HIV/AIDS by Siena Kathleen V.

Placino

Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome

Clinical Instructor: Dr. Dario Sumande, RN, MAN

Communicable Disease Nursing – BSN-IV

1. IDENTIFICATION
a. BACKGROUND
o HIV – is a virus that infects humans. It attacks your immune system
causing it to malfunction and makes you very ill. HIV stands for
human immunodeficiency virus, the virus that causes AIDS.
o AIDS – is a serious medical condition comprising of a variety of
diseases that occur because HIV interferes with the body’s ability to
fight off other infections. AIDS stands for acquired immunodeficiency
syndrome.
 THE BASICS
 First identified in 1981, HIV is the cause of one of humanity’s deadliest and
most persistent epidemics.
 Without HIV medicine, people with AIDS typically survive about 3 years!
Once someone has a dangerous opportunistic illness, life expectancy without
treatment falls to about 1 year.

 To put it briefly:
According to the CDC (Centers for Disease Control and Infection),
o “HIV is a virus spread through certain body fluids that attacks the
body\s immune system, specifically the CD4 cells, often called T cells.
Over time, HIV can destroy so many of these cells that the body can’t
fight off infections and disease. …Untreated, HIV reduces the number
of CD4 cells (T cells) in the body. This damage to the immune system
makes it harder and harder for the body to fight off infections and
some other diseases. Opportunistic infections or cancers take
advantage of a very weak immune system and signal that the person
has AIDS …(the last stage of HIV infection).”
o NO EFFECTIVE CURE currently exists, but with proper medical
care, HIV can be controlled.
o The medicine used to treat HIV is called
 “antiretroviral therapy” or ART.
 b. INFECTIOUS AGENT
 RETROVIRUS - HUMAN IMMUNODEFICIENCY VIRUS (HIV) is the causative
agent for AIDS.
o Previously called Human T-cell lymphotropic virus III (HTLV-3)
 phased out now
 General characteristics of the virus:
o Double stranded RNA retrovirus (reverse transcriptase – proviral DNA integrates
into HOST DNA  ready to be transcribed and replicated)
o Envelope
o Capsid
o ERRORS during REPLICATION different strains of the virus/ frequent
mutations  makes it very difficult to cure!
Healthy T-Cell

A scanning electron micrograph of a

human T-lymphocyte from the
immune system of a healthy donor.

HIV-Infected CD4-cell

A scanning electron micrograph of an HIV-

infected CD4 cell. Computer colorization
helps differentiate the budding HIV virions
(in yellow) as they emerge from the infected
cell (in green and turquoise).

***NOTE

 A CD4 cell is a type of T-

lymphocyte cell (or T-cell) which
have a glycoprotein called CD4 on
their surface.

 Also known as "helper" cells, CD4

does not neutralize infection, but
rather prompt the body's immune
system to act upon an infective
agent.

HIV Budding From an Infected

CD4 Cell

HIV virions are shown budding and

releasing from an infected CD4 cell.
  ETIOLOGY

Scientists identified a type of chimpanzee in Central Africa as the source of HIV

infection in humans.

THE ORIGIN THEORY:

 Chimpanzee version of the

immunodeficiency virus
(SIMIAN
IMMUNODEFICIENCY
VIRUS or SIV) most
likely transmitted to
humans and MUTATED
into HIV!

 Over decades, the virus slowly spread across Africa and later to other parts of the
world! (existed in the U.S. at least from the mid-late 1970s)
 c. OCCURRENCE
 According to the WHO (World Health Organization):

GLOBAL SITUATION AND TRENDS

 Since the beginning of the epidemic: 75 million people have been infected
with HIV and about 32 million people have died of HIV. (WHO, 2018)
 According to the Joint United Nations Program on HIV/AIDS, approximately
33.4 million people worldwide are living with HIV/AIDS, and more than 2.7
million people were newly infected in 2008—about 7,400 each day.(NIH,
2018)
  In the United States, more than 1 million people are living with HIV/AIDS,
with one fifth of the people unaware of their status, and approximately 56,000
new infections occur each year. HIV/AIDS disproportionately affects racial
and ethnic minorities, women of color, and men who have sex with men.
(NIH, 2018)
 At the end of 2016, an estimated 1.1 million people aged 13 and older had
HIV infection in the United States, including an estimated 162,500 (14%)
people whose infections had not been diagnosed. CDC. Estimated HIV
incidence and prevalence in the United States, 2010-2016.Apr 12, 2019 (CDC,
2016)

d. RESERVOIR OF INFECTION
 THE HUMAN BODY
 The reason why HIV causes so much trouble when it gets inside the human body is because
it targets CD4 cells, infects them, multiplies, and fills them with hundreds of new viruses.

The new viruses can bud off from the infected cells, but eventually there are so many that the
cells burst and die. Newly formed viruses are then released into the bloodstream where they can
infect other uninfected CD4 cells.
 Over time  HIV infection causes a MASSIVE DROP in the total number of CD4 cells
from about 1000 cells/ microliter of blood to less than 200 per microliter!

