Management of patient with AIDS

AIDS MANAGEMENT

1. Management of Patient with AIDS MATHEW VARGHESE V MSN(RAK),FHNP (CMC Vellore),CPEPC Nursing officer AIIMS Delhi

2. Introduction HIV continues to be a major global public health issue, having claimed more than 32 million lives so far. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives. There were approximately 37.9 million people living with HIV at the end of 2018.

3. HIV AND AIDS IN INDIA

4. Basic facts about HIV HIV stands for human immunodeficiency virus. The virus destroys a type of white blood cell in the immune system called a T-helper cell (CD4 cells) and makes copies of it inside these cells As HIV destroys more CD4 cells and makes more copies of it, it gradually weakens a person’s immune system. If HIV is left untreated, it may take up to 10 or 15 years for the immune system to be so severely damaged However, the rate at which HIV progresses varies depending on age, general health and background

5. Basic facts about HIV People with HIV can enjoy a long and healthy life by taking ART which is effective and available to all. It’s possible for antiretroviral treatment to reduce the level of HIV in the body to such low levels that blood tests cannot detect it. People living with HIV whose viral load is confirmed as undetectable cannot pass on HIV. Regular   for HIV is important to know your status.

6. Basic facts about AIDS AIDS stands for acquired immune deficiency syndrome; it’s also called advanced HIV infection or late-stage HIV. AIDS is a set of symptoms and illnesses that develop as a result of advanced HIV infection which has destroyed the immune system. Although there is no cure for HIV, with the right treatment and support, people living with HIV can enjoy long and healthy lives.

7. Causative agent of AIDS- Human immunodeficiency Virus HIV is a retrovirus that contains only RNA. The most common type is known as HIV-1 There is also an HIV-2 that is much less common and less virulent, but eventually produces clinical findings similar to HIV-1. The HIV-1 type itself has a number of subtypes (A through H and O) which have differing geographic distributions but all produce AIDS similarly.

8. The structure of HIV

9. Mode of transmission

10. WHO clinical staging of HIV disease in adults, adolescents and children

11. IMMUNOLOGICAL STAGING OF HIV INFECTION Stage CD4 cell count Not significant immunosuppression >500/mm3 Mild immunosuppression 350 −499/mm3 Advanced immunosuppression 200−349/mm3 Severe immunosuppression <200/mm3

12. IMPLICATIONS FOR CLINICAL AND IMMUNOLOGICAL CRITERIA FOR INITIATING ART IN ADULTS AND ADOLESCENTS Clinical stage ART 4 Treat. 3 Consider treatment: CD4, if available, can guide the urgency with which ART should be started. 1 or 2 Only if CD4<200/mm3

13. Opportunistic Infections common to HIV/AIDS

14. Cancers common to HIV/AIDS

15. complications

16. DIAGNOSIS OF HIV INFECTION

17. Tests to stage disease and treatment

18. Tests for complications

19. Diagnosis of clinically symptomatic clients

20. Diagnosis of clinically asymptomatic clients

21. ART Treatment

22. When is ART Given?

23. AIDS Medications Nucleoside Reverse Transcriptase Inhibitors (NRTI) These drugs interrupt the virus from duplicating, which may slow the spread of HIV in the body. They include: Abacavir ( Ziagen , ABC) Didanosine ( Videx , dideoxyinosine , ddI ) Emtricitabine ( Emtriva , FTC) Lamivudine ( Epivir , 3TC) Stavudine ( Zerit , d4T) Tenofovir ( Viread , TDF) Zalcitabine ( Hivid , ddC ) Zidovudine ( Retrovir , ZDV or AZT)

24. Protease Inhibitors (PI) These FDA-approved drugs interrupt virus replication at a later step in the virus life cycle. Protease inhibitors include: Amprenavir ( Agenerase , APV) Atazanavir ( Reyataz , ATV) Fosamprenavir ( Lexiva , FOS) Indinavir ( Crixivan , IDV) Lopinavir ( Kaletra , LPV/r) Ritonavir ( Norvir , RIT) Saquinavir ( Fortovase , Invirase , SQV)

25. Other AIDS Medications Fusion Inhibitors Fusion inhibitors are a new class of drugs that act against HIV by preventing the virus from fusing with the inside of a cell, preventing it from replicating. The group of drugs includes Enfuvirtide , also known as Fuzeon or T-20.

26. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) block the infection of new cells by HIV. These drugs may be prescribed in combination with other anti-retroviral drugs. NNRTs include: Delvaridine ( Rescriptor , DLV) Efravirenz ( Sustiva , EFV) Nevirapine ( Viramune , NVP)

27. Highly Active Antiretroviral Therapy (HAART) In 1996, highly active antiretroviral therapy (HAART) was introduced for people with HIV and AIDS. HAART — often referred to as the anti-HIV "cocktail" — is a combination of three or more drugs, such as protease inhibitors and other anti-retroviral medications. The treatment is highly effective in slowing the rate at which the HIV virus replicates itself, which may slow the spread of HIV in the body. The goal of HAART is to reduce the amount of virus in your body, or the viral load, to a level that can no longer be detected with blood tests.

28. Prevention Use a new condom every time you have sex.   Consider pre exposure prophylaxis ( PrEP ). Tell your sexual partners if you have HIV Use a clean needle.   If you're pregnant, get medical care right away.   Consider male circumcision

29. Nursing management

30. Nursing Diagnoses Nursing Diagnosis: Diarrhea related to enteric pathogens or HIV infection Goal: Resumption of usual bowel habits Nursing Diagnosis: Risk for infection related to immunodeficiency Goal: Absence of infection Nursing Diagnosis: Ineffective airway clearance related to Pneumocystis carinii pneumonia, increased bronchial secretions, and decreased ability to cough related to weakness and fatigue Goal: Improved airway clearance

31. Nursing Diagnoses Nursing Diagnosis: Imbalanced nutrition, less than body requirements, related to decreased oral intake Goal: Improvement of nutritional status Nursing Diagnosis: Deficient knowledge related to means of preventing HIV transmission Goal: Increased knowledge concerning means of preventing disease transmission Nursing Diagnosis: Social isolation related to stigma of the disease, withdrawal of support systems, isolation procedures, and fear of infecting others Goal: Decreased sense of social isolation

32. Nursing Diagnoses Nursing Diagnosis Risk For compliocations : Opportunistic infections; impaired breathing; wasting syndrome and fluid and electrolyte imbalances; adverse reaction to medications Goal: Absence of complications Opportunistic Infections Impaired Breathing Wasting Syndrome and Fluid and Electrolyte Disturbances Reactions to Medications

33. study Nursing Practice to Support People Living With HIV With Antiretroviral Therapy Adherence A Qualitative Explorative Study (16 Samples) Rouleau , Geneviève RN, MSc * ; Richard, Lauralie RN, PhD; Côté , José RN, PhD; Gagnon, Marie-Pierre PhD; Pelletier, Jérôme RN, MSc Author Information Journal of the Association of Nurses in AIDS Care:  July-August 2019 - Volume 30 - Issue 4 - p e20-e37 doi : 10.1097/JNC.0000000000000103

34. Results We explored HIV nursing practice, particularly the challenges that nurses face in promoting ART adherence and opportunities for practice development in the field. The nurse–patient relationship was at the forefront of nursing practice to support PLWH. This practice translated into a range of nursing activities to foster ART adherence by supporting PLWH in their whole situation, including the assessment of an array of dimensions related to PLWH health, teaching and sharing knowledge, coordinating care, and connecting PLWH with resources.

35. Results Providing HIV nursing care, especially ART-related care, to PLWH was challenging in three areas: (a) performing nursing roles at the interface of social and biomedical boundaries, (b) misalignment between nurse and patient expectations regarding ART (non) adherence, making nurses feel powerless when faced with situations of nonadherence , and (c) dealing with sociopolitical determinants affecting access to health care resources and services. Nurses mobilized a range of resources—knowledge, networks, and strategies—to build capacity and overcome challenges relating to their practices with PLWH.

36. References UNAIDS ‘ Overview: India ’ accessed November 2019) World Bank, ‘ Data: India ’ (accessed November 2019) UNAIDS ‘ Overview: India ’ accessed November 2019) https://www.mayoclinic.org/diseases-conditions/hiv-aids/diagnosis-treatment/drc-20373531 https://www.google.com/search?q=diagnosis+f+hiv&rlz=1C1CHBF_enIN808IN808&oq=diagnosis+f+hiv&aqs=chrome..69i57j0l7.8650j1j7&sourceid= chrome&ie =UTF-8 https://www.mayoclinic.org/tests-procedures/hiv-testing/about/pac-20385018 https://webpath.med.utah.edu/TUTORIAL/AIDS/AIDS.html https://www.avert.org/about-hiv-aids/how-infects-body https://www.who.int/news-room/fact-sheets/detail/hiv-aids https://www.healthline.com/health/hiv-aids