SEMINAR

ON
NURSING MANAGEMENT OF
NEURO INFECTION WITH HIV AND
AIDS

PRESENTED
BY:
DENDEN DIANA
M. Sc(N) 2nd Yr
R.I.N.P.S
 INTRODUCTION
• HIV stands for human immunodeficiency virus. It is the
virus that can lead to acquired immunodeficiency
syndrome or AIDS if not treated. HIV attacks the body’s
immune system, specifically 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. Over time, HIV
can destroy so many of these cells that the body can’t
fight off infections and disease. 
AIDS
• Acquired immunodeficiency syndrome (AIDS) is the late
stage of HIV infection that occurs when the body’s
immune system is badly damaged because of the virus.
• A: Acquired (acquired during lifetime, not inherited)

• I: Immuno- (related with immune system)

• D: Deficiency (related with deficient immune response)

• S: Syndrome (collection of symptoms)

IMMUNE SYSTEM
 CONTD….

• B Lymphocytes: The main function of B lymphocytes is

humoral (antibody) immunity. Each B cell can recognize
specific antigen targets and can secrete specific antibodies.
• T lymphocytes: T lymphocytes have two major functions:
regulation of the immune system and killing of cells that bear
specific target antigens. Each T cell has a surface marker, such
as CD4+, CD8+, and CD3+, that distinguishes it from other
cells.
• Phagocytes: Phagocytes include monocytes and
macrophages, large white blood cells that engulf and digest
cells carrying antigenic particles.
 INCIDENCE
• In 2018 an estimated 37.9 million people were living with HIV
(including 1.7 million children), with a global HIV prevalence of
0.8% among adults. Around 21% of these same people do not know
that they have the virus.
• In 2018, 770,000 people died of AIDS-related illnesses.
• The vast majority of people living with HIV are located in low- and
middle- income countries, with an estimated 68% living in sub-
Saharan Africa. Among this group 20.6 million are living in East and
Southern Africa which saw 800,000 new HIV infections in 2018.
CONTD….
• India has the third largest HIV epidemic in the world. In 2017,
HIV prevalence among adults (aged 15-49) was an estimated
0.2%. 

• Recent report by NACO confirms that the HIV epidemic is very

high in Meghalaya (0.76%), which is the third highest in the
country after Mizoram (1.19%) and Nagaland (0.82%). [1]
Around 30% of people who are infected
with HIV in Northeastern states are injecting drug users.
 CAUSATIVE AGENT
• HIV is the causative agent that can lead to
AIDS.
• Family: Retroviridae
• Genus: Lentivirus
• Class: Incertae sedis
• Phylum: Incertae sedis
 MODE OF TRANSMISSION
• Sharing of needles
• Needle prick injury
• Mother to child during pregnancy, delivery or
through breastfeeding
• Organ transplantation
• Blood transfusion
• Sexual contact (both male and female)
 INCUBATION PERIOD:

• The incubation period is from HIV infection

till development of AIDS.
• It is from a few months to 10 years or even
more.
 SOURCE OF HIV IN HUMANS
• Scientists identified a type of chimpanzee in Central Africa as
the source of HIV infection in humans. 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.
STAGES OF HIV
 Stage 1: Acute HIV infection

• Acute HIV infection is a

condition that occurs
within 2 to 4 weeks after
the initial infection and
last for 1 to 3 weeks. Acute
HIV infection is also known
as primary HIV infection or
acute retroviral syndrome.
 Stage 2: Asymptomatic HIV infection
(Chronic HIV infection or clinical latency)
• It is the second stage of HIV/AIDS.
During this stage, there are no
symptoms of HIV infection. This
stage is also called chronic HIV
infection or clinical latency. During
this time, CD4+ T cell counts
remain above 500 cells/µL (normal
or only slightly decreased), and the
viral load in the blood is low.
 Stage 3: Acquired immunodeficiency syndrome (AIDS)

• AIDS is the 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 illnesses.
 RISK FACTORS
• having unprotected anal or vaginal sex;
• having another sexually transmitted infection (STI) such
as syphilis, herpes, chlamydia, gonorrhoea and bacterial
vaginosis;
• sharing contaminated needles, syringes and other injecting
equipment and drug solutions when injecting drugs;
• receiving unsafe injections, blood transfusions and tissue
transplantation, and medical procedures that involve
unsterile cutting or piercing; and
• experiencing accidental needle stick injuries, including
among health workers
 PATHOPHYSIOLOGY
Due to the etiological factors

The virus comes in contact with CD4 lymphocytes

After binding the virus enters the cell

The virus genome uncoats and with the help of

reverse transcriptase, converts the single RNA
into double stranded DNA
 CONTD….

