Protease acts to break up the long protein chains that form the

HIV/AIDS immature virus.

The smaller HIV proteins combine to form mature (infectious)
HIV.
Definition
HIV stands for human immunodeficiency virus. AIDS stands for HIV Types
acquired immunodeficiency syndrome. There are two types of HIV that cause AIDS: HIV type 1 (HIV-1) and
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially HIV-2.
life-threatening condition caused by the human immunodeficiency virus
They have the same modes of transmission and are associated with the
(HIV). By damaging your immune system, HIV interferes with your
same opportunistic infections, but HIV-2 appears to progress more
body's ability to fight the organisms that cause disease.
slowly.
HIV is a retrovirus that primarily infects vital organs of the human
immune system such as CD4+ T cells.
Anatomy & Physiology: Immune Systen
Retrovirus Protects the body by recognizing antigens on invading bacteria and viruses
An RNA virus that is replicated in a host cell via the enzyme reverse and reacting to them.
transcriptase to produce DNA from its RNA genome. Antigen
The DNA is then incorporated into the hosts genome by an integrase Any substance that induces a state of sensitivity and immune
enzyme. The virus thereafter replicates as part of the host cells DNA. responsiveness.
They interact with antibodies and immune cells, initiating an
HIVs Structure immune response. (This process destroys the antigen, allowing
HIV consists of a cylindrical center surrounded by a sphere-shaped lipid the body to be free of infections.)
bilayer envelope. Types of antigens: Bacteria, viruses, fungi, parasites
There are two major viral glycoproteins in this lipid bilayer, gp120 and When the immune system is weakened or destroyed by a virus such as HIV,
gp41. the body is left vulnerable to infections.
The major function of these proteins is to mediate recognition of CD4+ The immune system consists of lymphoid organs and tissues, including the
cells and chemokine receptors, thereby enabling the virus to attach to bone marrow, thymus gland, lymph nodes, spleen, tonsils, adenoids,
and invade CD4+ cells. appendix, blood, and lymphatic vessels.
The inner sphere contains two single-stranded copies of the genomic
material, RNA, as well as multiple proteins and enzymes necessary for
HIV replication and maturation: p24, p17, reverse transcriptase,
integrase, and protease.
Unlike other retroviruses, HIV uses nine genes to code for the necessary
proteins and enzymes.
The three principal genes are gag, pol, and env.
o Gag encodes core proteins.
o Pol encodes the enzymes reverse transcriptase, protease, and
integrase.
o Env encodes the HIV structural components known as
glycoproteins.

HIVs Life Cycle

1) Binding and Entry
Also called Attachment
HIV binds itself to receptors on surface of CD4 cell.
2) Fusion
HIV envelope and the CD4 cell membrane fuse, which allows HIV
to enter the CD4 cell
3) Reverse Transcription
Inside the CD4 cell, HIV releases and uses reverse transcriptase
(an HIV enzyme) to convert its genetic material (HIV RNA)
into HIV DNA.
The cpnversion of HIV RNA to DNA allows HIV to enter the CD4
cell nucleus and combine with the cells genetic material cell
DNA.
4) Integration
Inside the CD4 cell nucleus, HIV releases integrase (an HIV All components of the immune system are vital in the production and
enzyme) and uses it to insert its viral DNA into the DNA of the development of lymphocytes, or white blood cells.
CD4 cell. B lymphocytes (or B cells) and T lymphocytes (or T cells) are produced
from stem cells in the bone marrow.
o B cells stay in the bone marrow to complete the maturation process
5) Replication
o T lymphocytes travel to the thymus gland to complete their
Once integrated into the CD4 cell DNa, HIV begins to use the
maturation. There T lymphocytes become immunocompetent,
machinery of the CD4 cell to make long chains of HIV proteins.
multiply, and become more differentiated.
The protein chains are the building block for more HIV.
6) Assembly
B Lymphocytes
New HIV proteins and HIV RNA move to the surface of the cell
and assemble into immature (non-infectious) HIV. Main function is humoral (antibody) immunity.
7) Budding Each B cell can recognize specific antigen targets and can secrete
Newly formed immature HIV pushes itself out of the host CD4 specific antibodies.
cell. Antibodies
The new HIV releases protease (an HIV enzyme). function by coating antigens, which makes the antigens
more vulnerable to phagocytosis (engulfing and ingestion
 of invading organisms by leukocytes and/ or Blood Transfusions
macrophages), Sharing Needles
Or by triggering the complement system, leading to an Pregnancy or breastfeeding
inflammatory response.
Highly specialized serum protein molecules.
Grouped into five classes, each having a specialized
function: Immunoglobulin G (IgG), IgA, IgM, IgE, IgD.
Symptomatology
T Lymphocytes
Clinical Latency/Asymptomatic Disease (Clinical Stage 1)
Two major functions: regulation of the immune system and killing
of cells that bear specific target antigens. Asymptomatic
Each T cell has a surface marker, such as CD4+, CD8+, and CD3+, Persistent lymphadenopathy
that distinguishes it from other cells. May last 810 years
CD4+ cells are helper cells that activate B cells, killer cells, and HIV enzyme-linked immunosorbent assay and Western blot or
macrophages when a specific target antigen is present. immunofluorescence assay will be positive.
There are two main types of CD8+ cells. CD4+ count is greater than 500 cells/L
1. Cytotoxic CD8+ cells kills cells infected by viruses or Mild Signs and Symptoms of HIV (Clinical Stage 2)
bacteria, as well as cancer cells. May appear to be healthy for years, and then minor signs
2. T-suppressor cells inhibits or suppresses immune Candidiasis
responses. Lymphadenopathy
Normal CD8+ cell count is between 300 and 1,000 cells in Persistent hepatosplenomegaly
adults and children. Pruritic eruptions
Normal CD4+:CD8+ ratio is between 1.0 and 2.0. Herpes zoster
T cells can secrete cytokines (chemicals that kill cells), such as Peripheral neuropathy
interferon. CD4+ count falls is between 350-499/ uL
Cytokines can bind to target cells and activate the Advanced Signs and Symptoms of HIV (Clinical Stage 3)
inflammatory process. They also promote cell growth, activate Cryptosporidiosis
phagocytes, and destroy target cells. Pulmonary and lymph node tuberculosis
Interleukins are cytokines that serve as messengers between Wasting
white blood cells. Persistent fever (longer than one month)
Persistent candidiasis
Phagocytes
Recurrent bacterial pneumonia
Include monocytes and macrophages, large white blood cells that
CD4+ count falls to less than 200-349 cells/L
engulf and digest cells carrying antigenic particles.
Found throughout the body, phagocytes rid the body of worn-out Clinical Stage 4 or AIDS
cells, initiate the immune response by presenting antigens to Pneumocystis jirovecii pneumonia
lymphocytes, are important in immune response regulation and Cytomegalovirus infection
inflammation, and carry receptors for cytokines. Toxoplasmosis
Dendritic cells another type of phagocyte, also are antigen- Mycobacterium avium complex
presenting cells. They have long, threadlike extensions that help Cryptococcal meningitis
trap lymphocytes and antigens and are found in the spleen and Progressive multifocal leukoencephalopathy
lymph nodes. Kaposi sarcoma
Neutrophils are granulocytic phagocytes that are important in CD4+ count is less than 200 cells/L
the inflammatory response. Death in imminent

