AIDS

DISEASE
AIDS (Acquired Immunodeficiency Syndrome)
 It is a disease caused by the retrovirus human immunodeficiency
virus (HIV) and characterized by profound immunosuppression that
leads to opportunistic infections, secondary neoplasms and
neurological manifestations.
 The acquired immune deficiency syndrome AIDS was first
recognized in 1981 in US.
 AIDS is a term which applies to the most advanced stages of HIV
infection, it is defined by the occurrence of any more than 20
opportunistic infections or HIV-related cancers.
 AIDS is a chronic, life threatening condition caused by HIV. By
damaging immune system. HIV interferes with the body’s ability to
fight off viruses, bacteria and fungi that cause disease.
 AIDS is the name given to the later stages of an HIV infection.
 INCIDENCE
01
Fast Facts. Approximately 1.2 million people in the U.S.
have HIV. About 13 percent of them don't know it and
need testing. HIV continues to have a disproportionate
impact on certain populations, particularly racial and ethnic
minorities and gay, bisexual, and other men who have sex
with men.

Oct 27, 2022

 INCIDENCE IN THE PHILIPPINES

In February 2022, there were 1,054 confirmed HIV-

positive individuals reported to the HIV/AIDS & ART
Registry of the Philippines (HARP) and were
accounted to the total (96,266) reported cases since
January 1984. Moreover, 28% (297) of individuals
reported in February had advanced HIV infection at
the time of testing.

02
02
HIV/AIDS IN ILOCOS REGION
03
From 1984 to January 2018, of the total cases of
HIV/AIDS in the province of Ilocos Sur, nine local
government units have recorded the most number of
cases. These are Vigan City with 24 cases; Candon
.
City with 20 cases; Narvacan with 13 cases;
Tagudin with 12 cases; Bantay, San Juan and
Santiago with 8 cases each; and, Sta. Cruz and Sta.
Maria with 7 cases each.
 WHERE DID HIV COME FROM?
● They believe that the chimpanzee version of the
immunodeficiency virus (called simian
immunodeficiency virus or SIV) most likely was
transmitted to humans and mutated
into HIV when humans hunted these
chimpanzees for meat and came into contact with
their infected blood
A patient with AIDS is:
• Very infectious
• Very ill and,
• Prone to aggressive kinds of opportunistic disease

It is important to emphasize to patients that AIDS is acquired,

which means it is not hereditary or inborn, except in cases of
congenital HIV. However, not every child born to a mother with
HIV will acquire the virus from her.
 HIV is a typical retrovirus with a small RNA genome of 9300
base pairs.
 Is a spherical and contains nucleocapsid core surrounded by a
lipid bilayer or envelop derived from host membrane.
 The viral genome encodes 3 major open reading frames-
 GAG encodes- a polyprotein that is processed to release
major structural proteins of virus.
 POL encodes 3 important enzymes are RNA dependent DNA
polymerase or reverse transcriptase with RNAse H, Protease
and Integrase.
 ENV encodes for large transmembrane envelop proteins
responsible for cell binding and entry.
 Several small genes encodes regulatory proteins that enhances
virion production or combat host defense
• HIV is a retrovirus that belongs to genus Lentivirus, (lente-, Latin for
“slow”), because the time between infection and the appearance of
symptoms tend to be much longer, allowing more opportunities for
these pathogens to be transmitted to other hosts.
• The virus attacks and slowly destroys the immune system, which leads
to “immune deficiency”.
• It is progressive and leads to a profound lack of defense against all
kinds of infections, including the organisms that do not normally cause
severe illness in humans.
• HIV infection can also lead to increased susceptibility to CANCER.
• It is a lifelong condition and there is currently no definite cure,
although some scientist are working to find one.
• However, with medical care and treatments such as antiretroviral
therapy, it is to possible to manage HIV and live with the condition for
many years.
MODE OF TRANSMISSION

Sexual intercourse

Vertical or Perinatal transmission

Blood tranfusion and sharing of infected syringes

and needles among intravenous drug users
 CLASSIFICATION
• The stages of HIV disease is based on clinical history, physical examination, laboratory
evidence of immune dysfunction, signs and symptoms, and infections and malignancies.

• Primary infection (Acute/Recent HIV Infection). The period from infection with HIV to the
development of HIV-specific antibodies is known as primary infection.

• HIV asymptomatic (CDC Category A). After the viral set point is reached, HIV-positive
people enter into a chronic stage in which the immune system cannot eliminate the virus
despite its best efforts.

