1. AIDS NAZNEEN VAHORA
CLINICAL INSTRUCTOR
MTIN,CHARUSAT

2. INTRODUCTION
 Human immunodeficiency virus infection is an serious form it
result in the HIV Syndrome known as ACQacquired infection
in which the HIV integrates itself into CD4 ( T helper ) cells,
causing severe immune dysfunction.
 HIV infection renders the person unusually susceptible to other
life threatening infections & malignancies.

3. ETIOLOGY
 The causative agent of HIV infection & AIDS is the
human immune deficiency virus , A retrovirus that
belongs to the lentivirus subfamily .

4.  THE ROUTE OF TRANSMISSION :-
1. Directly from person to person by SEXUAL
CONTACT
2. Direct inoculation with contaminated blood
products, needles, or syringes .
3. From infected mother to her fetus or new born.

5. HIV has been cultured from a variety of body fluids ,
including…………..
 Blood
 Semen
 vaginal secretion
 Cerebrospinal fluid
 Saliva
 Tears
 Breast milk

6.  RISK FACTORS :-
 Sexual practices
 Unprotected sex
 Multiple sex partner
 Anal Or Oral sexual activity
 Improper Condom use OR condom breakage
 Open sore , lesions or irritation in genital area

7.  contaminated blood
 Contaminated needle
 Occupational exposure
 All health care workers – acute care , long term care
, home care
 Dental workers
 Perinatal exposure ( during pregnancy , birth, or
breast feeding )

8.  Women who are HIV infected may pass the virus by
following routes; DURING GESTATION, DURING
DELIVERY & VIA BREAST MILK .

9.  HIV NOT TRANSMITTED THROUGH …
 Causal contact including
 sneezing
 coughing
 Spitting
 Handshakes
 contact with potential secretion on ………
 Toilet seats
 Bath tubs
 Shower
 Swimming pools
 Utensils , dishes or linen
 Biting or blood sucking insects.

10.  CD4 Cell receptor which expressed on the surface of T
lymphocytes, monocytes , dendritic cell & brain
microglia.
 CD4 Cell 700- 1000 cell / mm3
 Up to 500 cell / mm3 considered as normal

12. CLINICAL MANIFESTATION
Diagnostic
Categories
Clinical categories
CD4 + T
lymphocyte
/mm³
A
Asymptomatic
B
Symptomatic
C
AIDS
500 200 -499 Less than
200

13.  ASYMPTOMATIC HIV DISEASE
 ( Category A)
 it may be followed by period of latency that may last
from several months to 10 years or more .
 During this time , client experienced only mild
symptoms such as Fatigue , headache,
lymphadenopathy .
 During this stage CD4+ cell
gradually declines .

14.  SYMPTOMATIC HIV DISEASE
( category B )
 As the immune system further compromised
 Bacillary angiomatosis
 Candidiasis , oropharyngeal or vulvovaginal
 Cervical dysplasia, CA cervix in situ

15.  Constitutional symptom like
fever (38.5˚c) or diarrhea
exceeding 1 month in
duration.
 Hairy leukoplakia , oral
 Herpes zoster ( shingles ) at least 2 distinct episodes
 Idiopathic thrombocytopenic purpura
 Listeriosis
 Pelvic inflammatory disease
 Peripheral neuropathy

16.  AIDS ( category C)
 AIDS is also associated with opportunistic
infections………
 Pulmonary infection :- severe hypoxemia,
Compromised respiratory function, can also result from
plumonary infiltration by lymphoma.

17.  GI problems :- Granulomatous hepatitis, drug toxicity
hepatitis , Kaposi’s sarcoma, cholangitis, pancreatic
lesions. Client may feeling difficulty eating or
swallowing or may experience dyspepsia, diarrhea &
weight loss.Loss of lean muscle mass is common .

18. KAPOSI’S SARCOMA

19.  CNS :- HIV able to cross the blood brain & blood CSF
barrier & infect microglia & possibly other cell
resulting in encephalopathy loss of cognitive & motor
function. Peripheral neuropathy with loss of motor
function often occurs.

20.  Skin :- macular roseola ,skin eruption may be present
during initial infection with HIV. Later seborrheic
dermatitis, psoriasis, Kaposi’s sarcoma lesion can
occur.

21.  Eyes :- HIV infection causes eyes to be vulnerable to
invasion by CMV , which can result in Blurring of
vision & decrease acuity.
 Heart :- pericarditis , myocarditis , severe pulmonary
hypertension.

22.  Endocrine gland :- all the endocrine gland can be
infiltrated with HIV. Adrenal gland is most affected.
 Musculoskeletal :- arthralgia , myalgia, weakness &
wasting secondary to decrease appetite.
 Fluid & electrolyte:- acute kidney failure – secondary
to hypovolemia , nephropathy.

23. DIAGNOSTIC EVALUATION
SR
NO
TEST FINDINGS IN HIV
INFECTION
1. EIA ( enzyme
immunoassay)
Antibodies are detected ,
resulting in positive
results & marking the end
of the window period .
2. Western blot Also detet antibody to HIV
, used to confirm EIA
3. Viral load ,measures HIV RNA in
the plasma

24. SR
NO
TEST FINDINGS IN HIV
INFECTION
4. CD4/CD8 These are the
markers found on
lymphocytes. HIV kills
CD4+ cells, which
results in a
significantly impaired
immune system.

25.  In addition to this HIV – I Antibody assay, 2
additional techniques available .
 Orasure test uses saliva to perform EIA.
 Oraquick rapid HIV-I using less than a drop of blood.
(99.6%accuracy) to detect antibodies of HIV –I.

26. TREATMENT
 MEDICATION :- HIGHLY ACTIVE
ANTIRETROVIRAL THERAPY ( HAART )
SR
NO
CATEGORY
OF DRUGS
ACTIONS
1. Nucleoside
reverse
transcriptase
inhibitors
( NRTI)
(AZT,ddl,D4t,
3TC, ddC)
It become incorporated
into the growing DNA
chains by Viral reverse
transcriptase, there by
interfering with the early
stages of HIV viral
replication.

27. 2. Protease inhibitors
( indinavir, ritonavir,
squinavir, nelfinavir)
It prevent HIV from
making the long protein
molecules necessary to
create new virus, so
halting replication
toward the end of viral
replication.
3. Non nucleoside
reverse
transcriptase
inhibitors
( NNRTIS)
Nevirapine ,
delavirdine .
Block HIV replication by
protecting non-HIV
infected cells.

28.  SURGICAL MANAGEMENT :- surgery does not play
important role in the management. Clients may
undergo surgical biopsy of skin lesions that do not
respond to chemotherapy, or drainage of abscesses or
other site of infection.
 DIET :- HIGH CALORIE & HIGH PROTEIN DIET.
 ACTIVITY :- no activity restriction. Most frequent rest
period is necessary for patient to prevent fatigue.

29. NURSING MANAGEMENT
1. Preventing infection : standard precaution
 Hand hygiene
 Personal protective equipment (PPE)
 Soiled client care equipment
 Environment control
 Textile & laundry
 Client resuscitation
 Client placement
 Respiratory hygiene

30. 2. Improving airway
3.Promoting nutrition
4.. Controlling fatigue
5. Supporting individual coping
6. Promoting effective therapeutic regimen management.
7. Monitoring & managing potential complication.
8. Promoting skin integrity
9. Decreasing the sense of isolation.

31. FOR KNOWLEDG
 In molecular biology, CD4 (cluster of
differentiation 4) is a glycoproteinfound on the
surface of immune cells such as T helper
cells, monocytes,macrophages, and dendritic cells