Human Immunodeficiency Virus (HIV) Auto Immune Deficiency

Syndrome (AIDS) - 3 Nursing CEs

Author: Kristi Hudson RN MSN CCRN

Written: 1/21/06

Updated:October 14, 2009

Course Description:

This course is designed to give an overview of the care and management of the patient with HIV/AIDS. Focus will be placed on the statistics surrounding HIV/AIDS as well as the mode of transmission, risk factors, prevention, infection control issues and diagnosis. Medical management including pharmaceuticals and combination therapies will also be presented. State laws regarding the impact of testing and confidentiality will be the final focus of this course.

Course Objectives:

Upon completion of this course the student will be able to:

• Have a better understanding of the HIV/AIDS virus and its mode of transmission
• List 3 statistics surrounding the HIV/AIDS virus
• Describe 2 risk factors for contracting HIV/AIDS
• Explain the infection control issues that surround  HIV/AIDS
• Discuss pharmaceutical management of the HIV/AIDS
• List the intended purpose and rationale for 3 different antiviral medications
• Explain what is meant by medication combination therapy
• Discuss state laws regarding testing and confidentiality of patients diagnosed with HIV/AIDS

What is HIV/AIDS?

HIV – (Human Immunodeficiency Virus) is a virus that leads to the development of AIDS (Acquired Immunodeficiency Syndrome). HIV causes a multitude of other disease process because this virus affects and incapacitates a person’s immune system. HIV in and of itself is not considered to be an illness and does not always immediately lead to the development of AIDS.

AIDS – (Acquired Immunodeficiency Syndrome) is a health condition that results in the deficiency of the body’s own immune system following HIV infection. As the immune system weakens from HIV infection the body loses its natural ability to ward off or fight disease. At this stage a variety of disease process can affect a person. The following is a breakdown of each term in the diagnosis of AIDS to help better explain the disease process itself:

Acquired – this means that the disease is not hereditary but develops after birth from contact with a disease causing agent (in this case, HIV).

Immunodeficiency – means that the disease is characterized by a weakening of the immune system that prevents the body from warding off disease.

Syndrome – refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system.

Statistics Surrounding HIV/AIDS:

• It is estimated that 40 million people in the world are living with HIV/AIDS.
• AIDS is the number one killer of African American women ages 25 to 34.
• More then 25 million people have died of AIDS since 1981.
• Africa has 12 million AIDS orphans.
• By December 2005 women accounted for 46% of all adults living with HIV (worldwide).
• In Sub-Sahara Africa 57% of those affected by the HIV virus are women.
• Young people ages 15 to 24 account for ½ of all new reported HIV infected people.
• More then 6,000 young people (again ages 215 to 24) become infected with HIV everyday.
• Only 1 million of the 6.5 million people in developing countries are receiving necessary life-saving AIDS medication.
• In 2004 it is estimated that 3 million people world wide died of AIDS.
• Currently more then 95% of new cases of HIV are occurring in developing countries.

Mode of Transmission:

A certain amount of virus and a portal of entry are the essential requirements for spreading HIV. The most common method of transmission is sexual contact that includes the blood-tainted semen or vaginal secretions of an infected partner. In addition to sexual activity; all of the following are also considered to be modes of transmission:

• Blood to blood contact (such as with contaminated blood transfusion products).
• Sharing injectable drug supplies (needles).
• Occupational exposure (healthcare, sports).
• Mother to child (in utero, during labor and delivery or with breast feeding).

Risk Factors for Contracting HIV:

It is important to be aware that HIV is not an age, gender, ethnicity or intelligence specific infection. There are however certain behaviors that can make the contraction of this infection more risky. All of the following are primary risk factors for contracting HIV:

• Engaging in unsafe sex (without the protection of a condom or other barrier).
• Having sex with multiple partner’s increases the risk.
• Having sex with a partner that uses IV drugs.
• Sharing needles or other IV drug paraphernalia.
• Receiving blood transfusions or treatments with contaminated products.
• Getting tattoo or piercing with contaminated equipment.
• Having a job with increased risk to blood/body fluid exposure (healthcare workers).
• Having a sexually transmitted disease (STD) increases person’s chances of contracting HIV (open ulcerations are considered to be ports of entry).