• HIV symptomatic (CDC Category B). Category B consists of symptomatic conditions in

HIV-infected patients that are not included in the conditions listed in category C.

• AIDS (CDC Category C). When the CD4+ T-cell level drops below 200 cells/mm3 of blood,
the person is said to have AIDS.
 WAYS OF RECEIVING INFECTED
BLOOD
● There is always a risk in receiving contaminated blood, whether by direct
transmission or through blood transfusion. In order to prevent this, international
health regulations require that all blood products must be screened for any viral or
bacterial contamination before they are used(CDC, 2019). There are several ways
by which patients can receive contaminated blood usually through:
1. Blood transfusion;
2. Sharing unsterilized syringes and needles previously used by other people; and
3. Organ donation; and
4. Accidental exposure to blood and blood products in hospitals or clinics.
 CLINICAL MANIFESTATIONS
2 weeks after the infection
Flu-like symptoms can include:
Fever
Chills
Rash
Night sweats
Muscle aches
Sore throat
Fatigue
Swollen lymph nodes
Mouth ulcers
 CLINICAL MANIFESTATIONS
During this time, HIV infection may
not show up on an HIV test, but
people who have it are highly
infectious and can spread the
infection to others. You should not
assume you have HIV just because
you have any of these symptoms.
Each of these symptoms can be
caused by other illnesses. And some
people who have HIV do not show
any symptoms at all for 10 years or
more.
 CLINICAL MANIFESTATIONS
Progression to AIDS
Rapid weight loss -Wasting Syndrome
Recurring fever or profuse night sweats
Extreme and unexplained tiredness
Prolonged swelling of the lymph glands in the armpits, groin, or neck
Diarrhea that lasts for more than a week
Sores of the mouth, anus, or genitals
Pneumonia
Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or
eyelids
Memory loss, depression, and other neurologic disorders
Peripheral Neuropathy
Oncologic - Kaposi's Sarcoma, B-Cell Lymphomas
 COMPLICATIONS

● RESPIRATORY MANIFESTATIONS
A. PNEUMOCYSTIS JIROVECII PNEUMONIA
- Formerly P. Carinii pneumonia, the organism has been renamed but the abbreviation
remains PCP. PCP is one of the first opportunistic infections associated with AIDS and
also the most common one. (Smeltzer et al, 2008).
B. MYBACTERIUM AVIUM COMPLEX (MAC)
-comprises a group of acid-fast bacilli that includes M. avium, M. Intracellularis, and M.
scrofulaceum. MAC usually infects the respiratory system but it can also affect the GIT,
lymph nodes, and bone marrow.
 COMPLICATIONS

● TUBERCULOSIS
- That occurs late in HIV infection is characterized by absence of an immune response to the
tuberculin test. This occurs because the compromised immune system can no longer respond
to the TB antigen. In the alter stage of HIV infection, TB may be disseminated to
extrapulmonary sites such as the CNS, the bones, pericardium, stomach, and peritoneum.
 COMPLICATIONS
● GASTROINTESTINAL MANIFESTATIONS
A. ORAL CANDIDIASIS
- Is a fungal infection that occurs in almost all patients with AIDS and AIDS- related
conditions. This is characterized by creamy white patches in the oral cavity that, if left
untreated, will affect the esophagus, up to the stomach. The patient experiences difficult
and painful swallowing and retrosternal pain.
B. WASTING SYNDROME
- Occurs when the patient goes into a hypermetabolic state in which excessive calories are
burned and lean body mass is lost. Diarrhea, gastrointestinal malabsorption and anorexia
cause progressive muscle wasting.
ORAL CANDIDIASIS WASTING SYNDROME
 COMPLICATIONS

● ONCOLOGIC MANIFESTATIONS
A. KAPOSI’S SARCOMA
- Is the most commo HIV related malignancy. It is associated with a low CD4 count.
Cutaneous lesions can appear anywhere in the body, and are brownish-pink in color. They
may be raised or just flat on the skin.
B. B-CELL LYMPHOMAS
- Are the second most common malignancy associated with AIDS. More often than not, B-
cell lymphomas develop outside the lymph nodes. They tend to spread out to the brain, bone
marrow, and the GIT.
 CONFIRMATORY TEST

● ELISA Test ELISA, which stands for

enzyme-linked immunosorbent assay,
is used to detect HIV infection. If an
ELISA test is positive, the Western
blot test is usually administered to
confirm the diagnosis.
KAPOSI’S SARCOMA B-CELL LYMPHOMA
 COMPLICATIONS

