1060 Module 1 - HIV

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1060 Module 1 - HIV
HIV (Human Immunodeficiency Virus

Attack of the CD4 cells (T cells), which help the immune system fight off infections.
• Untreated HIV reduces the number of CD4 cells (T cells) in the body, making the person more
likely to get other infections or infection-related cancers.
• These opportunistic infections/cancers take advantage of a very weak immune system
and signal that the person has AIDS, the last stage of HIV infection.
• No effective cure currently exists, but with proper medical care, HIV can be controlled.
HIV is treated with antiretroviral therapy or ART. If people with HIV take ART
as prescribed, their viral load (amount of HIV in their blood) can become undetectable. If it
stays undetectable, they can live long, healthy lives and have effectively no risk of
transmitting HIV to an HIV-negative partner through sex.
• Today, someone diagnosed with HIV and treated before the disease is far advanced can live
nearly as long as someone who does not have HIV.
Describe the pathophysiology, modes of transmission, and prevention of HIV infection.
Pathophysiology of HIV
HIV is a ribonucleic acid virus.
◦ Called retroviruses because they replicate in a “backward” manner going from RNA to DNA
◦ RNA virus that was discovered in 1983
◦ Binds to specific CD4 and chemokine receptors to enter cell
Immune problems start when CD4+ T-cell counts drop to < 500 cells/μL.
◦ Severe problems develop when < 200 CD4+ T cells/μL.
◦ Normal range is 800 to 1200 cells/μL.
Cells with CD4 receptor sites are infected.

Immune dysfunction in HIV disease is caused by damage to and destruction of CD4+ T cells
The normal life span of a CD4+ T cell is about 100 days, but HIV-infected CD4+ T cells will die
after an average of only 2 days
The body can produce new CD4+ T cells to replace the destroyed cells for many years.
However, eventually the ability of HIV to destroy CD4+ T cells exceeds the body’s ability
to replace the cells.
Insufficient immune response allows for opportunistic diseases.

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Modes of Transmission of HIV
Sexual contact, contact with blood and blood products, perinatal transmission.
1. Sexual Contact
◦ Sexual acts permit infected seminal fluid to come into contact with mucous membranes or
non-intact skin.
◦ Gender affects HIV transmission, like all other sexually transmitted diseases
(STDs), and it is more easily transmitted from infected male to uninfected
female than vice versa.
◦ The practice with the highest risk is anal intercourse with the penis and
seminal fluid of an infected person coming into contact with the mucous
membranes of the uninfected partner's rectum.
◦ Tears the mucous membranes, making infection more likely.
◦ Teach patients who engage in anal intercourse that the semen depositor
needs to wear a condom.
2. Contact with blood and blood products.

◦ Sharing drug-using equipment is risky 0.3% to 0.4% (or 3 to 4 out of 1000)
◦ Infection through transfusions of blood or clotting factors is now unlikely with
implementation of screening measures.
◦ Puncture wounds are most common means of work-related HIV transmission.
◦ Splash exposures of blood on skin with an open lesion present some risk, but
it is much lower than from a puncture wound.
◦ Health care workers have a low risk of acquiring HIV at work, even after a
needle-stick injury.
3.Perinatal Transmission
◦ Can occur during pregnancy, delivery, or breastfeeding.
◦ An average of 25% of infants born to women with untreated HIV will contract the infection.
◦ Treatment with an ART reduces the chance of transmission to less than 2%.
Testing for HIV

1. Nucleic Acid Tests (NAT) looks for the actual virus; drawing blood from a vein.
•Can tell if a person has HIV or tell how much virus is present in the blood (known as an HIV
viral load test) 10-33 days post exposure.
•Viral load is the amount of HIV in the blood of someone who has HIV.
•HIgher load = more likely that person is to transmit HIV.
•Viral load is highest during the acute phase of HIV
•Taking HIV medicine can make the viral load very low—so low that a test can’t
detect it (called an undetectable viral load).
•While a NAT can detect HIV sooner than other types of tests, this test is very
expensive and not routinely used for screening individuals unless they recently had
a high-risk exposure or a possible exposure and have early symptoms of HIV
Infection.
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2. Antigen/antibody tests looks for both HIV antibodies and antigens. If you have HIV, an
antigen called p24 is produced even before antibodies develop.
•Antigen/antibody tests are recommended for testing done in labs and are now
common in the United States. This lab test involves drawing blood from a vein.
There is also a rapid antigen/antibody test available that is done with a finger prick.
•Blood from a vein can usually detect HIV infection 18 to 45 days after an exposure.
•A finger prick can take longer to detect HIV (18 to 90 days after an exposure).
3. Antibody tests - Enzyme immunoassay (EIA) formerly referred to as the