Complement Medical Management (Lab test, Meds, Treatment)

Consists of 25 proteins
Complement can induce an inflammatory response when it
functions with antibodies to facilitate phagocytosis or weaken the
bacterial cell membrane.
The complement proteins interact with one another in a sequential
activation cascade, promoting the inflammatory process.
Etiology
Type of chimpanzee in Central Africa
How does HIV become AIDS?
HIV destroys CD4 cells a specific type of white blood cell that plays
a large role in helping the body fight disease.
Immune system weakens as more CD4 cells are killed.
HIV progress to AIDS when the CD4 count falls below 200 or
experience an AIDS-defining complication.
Transmission
Sexual Intercourse
Laboratory Tests
CD4/T-cell count
gives a general measure of the health of immune system
good measurement of immunosuppression and risk
of opportunistic infections
Normal CD4 cell count is more than 500 cells per cubic
millimeter (mm3) of blood.
CD4 count of fewer than 200/mm3, is diagnosed as AIDS.
CD4 Percentage
Measures how many of your white blood cells are actually
CD4 cells.
More stable than CD4 counts over a long period of time.
Less likely to vary in between blood tests than CD4 counts
(which can vary from month to month or day to day).
Viral Load (VL)
Measures the amount of HIV in blood.
goals of HIV treatment are to keep your viral load
at undetectable levels and to keep CD4 count high.
Good indicator of how well the treatment is working to
achieve those goals.
Medications
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
Zidovudine (Retrovir)
Interrupts the life cycle of HIV as it tries to copy itself.
Prevent HIV from replicating in body.
 Protease inhibitors
Ritonavir (Norvir)
Binds to protease which is a protein that HIV needs to
replicate in the body.
Reduces the number of viruses that can infect more cells.
Entry Inhibitors
Enfuvirtide (Fuzeon)
Blocks the virus from entering the host T cell.
Prevent destruction of targeted cells.
Treatment
Antiretroviral therapy (ART)
Use of HIV medicines to treat HIV infection.
Cant cure HIV, but HIV medicines help people with HIV live
longer, healthier lives.
ART also reduces the risk of HIV transmission.
Nursing Diagnosis and Management
1. Imbalanced Nutrition: Less Than Body Requirements R/T
increased metabolic rate/nutritional needs (fever/infection)
Assess patients ability to chew, taste, and swallow.
Lesions of the mouth, throat, and esophagus and metallic or other
taste changes caused by medications may cause dysphagia,
limiting patients ability to ingest food and reducing desire to eat.
Weigh as indicated. Evaluate weight in terms of premorbid weight.
Compare serial weights and anthropometric measurements.
Indicator of nutritional adequacy of intake. Because of depressed
immunity, some blood tests normally used for testing nutritional
status are not useful.
Limit food(s) that induce nausea and/or vomiting or are poorly
tolerated by patient because of mouth sores or dysphagia. Avoid
serving very hot liquids and foods. Serve foods that are easy to
swallow like eggs, ice cream, cooked vegetables.
Pain in the mouth or fear of irritating oral lesions may cause
patient to be reluctant to eat. These measures may be helpful in
increasing food intake.
Provide frequent mouth care, observing secretion precautions. Avoid
alcohol-containing mouthwashes.
Reduces discomfort associated with nausea and vomiting, oral
lesions, mucosal dryness, and halitosis. Clean mouth may enhance
appetite and provide comfort.
Provide rest period before meals. Avoid stressful procedures close to
mealtime.
Minimizes fatigue; increases energy available for work of eating
and reduces chances of nausea or vomiting food.
2. Fatigue R/T increased energy requirement
Monitor physiological response to activity: changes in BP, respiratory
rate, or heart rate.
Tolerance varies greatly, depending on the stage of the disease
process, nutrition state, fluid balance, and number or type of
opportunistic diseases that patient has been subject to.
Encourage nutritional intake.
Adequate intake or utilization of nutrients is necessary to meet
increased energy needs for activity. Continuous stimulation of the
immune system by HIV infection contributes to a hypermetabolic