● NUEROLOGIC MANIFESTATIONS
A. HIV ENCEPHALOPATHY
- Formerly known as AIDS dementia complex. Signs observed from the patient include
memory deficit, headache, difficulty in concentrating psychomotor slowing progressing
to delay in verbal responses, hallucinations, spastic paraparesis, seizures, blank stares,
and mutism. Death can follow any time. (Smeltzer et al, 2008).
B. VASCULAR MYELOPATHY
- Is a degenerative disorder that affects the lateral and posterior columns pf the spinal cord,
resulting in spastic paraparesis, ataxia and incontinence.
PERIOD OF
COMMUNICABILITY INCUBATION PERIOD

● Infectivity is presumed to be ● The interval from HIV

lifelong, although successful infection to the diagnosis of
therapy with cART can lower AIDS ranges from about 9
the viral load in blood and months to 20 years or longer,
semen to undetectable levels. with a median of 12 years.
 DIAGNOSTIC PROCEDURES
● Confirming Diagnosis: Signs and symptoms may occur at any time after infection, but AIDS
isn’t officially diagnosed until the patient’s CD4+ T-cell count falls below 200 cells/mcl or
associated clinical conditions or disease.
● CBC: Anemia and idiopathic thrombocytopenia (anemia occurs in up to 85% of patients
with AIDS and may be profound)
● PPD: Determines exposure and/or active TB disease. Of AIDS patients, 100% of those
exposed to active Mycobacterium tuberculosis will develop the disease.
● Serologic: Serum antibody test: HIV screen by ELISA. A positive test result may be
indicative of exposure to HIV but is not diagnostic because false-positives may occur.
● Western blot test: Confirms diagnosis of HIV in blood and urine.
● STD screening tests: Hepatitis B envelope and core antibodies, syphilis, and other common
STDs may be positive
 DIAGNOSTIC PROCEDURES

● Viral load test.

● Cultures: Histologic, cytologic studies of urine, blood, stool, spinal fluid,
lesions, sputum, and secretions may be done to identify the opportunistic
infection.
• Bronchoscopy/tracheobronchial washings: May be done with biopsy when
PCP or lung malignancies are suspected (diagnostic confirming test for PCP).
• Barium swallow, endoscopy, colonoscopy: May be done to identify
opportunistic infection (e.g., Candida, CMV) or to stage KS in the GI system.
 DIAGNOSTIC PROCEDURES
● Neurological studies: Indicated for changes in mentation, fever of undetermined
origin, and/or changes in sensory/motor function to determine effects of HIV
infection/opportunistic infections.
● Chest x-ray: May initially be normal or may reveal progressive interstitial infiltrates
secondary to advancing PCP (most common opportunistic disease) or other pulmonary
complications/disease processes such as TB.
● Pulmonary function tests: Useful in early detection of interstitial pneumonias.
● Gallium scan: Diffuse pulmonary uptake occurs in PCP and other forms of
pneumonia.
● Biopsies: May be done for differential diagnosis of Kaposi’s sarcoma (KS) or other
neoplastic lesions.
● PCR. Polymerase chain reaction.
 PATHOPHYSIOLOGY
Because HIV infection is an infectious disease, it is important to understand how
HIV-1 integrates itself into a person’s immune system and how immunity plays a
role in the course of HIV disease.

• In this first step, the GP120 and GP41 glycoproteins of HIV bind with the host’s
uninfected CD4+ receptor and chemokine coreceptors, usually CCR5, which
results in the fusion of HIV with the CD4+ T-cell membrane.
• The contents of HIV’s viral core are emptied into the CD4+ T cell.
• DNA synthesis. HIV changes in genetic material from RNA to DNA through the
action of reverse transcriptase, resulting in double-stranded DNA that carries
instruction for viral replication.
• New viral DNA enters the nucleus of the CD4+ T cell and through the action of
integrase is blended with the DNA of the CD4+ T cell, resulting in permanent,
lifelong infection.
 PATHOPHYSIOLOGY
• When the CD4+ T cell is activated, the double-stranded DNA forms
single-stranded messenger RNA, which builds new viruses.

• The mRNA creates chains of new proteins and enzymes that contain the
components needed in the construction of new viruses.

• The HIV enzyme protease cuts the polyprotein chain into the individual
proteins that make up the new virus.