Prevention of Contracting HIV/AIDS:

Currently education is the single most valuable asset in the prevention of contracting and spreading HIV/AIDS. Though HIV/AIDS does not discriminate; it is thought that the following populations will receive the greatest benefit from HIV/AIDS public education programs:

• Those who lack educational and economic opportunity (homeless, convicted criminals)
• Prostitutes
• Women who have sexual partners not willing to use condoms
• Non-English speaking people
• People with low socioeconomic standing
• Adolescents (high sexual contagions)
• People with sexual transmitted diseases
• IV drug abusers
• Homosexuals
• Education of parents with teens

In addition to education and educational materials, other suggested ideas to prevent the spread of HIV/AIDS include:

• Needle exchange programs (for IV drug users)
• Providing clean syringes and other drug paraphernalia
• Methadone programs to help people stop using IV drugs
• Availability of condoms (free at clinic’s and public health areas)
• Sex education programs for teens
• If no needle exchange program available teach proper sterilization of needles to IV drug users (cleaning with bleach and soaking for 30 seconds)
• Encouraging people to donate autogolous blood prior to elective surgery

Infection Control Issues:

Data shows that nurses are at greatest risk for an occupational exposure to HIV/AIDS. Though transmission can occur with mucosal contact the majority of transmission occurs with percutaneous injuries (most commonly needle sticks).

The use of Universal Precautions (which is the assumption that all patients carry a contagious/contractible virus or infection) is the number one intervention to prevent the contraction or transmission of HIV/AIDS. The following are other infection control interventions that should be followed to assure that the risk of infection is minimized:

• Gloves should be worn whenever anticipating contact with blood or body fluids.
• Hand washing must occur before and after gloves are put on.
• Discard used gloves and other barriers in the appropriate containers.
• Cover any cuts and/or abrasions with waterproof barriers before participating in patient care.
• Immediately report any blood or body exposure to a supervisor and the occupational health department.
• Other protective barrier equipment should be worn if the potential for blood and or body fluids to splash or fly through the air exists (during child birth or with pulmonary secretions for example).
• Extreme caution when disposing of sharps in imperative (never recap a needle)
• Always remember that each individual is responsible for protecting themselves.
• Make sure you are familiar with the equipment you are using.

Diagnosing HIV/AIDS:

Diagnosis of HIV/AIDS is made by performing a blood test called ELISA (Enzyme Linked Immunosorbant Assay) which detects specific anti-bodies to the virus. If the first ELISA test is positive a second confirmatory blood test is conducted. A second blood test called the Western blot (which produces instant results), can also be performed but this test has proven to be very expensive.

Medical/Pharmaceutical Treatment:

There is currently no cure for HIV/AIDS so medical treatment options are focused on treating the symptoms and disease process that arise due to HIV/AIDS. The FDA has so far approved twenty drugs to assist individuals with treatment of HIV. These drugs are known as antiretroviral drugs because they attack HIV (which is a retrovirus). The first approved antiretroviral drugs were effective in preventing HIV from using specific enzymes to multiply. The following drugs fall into this category:

• Reverse Transcriptase (RT) inhibitors – these drugs interfere with the enzyme “reverse transcriptase” and inhibit HIV from replicating itself. Examples of RT inhibitor include Nucleoside/Nucleotide drugs (Abcavir and 3TC for example), provides faulty building blocks for DNA and Non-Nucleoside/Nucleotide drugs (Delavirdine and Nevirapine for example), bind RT so the virus cannot carry out its copy function.
• Protease Inhibitors (PI) – PI drugs (Ritonavir [also known as AZT] and ddC or ddl for example) interfere with the protease enzyme that HIV uses to produce infectious viral particles.
• Fusion Inhibitors (the newest drug in this category) – these drugs (Enfuvirtide for example) interferes with the virus’ ability to fuse with the cellular membrane which blocks entry into the host cell.