 RESULTING IN IMMUNODEFICIENCY
Summary of how the human immunodeficiency virus finds its way into human CD4 cells:
 e. MODE OF TRANSMISSION

According to CDC:

The most common way to get HIV is by having sex with an HIV infected
person!
HIV spreads when certain body fluids (BLOOD, SEMEN, VAGINAL SECRETIONS,
RECTAL FLUIDS, and BREAST MILK) from an HIV infected person come into contact
with a mucous membrane in the NOSE, MOUTH, RECTUM, VAGINA, or PENIS of an
uninfected person.

VAGINAL, ANAL, and ORAL SEX may all be means of transmission for HIV.

The 2nd most common way to get HIV is by injecting HIV directly into the
body.
 Most commonly: HIV contaminated needles or syringes, or other drug
injecting equipment is shared by injection drug users
  HIV IS NOT SPREAD VIA:
o Air/ water
o Touching
o Hugging
o Sneezing or coughing
o Eating or drinking from common utensils
o Saliva, tears or sweat
o Insects (mosquitoes or ticks)

Mode of transmission according to Planned Parenthood:

 HIV is carried in semen, vaginal fluids, anal mucus, blood, and breast milk.
 The virus gets in your body through CUTS or SORES in your skin, and through
mucous membranes (like the inside of the vagina, rectum, and opening of the penis)
 You can get HIV from:
o Having vaginal or anal sex
o Sharing needles or syringes for shooting drugs, piercings, tattoos, etc.
o Getting stuck with a needle that has HIV-infected blood on it (accidental
needle-sticks!)
o Getting HIV- infected blood, semen, or vaginal fluids into open cuts or sores
on your body
 HIV usually spreads through UNPROTECTED SEX.
 HIV can also be passed to babies during PREGNANCY, BIRTH or
BREASTFEEDING. (via placenta, delivery, and breast milk)
f. INCUBATION PERIOD

WHAT ARE THE STAGES OF HIV? (if left untreated)

STAGE 1: ACUTE HIV INFECTION

 Within 2-4 weeks, the infection takes hold

o Fever
o Headache
o Fatigue
o Swollen lymph glands
 a.k.a.  Flu-like illness for a few weeks
 Large amount of virus in their blood  VERY CONTAGIOUS!
 People at this stage are often UNAWARE because they may not feel sick
right away.

STAGE 2: CLINICAL LATENCY (HIV Inactivity or Dormancy)

 HIV is still active but reproduces at very low levels

 May not have any symptoms or get sick during this stage
 The virus is STILL TRANSMITABLE at this stage!
o But people who take HIV medicine as prescribed and stay
VIRALLY SUPRESSED have effectively NO RISK of
TRANSMISSION
 At the end of this phase, a person’s viral load starts to go up and the CD4
cell count begins to go down  immunodeficiency  increased symptom
manifestation!
STAGE 3: ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

 AIDS is the MOST SEVERE PHASE of HIV infection.

NOTE!

A person with HIV is considered to have progressed to AIDS when:

 The number of their CD4 cells fall below 200 cells per cubic millimeter of
blood (200 cells/mm3)
o A healthy immune system has CD4 counts between 500 and 1,600
cells/mm3
 They develop one or more opportunistic infections regardless of their CD4
count.
 Common AIDS symptoms:
o Chills
o Fever
o Extreme fatigue
o Night sweats
o Swollen lymph glands
o Weakness
o (Rapid) weight loss
o Chronic diarrhea
o Sores in mouth, anus, or genitals
o Pneumonia
o Purplish lesions on skin or in mouth
o Memory loss and depression

 People with AIDS can have HIGH VIRAL LOAD and be VERY
INFECTIOUS.
 The US Centers for Disease Control and Prevention have published a list of over
20 AIDS-defining diseases that may occur in the later stages of HIV infection:

CD4 cells AIDS-defining diseases

per
microliter
of blood
Around 500 Fungal infections (Candida): The first opportunistic infections that
you are likely to get if you have HIV are minor fungal infections
caused by an overgrowth of Candida, the fungus that causes diaper
rash in babies. Candida infections commonly occur in the mouth and
throat (oral candidiasis or thrush), airways and lungs, or vagina
(vaginal candidiasis). This fungus typically forms white patches on
your gums, tongue and lining of your mouth, and can make it so
painful to swallow that you lose your appetite. An infection in your
vagina will cause itching or burning, and soreness and redness
accompanied by a thick white discharge.
500 to 200 Kaposi’s sarcoma: Kaposi’s sarcoma is a tumour caused by a
human herpes virus. The tumour usually appears as purplish
lesions on the skin of your legs or face, or inside your mouth, and
can spread to other parts of your body without you knowing it. If
the cancer spreads to your guts or lungs, it can cause bleeding or
difficulty with breathing that can be life threatening.
200 to 100 Pneumocystis jiroveci pneumonia: Pneumocystis jiroveci
pneumonia is a type of pneumonia that severely affects the lungs and
is the most common opportunistic infection in people with AIDS.
Signs and symptoms of pneumocystis can include shortness of breath,
fever, dry cough and chest pain. It usually takes weeks or months to
develop, but can be life threatening if not treated.
100 to 50 Cytomegalovirus: Cytomegalovirus is everywhere and it is thought
that most people throughout the world have been exposed to it, but
mostly didn’t notice. Nevertheless; like HIV, once you have the virus
you have it for life. If you are HIV infected and have low CD4 cell
counts, you should not be surprised if you get a cytomegalovirus
infection in your gut, or your eyes (cytomegalovirus retinitis), where
it may lead to blindness if you don’t get treatment.
less than 50 Mycobacterium avium complex: Mycobacterium avium complex
exists everywhere in the environment and can infect the lungs and
intestines of people with severe immunodeficiency. It can be deadly
if it spreads to other parts of your body.
g. PERIOD OF COMMUNICABILITY