• New proteins and viral RNA migrate to the membrane of the infected
CD4+ T cell, exits from the cell, and starts the process all over .
1ST OF
DECEMBER
World AIDS Day is marked annually
on the 1st of December to call for
standing in solidarity with the 38
million people living with HIV
worldwide and we remember the
millions who lost their lives to AIDS.
 MEDICAL MANAGEMENT
1. Treatment of Opportunistic Infections
For Pneumocystis pneumonia, TMP-SMZ is the treatment of choice; for mycobacterium
avian complex, azithromycin or clarithromycin are preferred prophylactic agents; for
cryptococcal meningitis, the current primary treatment is IV amphotericin B.
2. Prevention of Infection
Trimethoprim-Sulfamethoxazole is an antibiotic for treating infection causing organisms.
3. Antidiarrheal Therapy
Therapy with octreotide acetate (Sandostatin), a synthetic analog of somatostatin, has been
shown to be effective in managing severe chronic diarrhea.
 MEDICAL MANAGEMENT

4. Antidepressant Therapy
● Treatment for depression in patients with HIV infection involves
psychotherapy integrated with imipramine, desipramine or fluoxetine.
5. Nutrition Therapy
● For all AIDS patients who experience unexplained weight loss, calorie
counts should be obtained, and appetite stimulants and oral
supplements are also appropriate
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,
● Didanosine,
● Emtricitabine,
● Lamivudine,
● Stavudine,
● Tenofovir,
● Zalcitabine,
● Zidovudine
PROTEASE INHIBITORS
● These FDA-approved drugs interrupt virus replication at a later step in
the virus life cycle. Protease inhibitors include:
● Amprenavir,
● Atazanavir,
● Fosamprenavir,
● Indinavir,
● Lopinavir,
● Ritonavir,
● Saquinavir
 NURSING MANAGEMENT
1. HEALTH EDUCATION
● Know your audience. Nurses should be aware of the physical and psychological consequences associated
with HIV/AIDS patients.
● Instruct patients, and their families and friends about the modes of transmission of the disease. Including
handwashing in the discussion.
● Avoid fear tactics. Give correct information, values clarification and impose confidentiality.
● Avoid judgmental and moralistic messages. Be tactful.
● Be consistent and concise in giving instructions. Use positive statements.
2. PRACTICE UNIVERSAL/STANDARD PRECAUTIONS
● Practice thorough medical handwashing after every contact with patients and after removing the gloves,
and before leaving the room of a person suspected of AIDS or an established case of HIV.
● Use universal barrier or personal protective equipment (PPE) cap, mask, gloves, gown, face shield or
goggles.
 NURSING MANAGEMENT
3. PREVENTIVE MEASURES
● Observe correct technique to avoid pricks from sharp instruments contaminated with potentially
infectious materials from a patient with AIDS.
● Gloves should be worn when handling blood specimens and other body secretions as well as surfaces,
materials, and objects exposed to these bodily fluids.
● Blood spills should be cleaned immediately with common household disinfectants, such as sodium
hypochlorite.
● Blood and other specimens should be labeled with a special warning such as “AIDs Precaution”.
● Needles should not be bent after use. These should be disposed of in a puncture resistant container.
● Personal articles like razors, razor blades and toothbrushes should not be shared with other members of
the family, razor blades may be disposed of in the same manner as needles.
● Patients with active AIDS should be isolated to decrease exposure to pathologic organisms.
 NURSING DIAGNOSIS
• Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation,
and diarrhea.
• Diarrhea related to enteric pathogens of HIV infection.
• Risk for infection related to immunodeficiency.
• Activity intolerance related weakness, fatigue, malnutrition, impaired F&E balance, and
hypoxia associated with pulmonary infections.
• Disturbed thought processes related to shortened attention span, impaired memory, confusion,
and disorientation associated with HIV encephalopathy.
• Ineffective airway clearance related to PCP, increased bronchial secretions, and decreased
ability to cough related to weakness and fatigue.
• Pain related to impaired perianal skin integrity secondary to diarrhea, KS, and peripheral
neuropathy.
• Imbalanced nutrition, less than body requirements related to decreased oral intake.
“HIV AIDS is a disease with stigma.
And we have learned with
experience, Hate AIDS, not the
people having It.”

- MARGARET CHAN
 PREVENTIONS

● 1. A-B-C
Abstinence
Be FAITHFUL
Condoms!
● 2. Needle Precaution
 CONCLUSIONS
• Remember AIDS does not discriminate
cast, creed, religion, education or social
status.

• Prevention of AIDS is our joint

responsibility.

• Education and awareness is only weapon in

our hand.
A Pictures Is
Worth A
Thousand
Words
THANK YOU!