state.
Provide supplemental O2 as indicated.
Presence of anemia or hypoxemia reduces oxygen available for
cellular uptake and contributes to fatigue.
Refer to community resources
Provides assistance in areas of individual need as ability to care
for self becomes more difficult.
Refer to physical and/or occupational therapy.
Programmed daily exercises and activities help patient maintain
and increase strength and muscle tone, enhance sense of well-
being.
3. Acute/Chronic Pain R/T tissue inflammation: infections
Assess pain reports, noting location, intensity (010 scale), frequency,
and time of onset. Note nonverbal cues like restlessness, tachycardia,
grimacing.
Indicates need for or effectiveness of interventions and may signal
development or resolution of complications. Chronic pain does not
produce autonomic changes; however, acute and chronic pain can
coexist.
Encourage verbalization of feelings.
Can reduce anxiety and fear and thereby reduce perception of
intensity of pain.
Provide diversional activities: provide reading materials, light
exercising, visiting, etc.
Refocuses attention; may enhance coping abilities.
Perform palliative measures: repositioning, massage, ROM of
affected joints.
Promotes relaxation and decreases muscle tension.
Instruct and encourage use of visualization, guided imagery,
progressive relaxation, deep-breathing techniques, meditation, and
mindfulness.
Promotes relaxation and feeling of well-being. May decrease the
need for narcotic analgesics (CNS depressants) when a
neuro/motor degenerative process is already involved.
4. Impaired Skin Integrity R/T immunologic deficit
Assess skin daily. Note color, turgor, circulation, and sensation.
Establishes comparative baseline providing opportunity for timely
intervention.
Maintain and instruct in good skin hygiene: wash thoroughly, pat dry
carefully, and gently massage with lotion or appropriate cream.
Maintaining clean, dry skin provides a barrier to infection. Patting
skin dry instead of rubbing reduces risk of dermal trauma to dry
and fragile skin. Massaging increases circulation to the skin and
promotes comfort.
Reposition frequently. Use turn sheet as needed.
Reduces stress on pressure points, improves blood flow to tissues,
and promotes healing.
Maintain clean, dry, wrinkle-free linen, preferably soft cotton fabric.
Skin friction caused by wet or wrinkled or rough sheets leads to
irritation of fragile skin and increases risk for infection.
Encourage ambulation as tolerated.
Decreases pressure on skin from prolonged bedrest.
5. Impaired oral mucous membrane R/T dehydration AEB open
ulcerated lesions
Assess mucous membranes and document all oral lesions. Note
reports of pain, swelling, difficulty with chewing and swallowing.
Edema, open lesions, and crusting on oral mucous membranes and
throat may cause pain and difficulty with chewing and swallowing.
Provide oral care daily and after food intake, using soft toothbrush,
non abrasive toothpaste, non alcohol mouthwash, floss, and lip
moisturizer.
Alleviates discomfort, prevents acid formation associated with
retained food particles, and promotes feeling of well-being.
Rinse oral mucosal lesions with saline and dilute hydrogen peroxide
or baking soda solutions.
Reduces spread of lesions and encrustations from candidiasis, and
promotes comfort.
Suggest use of sugarless gum and candy.
Stimulates flow of saliva to neutralize acids and protect mucous
membranes.
Encourage oral intake of at least 2500 mL/day.
Maintains hydration and prevents drying of oral cavity.
Prognosis
The prognosis, or prospect of recovery, for HIV-positive and AIDS patients
has improved tremendously over the past 20 years, but still depends on
multiple factors.
The most important include the patients access to HIV specialists and proper
drug treatments.
 At this time, there is still no cure for AIDS, but combinations of various drugs
can slow down the viruss progress, often allowing patients to live longer,
healthier lives.
The time to develop AIDS after HIV infection depends on the individuals
health status, behaviors, and how soon he or she seeks treatment.
In most cases, treating HIV infections or AIDS as early as possible is the best
way to improve prognosis.
Pathophysiology: AIDS