states and District of Columbia that make up the South.
The South now experiences the highest burden of HIV infection, illness, and deaths of any U.S. region, and lags far behind in providing quality HIV prevention and care to its citizens. Closing these gaps is essential to the health of people in the section and to our nation’s long-term success in ending the epidemic. State of the HIV Epidemic in the South Southern states today account for an estimated 45 percent of all people living with an HIV diagnosis in the U.S.
The South faces internal disparities based on geography. Like the rest of the country, the majority of HIV diagnoses occur in urban areas. The region, however, has higher HIV diagnosis rates in suburban and rural areas as compared to the other areas nationwide, which poses unique challenges to HIV prevention efforts.
In 2916, CDC reports that among African Americans diagnosed with HIV/AIDS, they account for 44% of new HIV diagnosis, although they make up only 12% of the US population.
The cause and stages of HIV
HIV is spread through contact with certain body fluids from a person with HIV. These body fluids include:
- Pre-seminal fluid
- Vaginal fluids
- Rectal fluids
- Breast milk
The spread of HIV from person to person is called HIV transmission. The proliferation of HIV from a woman with HIV to her child during pregnancy, childbirth, or breastfeeding is called mother-to-child transmission of HIV.
In the United States, HIV is spread mainly by having sex with or sharing drug injection equipment with someone who has HIV. To reduce your risk of HIV infection, use condoms correctly and consistently during sex, limit your number of sexual partners, and never share drug injection equipment.
Mother-to-child transmission is the most common way that children become infected with HIV. HIV medicines, given to women with HIV during pregnancy and childbirth and to their babies after birth, reduce the risk of mother-to-child transmission of HIV.
You cannot get HIV by shaking hands or hugging a person who has HIV. You also cannot get HIV from contact with objects such as dishes, food or drinks, toilet seats, or doorknobs used by a person with HIV. HIV does not spread through the air, sweat, tears, closed mouth kissing, through a mosquito bite, tick, or other insect bites and pets.
Within 2 to 4 weeks after someone becomes infected with HIV, they may have flu-like symptoms, such as fever, chills, or rash. The symptoms may last for a few weeks after they become infected; her symptoms may include:
Muscle aches and joint pain
A sore throat
Swollen lymph glands, mainly on the neck
Soaking night sweats
White spots or unusual lesions on the tongue or in the mouth
Unexplained weight loss
Skin rashes and bumps
After this earliest stage of HIV infection, HIV continues to multiply but at deficient levels. More severe symptoms of HIV infection, such as signs of opportunistic infections, generally don’t appear for many years. (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.)
Without treatment with HIV medicines, HIV infection usually advances to AIDS in 10 years or longer, though it may take less time for some people.
HIV transmission is possible at any stage of HIV infection—even if a person with HIV has no symptoms of HIV.
Diagnosis of HIV/AIDS
The following criteria are used to determine if a person with HIV has AIDS:
The person’s immune system is severely damaged, as indicated by a CD4 count of fewer than 200 cells/mm
A CD4 count measures the number of CD4 cells in a sample of blood. The CD4 count of a healthy person range from 500 to 1,600 cells/mm3.
- The person has developed certain opportunistic infections, depending on how well their immune system is working. These are infections that do not usually affect people with well-functioning immune systems. The diseases range from mild to life-threatening.
- Opportunistic infections include lymphoma which affects most of the functions of the body: skin, respiratory, gastrointestinal, neurological and others.
Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People on ART take a combination of HIV medicines called an HIV regimen every day. HIV medicines are often called antiretrovirals or ARVs. While there is no cure for HIV/AIDS, medications can block the replication of the virus in the body and slow down the disease progression. Medications include a combination of some of the following drugs:
Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Disable a protein needed by HIV to make copies of itself.
Efavirenz · Etravirine · Nevirapine
Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs): Stops spreading of infection.
Abacavir · Tenofovir · Lamivudine-Zidovudine.
Protease inhibitors (PIs): Blocks the action of an enzyme called protease, which is essential for HIV replication
Atazanavir · Darunavir · Fosamprenavir Indinavir.
Entry or fusion inhibitors: These drugs block HIV’s entry into CD4 cells.
Enfuvirtide · Maraviroc
Integrase inhibitors: These drugs work by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.
Raltegravir · Elvitegravir · Dolutegravir.
ART prevents HIV from multiplying and reduces the amount of HIV in the body. Having less HIV in the body protects the immune system and prevents HIV infection from advancing to AIDS.
Clinical management and nursing implications
Today, more than 1.1 million people are living with HIV in the United States. Thanks to better treatments, people with HIV are living longer, enjoying a better quality of life. Nurses have a significant impact on helping individuals with HIV/AIDS make better life choices to keep them healthy and protect others.
Goals of nursing in comprehensive care the goals of nursing care related to HIV/AIDS include reducing morbidity and mortality through a focus on assessment and implementation of interventions, including education on both prevention and care.
Nursing roles in comprehensive care include:
- Chronic disease management, including health monitoring and symptom
- Control of chronic disease process related to opportunistic infections
- Health promotion and education on disease prevention, and risk reduction to others
- Palliative care
- Mental health support to address the stigma attached to HIV/AIDS
- Patient support/advocacy, referral management
- Empowering and supporting patients to make their own choices on lifestyle adjustment that would bring about the best health and wellness.
Every nurse should be prepared to meet a person with HIV-infection. Nursing care of people with AIDS is a challenge as it holistically envelops patients and their families. After diagnosing an HIV-infection, a person will be in a crisis. If a nurse is familiar with the process of an emergency, there will be better understanding and support for the patient and family. With empathy, therapeutic attitude and by recognizing own reactions, a nurse will be able to meet the needs of the patients. The nursing plan helps a nurse to better address problems, to implement and to evaluate the nursing process of the patient with AIDS and to meet the unique needs of the patient with the HIV-infection.