All antibody-positive people carry the HIV virus.

Infectivity is presumed to be LIFE-LONG, although successful therapy with

cART can lower the viral load in blood and semen to undetectable levels.

h. SUSCEPTIBILITY

Everyone is susceptible to infection.

The presence of other sexually transmissible infections, especially those with skin
or mucosal ulceration, may increase susceptibility.

CDC HIV Risk Behaviors Research Study:

The table below lists the risk of transmission per 10,000 exposures for various types
of exposures.
Source for HIV Risk Behavior study:

Patel P, Borkowf CB, Brooks JT. Et al. Estimating per-act HIV transmission risk: a
systematic review. AIDS. 2014. doi: 10.1097/QAD.0000000000000298.

Pretty LA, Anderson GS, Sweet DJ. Human bites and the risk of human immunodeficiency
virus transmission. Am J Forensic Med Pathol 1999;20(3):232-239.

i. METHODS OF CONTROL
i. PREVENTIVE MEASURES

According to CDC HIV 101 pamphlet:

#1 Get tested. People who spread HIV easily are often unaware of their own HIV
status.
 ANTIBODY BASED DIAGNOSTIC TESTS:
o Screening tests
 ELISA (enzyme-linked immunosorbent assay)
 (detects HIV antibodies in the blood)
 Rapid tests
o Supplemental or confirmatory
 IFA (immunofluorescent assay)
 Western blot (confirmatory)
 LIA- lineimmuno assay
 RIPA- radio immune precipitation assay
o Other tests
 P24 antigen
 Culture
 PCR (Polymerase Chain Reaction – detect proviral DNA sequences)
 Plasma/ serum viral load

To avoid getting HIV, you must prevent any contaminated body fluids from entering your body
through your nose or mouth, vagina, anus, penis, or breaks in your skin. This can be done by
practicing safe sex and safe drug use, which means:

 Consistent and proper condom use

 Get tested regularly - this is a must if you are having sex with someone you know
has HIV, or if you are worried you might have been exposed to HIV, and

 Never share intravenous needles, syringes, cookers, cotton, cocaine spoons, or eye
droppers if you use drugs.

What is PrEP and how does it prevent HIV?

 PrEP = pre-exposure prophylaxis.

 Taken once a day that can help prevent HIV – consult with physician

What is PEP and how does it prevent HIV?

 PEP = post-exposure prophylaxis

 Series of pills you start taking after you’ve been exposed to HIV that lowers your chances
of getting HIV.
 MUST START PEP WITHIN 72 HOURS (3 DAYS)
What is ART and how does it prevent HIV?

 Antiretroviral Therapy (ART) is a combination of medicines that slows down the

effects of HIV in your body and can help you stay healthy for many years (can also lower
or even stop your chances of giving HIV to anyone else)
 ART lowers amount of HIV in your body (even up to undetectable level)

ii. CONTROL OF CASE

 STANDARD or UNIVERSAL PRECAUTIONS: prevent transmission of blood

and body-fluid borne pathogens
 No donations of blood, organs or other human tissue from patients or their
sexual partners

iii. TREATMENT

1. Antivirals : shorten the clinical course, prevent complications, prevent development of

latency and decrease transmission

Ex. ZIDOVUDINE (trade name: RETROVIR), NEVIRAPINE (trade name: VIRAMUNE)

2. Treatment of opportunistic infection

REFERENCES (LINKS):
https://www.cdc.gov/hiv/basics/whatishiv.html

https://www.who.int/gho/hiv/en/

https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/325/human-
immunodeficiency-virus

https://news.illinois.edu/view/6367/205875

https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids

https://www.khanacademy.org/science/health-and-medicine/infectious-diseases/hiv-
and-aids/a/what-is-hivaids?modal=1

https://www.researchgate.net/figure/Reservoirs-of-HIV-in-human-
body_fig2_260376811

https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-
advice/hiv-and-aids

https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids

https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

http://medind.nic.in/ibo/t08/i1/ibot08i1p42.pdf

https://www.austincc.edu/microbio/2704q/hiv

https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/45/hiv-aids--the-basics