Because there is not “one” specific drug to effectively treat HIV/AIDS, a combination treatment is recommended to prevent the spread of the virus. This type of therapy is referred to as Highly Active Anti-Retroviral Therapy or (HAART). There are many HARRT regimens that are thought to be safe and effective. The following are drug combination recommendations:

Nucleoside/Nucleoside combinations – this combination is the best studied double therapy approach. Studies in the US, Europe and Australia have shown that the use of AZT in combination with ddC or ddl for example are more effective then AZT alone.

A Protease Inhibitor plus two Nucleosides – studies have shown that a three drug combination such as this one resulted in a larger and longer acting reduction of HIV in the blood.

A Non-Nucleoside and two Nucleosides – the most studied combination in this category were the Non-Nucleoside Nevirapine with Nucleosides AZT and ddl. This combination therapy is thought to be stronger and more effective then a double drug therapy regimen.

State Law Requirements for Testing and Confidentiality:

• All 50 states including the District of Columbia and Puerto Rico are required to report new cases of HIV and AIDS to their state health departments (Requiring HIV reporting was met with much more resistance then AIDS reporting). This information is in turn reported to the Centers for Disease Control and Prevention (CDC).
• The collection and reporting of this data is based on confidential name-based surveillance and is regulated, legislated or otherwise mandated by each individual state health authority. Some states (confidentiality practice is determined by each individual state) have chosen and non name-based approach to reporting that uses the selected coded patient identifier format.
• In addition to individual reporting standards, different states have also implemented legislation that is to be enforced that is not nationally mandated. The following are examples of individual state legislation:
  • Florida – requires that all inmates leaving Florida prisons be HIV tested.
  • New York – Requires physicians to speak to HIV infected patients about “partner notification”.

Regardless of individual state legislation and reporting systems, it is the obligation of the reporter (physician and lab) to assure that information is reported in accordance with its extremely confidential nature as required by city, state, and federal laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

References

Arimateia Da Cruz, J. (2005). Review essay the HIV/AIDS pandemic hits Latin America. Journal of Third World Studies. Retrieved on December 12, 2005 at:

http://www.findarticles.com/p/articles/mi_qa3821/is_200510/ai_n15641436

Avert International. (2005). World HIV and AIDS Statistics. Retrieved on January 21, 2006 at:

http://www.avert.org/about.htm

Centers for Disease Control and Prevention. (2005). HIV/AIDS prevention technical notes. Retrieved on January 21, 2006 at:

http://www.cdc.gov/hiv/stats/hastr1100/technicalnotes.htm

Ebony Magazine (Author unknown). July 2005 HIV/AIDS Statistics. Retrieved on December 21, 2005 at:

http://www.findarticles.com/p/articles/mi_m1077/is_9_60/ai_n14708865#continue

Elliot, N., RN, BSN, CCRN (2001). The HIV/AIDS hour. Retrieved on January 21, 2006 at:

http://www.nursewise.com/courses/hiv_hour.htm

Engender Health (2005). Improving women’s health worldwide. Retrieved on January 21, 2006 at:

http://www.engenderhealth.org/wh/inf/dhiv.html#risk

Harrison W., J. (2005). HIV/AIDS. Journal of Bone and Joint Surgery. Retrieved on December 9, 2005 at: http://www.findarticles.com/p/articles/mi_qa3767/is_200509/ai_n15639203

Joint United Nations Progamme on HIV/AIDS.  (2006). About HIV/AIDS.  Retrieved on January 21, 2006 at:

http://www.youandaids.org/About%20HIVAIDS/What%20is%20HIVAIDS/index.asp

National Institute of Allergy and Infectious Disease. (2004). Treatment of HIV infection. Retrieved on January 21, 2006 at:

http://www.niaid.nih.gov/factsheets/treat-hiv.htm