enzyme-linked immunosorbent assay (ELISA) test.
•Confirmation testing includes #1. nucleic acid testing (NAT) and no longer
utilizes the Western Blot test.
•Only look for antibodies to HIV in your blood or oral fluid. In general, antibody tests
that use blood from a vein can detect HIV sooner after infection than tests done
with blood from a finger prick or with oral fluid.
•Most rapid tests and the only currently approved HIV self-test are antibody tests.
•Can take 23 to 90 days to detect HIV infection after an exposure.
Summarize the clinical manifestations, assessment, and treatment of patients of HIV infection.
Stages of HIV
Stage 1: Acute Infection - Flu-like symptoms within 2-4 weeks after infection.
Primary Infection: The period from infection with HIV to the development of antibodies
to HIV; characterized by intense viral replication and widespread dissemination of HIV
throughout the body.
Fever, chills, rash.
Night sweats,
Muscle aches, fatigue.
Sore throat,
Swollen lymph nodes, and mouth ulcers.
During primary infection, a window period occurs, during which a person with HIV infection tests
negative on the HIV antibody blood.
Stage 2: Chronic HIV Infection also called asymptomatic HIV infection or clinical latency.
•HIV is still active but reproduces at very low levels.
•People may not have any symptoms or get sick during this phase.
•Without taking HIV medicine, this period may last a decade or longer, but some may
progress faster.
•People can transmit HIV in this phase.
•At the end of this phase, the amount of HIV in the blood (called viral load) goes up and
the CD4 cell count goes down. The person may have symptoms as the virus levels
increase in the body, and the person moves into Stage 3.
•People who take HIV medicine as prescribed may never move into Stage 3.
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Stage 3: Acquired Immunodeficiency Syndrome (AIDS) - most severe phase of HIV infection.
•People with AIDS have such badly damaged immune systems that they get an
increasing number of severe illnesses, called opportunistic infections.
•People receive an AIDS diagnosis when their CD4 cell count drops below 200
cells/mm, or if they develop certain opportunistic infections.
•People with AIDS can have a high viral load and be very infectious.
•Without treatment, people with AIDS typically survive about three years.
Opportunistic Infections from HIV

Pneumocystic Pneumonia (PCP)– most common infx - nonspecific signs and symptoms:
nonproductive cough, fever, chills, dyspnea, and, occasionally, chest pain.
Respiratory failure can develop within 2 to 3 days after the initial appearance of symptoms.
Tuberculosis
Candidiasis
Wasting Syndrome
Kaposi Sarcoma (KS), the most common HIV-related malignancy.
An estimated 80% of all patients with AIDS experience some form of neurologic involvement
during HIV infection.
Drug Therapy for HIV

Antiretroviral Therapy (ART)
Main goals:
◦ Decrease viral load (viremia). HIV cannot be cured.
◦ Maintain/increased CD4+ counts – helpful in determining therapy response.
Each med attacks HIV at different stages of viral replication in the CD4+ lymphocyte.
◦ Prevent HIV-related symptoms and opportunistic diseases.
◦ Delay disease progression.
◦ Drug Resistance develops rapidly: Need Combination of Meds
Adherence to drug regimens is critical to prevent:
◦ Disease progression.
◦ Opportunistic disease.
◦ Viral drug resistance.
An individualized approach is best!
Can cause viremia to become undetectable in some pts
Can be lethal in combination with OTC and Herbal Meds
Explain preexposure prophylaxis for patients at high risk.
HIV PrPE Drug Therapy, Pre-exposure Prophylaxis (PrEP) –

◦ Use of HIV-specific antiretroviral drugs in a HIV-UNINFECTED adult for purpose of preventing
HIV infection – taken correctly 99% sex. 74% drug use
2 CDC PrEP meds:
•Truvada is for all people at risk through sex or injection drug use.
•Descovy is for people at risk through sex, except for people assigned
female at birth who are at risk of getting HIV from vaginal sex.
◦ PrEP is safe but some people experience side effects like diarrhea,
nausea, headache, fatigue, and stomach pain. These side effects usually go away over time.
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Explain postexposure prophylaxis for health care workers.
HIV PEP drug therapy, PEP (post-exposure prophylaxis) w ART (emergencies only).
Three categories:
1. Occupations exposure (needlestick).
2. Consensual exposure with an adult of unknown HIV status.
3. Sexual assault.
Starting ASAP is CRITICAL (max 72 hrs).
3 drug regime for 28 days or until HIV status of source is known.
Prevention for the Healthcare Provider

Prevention of HIV
•Decreasing risk: Work – risk is small but real.
•Adhere to standard precautions and safety measures to avoid exposure.
•Report all exposures for timely treatment and counseling.
•Post-exposure prophylaxis with combination ART can significantly decrease risk of infection.

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1060 Module 1 - HIV

HIV (Human Immunodeficiency Virus

Describe the pathophysiology, modes of transmission, and prevention of HIV infection.

Cells with CD4 receptor sites are infected.

Insufficient immune response allows for opportunistic diseases.

2. Contact with blood and blood products.

Testing for HIV

3. Antibody tests - Enzyme immunoassay (EIA) formerly referred to as the

Opportunistic Infections from HIV

Drug Therapy for HIV

Explain preexposure prophylaxis for patients at high risk.

HIV PrPE Drug Therapy, Pre-exposure Prophylaxis (PrEP) –

Prevention for the Healthcare Provider

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