DNA integrates into the infected cell genome

This integration causes the formation of HIV

virus progeny with the help of host cell
CLINICAL MANIFESTATIONS
 Neurologic Manifestations:

a)
 Peripheral neuropathy
 HIV encephalopathy
 Cryptococcus meningitis b)
c)
 Respiratory infections
• Pneumocystitis Pneumonia A)
• Mycobacterium avium complex
• Tuberculosis

C) B)
 Gastrointestinal Manifestations:

Oral candidiasis Wasting syndrome

 Oncologic Manifestations
Kaposi’s sarcoma B cell lymphomas
 Integumentary Manifestations:
• Herpes viruses A)
• Molluscum contagiosum
• Photodermatitis
C) B)
Gynecologic Manifestations
Genital ulcers: Cervical cancer
 DIAGNOSTIC EVALUATIONS:

• History and physical examination

 ELISA
• The ELISA test, also called
the EIA for enzyme
immunoassay, is used to
detect the HIV antibody. It
checks for certain proteins
that the body makes in
response to HIV
 Western blot test:
• The Western blot test
separates the blood proteins
and detects the specific
proteins (called HIV
antibodies) that indicate an
HIV infection.
 Polymerase chain reaction test
• PCR are used to
detect HIV's genetic material,
called RNA. These tests can
be used to screen the donated
blood supply and to detect
very early infections before
antibodies have been
developed.
 RAPID TEST
• A type
of HIV antibody test used
to screen for HIV infection.
A rapid
HIV antibody test can
detect HIV antibodies in
blood or oral fluid in less
than 30 minutes.
Immunofluorescence assay (IFA):
• IFA is a standard virologic
technique to identify the
presence of antibodies by
their specific ability to
react with viral antigens
expressed in infected
cells; bound antibodies
are visualized by
incubation with
fluorescently labeled
antihuman antibody.
 HIV VIRAL LOAD TEST:
• This test measures the amount
of the HIV virus in the blood.
It can find HIV faster than
antibody and antibody/antigen
tests, but it is very expensive.
 NUCLEIC ACID TESTS (NATS)
• NATS looks for HIV in the
blood. It looks for the virus and
not the antibodies to the virus.
Most, but not all people, will
have enough HIV in their
blood for a nucleic acid test to
detect infection 1 to 4 weeks (7
to 28 days) after infection.
 ANTIGEN/ANTIBODY
COMBINATION TESTS
• Antigen/antibody combination
tests can detect HIV earlier
than tests that only detect HIV
antibodies. Antigen/antibody
tests done with blood from a
finger prick can take longer to
detect HIV (18 to 90 days
after an exposure).
 ANTIBODY TEST
• An HIV antibody test can
determine if a person has
HIV from 3–12 weeks after
infection. That's because it
can take a few weeks or
longer for the immune
system to make antibodies
to HIV.
 MANAGEMENT
COLLABORATIVE CARE
• Monitoring HIV disease progression and immune function
• Initiating and monitoring ART
• Preventing the development of opportunistic diseases
• Detecting and treating opportunistic diseases
• Managing symptoms
• Preventing or decreasing complications of treatment and
• Preventing further transmission of HIV
 TREATMENT
Drug therapy for HIV infection:
The goals of Drug therapy for HIV infection are:
• Decrease the viral load
• Maintain or increase CD4+T cell counts

• Prevent HIV – related symptoms and opportunistic diseases

• Delay disease progression
• Prevent HIV transmission
 Drug classification Mechanism of action Examples

Entry inhibitors Prevent binding of HIV to  Enfuvirtide

cells, this preventing entry of  Maraviroc
HIV into cells where
replication would occur

Reverse Transcriptase Inhibitors

Nucleoside Reverse Insert a piece of DNA into the  Zidovudine (AZT, ZDV)

Transcriptase Inhibitors developing HIV DNA chain,  Didanosine (d4T)

blocking further development of  Lamivudine
(NRTIs)
the chain and leaving the  Emtricitabine
production of the new strand of
HIV DNA incomplete

Nonnucleoside Reverse Inhibit the action of reverse  Nevirapine

Transcriptase Inhibitors transcriptase  Delavirdine

 Efavirenz
(NNRTIs)
Nucleotide Reverse Combines with reverse  Tenofovir
Transcriptase Inhibitors transcriptase enzyme to block the
(NRTIs) process needed to convert HIV
RNA into HIV DNA
Integrase inhibitors Bind with integrase enzyme and  Raltegravir
prevent HIV from incorporating  Elvitegravir
its genetic material into the host  Dolutegravir
cell
Protease Inhibitors PIs Prevent the protease enzyme  Saquinavir
from cutting HIV proteins into  Indinavir
the proper lengths needed to  Ritonavir
allow viable virions to assemble  Nelfinavir
and bud out from the cell
membrane.
Fixed-dose Combination More than one drug combined  Atripla (Tenofovir DF +
Products into a single tablet. Drugs may be emtricitabine + efavirenz)
from the same or different classes  Combivir (lamivudine +
zidovudine)
 DRUG THERAPY FOR
OPPORTUNISTIC DISEASES
Pneumocystis Pneumonia
• TMP-SMZ (Bactrium, Cotrim,
Septra) is the treatment of choice for
PCP.
• Dose: TMP-15-20 mg/kg/day; SMZ-
75-100 mg/kg/day
• Duration 2 or 3 weeks
• it is as effective as parenteral
pentamidine isethionate
(Pentacarinat) and more effective
than other regimens.
 Mycobacterium avium Complex
• Adults and adolescents who are
infected with HIV should receive
chemoprophylaxis against
dessiminated MAC disease if they
have a CD4 + count less than 50
cells/µL. Azithromycin (Zithromax)
or calrithromycin (Biaxin) are the
preferred prophylactic agents.
• Dose: Adult-500 mg, twice daily,
Adolescent-250 mg twice daily.
 Cryptococcal meningitis
• Current therapy for
Cryptococcal meningitis is IV
amphotericin B with or without
oral flucytosine (5-FC).
• Dose: 0.7 to 1.0 mg/kg
• Should be given over 2 to 6
hours depending upon the dose.
 Cytomegalovirus Retinitis
• Retinitis caused by
cytomegalovirus is a leading
cause of blindness in
patients with AIDS. Oral
valganciclovir (Valcyte), IV
ganciclovir (Cytovene).
 OTHER INFECTIONS
Esophageal or oral
Herpes Simplex: candidiasis:
 NURSING MANAGEMENT
ASSESSMENT:

• Identification of potential risk factors including a history or risky sexual practices or

IV/injection drug abuse.

• Assess the neurological status of the patient

• Assess the respiratory status by monitoring the patient for cough, sputum production

(i.e., amount and colour), shortness of breath, orthopnea, etc

• Assess the patient’s physical status and psychological status

• Assess the nutrition by obtaining the dietary history and identifying factors that may

interfere with oral intake, such as anorexia, nausea, vomiting, oral pain or difficuly

swallowing.
 NURSING DIAGNOSIS

• Imbalance nutrition less than body requirement related to

inability to ingest food as evidenced by inability to ingest food
as evidence by weight loss.
• Impaired comfort (fatigue) related to disease process as
evidenced by decreased in daily living activities.
• Acute pain related to abdominal cramping as evidenced by
patient’s complain of pain abdomen.
• Disturbed thought process related to neurological disturbance
as evidence by changes in memory.
• Impaired skin integrity (dermatitis) related to immunologic
deficit as evidenced by ulcerations and skin lesion.
• Deficit knowledge regarding disease process as evidenced by
frequent asking questions by the patient.
 COMPLICATIONS:

• Pneumocystis pneumonia (PCP)

• Candidiasis (thrush). 
• Tuberculosis (TB). 
• Cytomegalovirus
• Cryptococcal meningitis
• Toxoplasmosis
• Lymphoma
• Kaposi's sarcoma
• Wasting syndrome
• Liver disease (HIV-associated nephropathy)
 PREVENTION AND EARLY DETECTION OF HIV:

• Increase safe sexual practices including condom use.

• Decrease equipment sharing among IV drug users.

• Increase clinician skills to assess for risk factors for HIV infection, recommended HIV testing,

and provide counseling for behavior change.

• Making voluntary HIV testing a routine part of health care.

• Increase access to HIV testing technologies especially rapid testing.

• Increase risk assessment and individualized behavior change messages to people with HIV to

prevent new infections.

• Decrease perinatal HIV infection by offering voluntary HIV testing as a part of routine perinatal

care.

• Provide counseling and appropriate HIV therapy to those who are infected.
 PROGNOSIS
• Without treatment, HIV infection progresses to AIDS in approximately 10
years, with death following within three years after onset of AIDS. With
appropriate treatment, a 20-year-old with HIV infection can expect to live
to reach 71 years of age. This dramatic increase in life expectancy
emphasizes the need for early diagnosis and treatment. Moreover, with
newer treatment regimens and guidelines, there is every reason to think
that life expectancy will continue to increase in patients who are able to
receive appropriate treatment. There are some factors that decrease life
expectancy, including use of illicit drugs and the coexistence of other
conditions like chronic hepatitis.
 RESEARCH ARTICLE
• TITLE: Regulation of HIV self‐testing in Malawi, Zambia and Zimbabwe: a qualitative
study with key stakeholders
• Author: Dacombe RJ et al
• Date of Publishing: 2019 Mar

• INTRODUCTION

• HIV self‐testing (HIVST) is being introduced as a new way for more undiagnosed people to
know their HIV status. As countries start to implement HIVST, assuring the quality and
regulating in vitro diagnostics, including HIVST, are essential. We aimed to document the
emerging regulatory landscape and perceptions of key stakeholders involved in HIVST
policy and regulation prior to implementation in three low‐ and middle‐income countries.
 CONTD…
• Methods
• Between April and August 2016, we conducted semi‐structured interviews in Malawi, Zambia and

Zimbabwe to understand the relationships between different stakeholders on their perceptions of current

and future HIVST regulation and the potential impact on implementation. We purposively sampled and

interviewed 66 national‐level key stakeholders from the Ministry of Health and the regulatory, laboratory,

logistical, donor and non‐governmental sectors. We used a thematic approach to analysis with an

inductively developed common coding framework to allow inter‐country comparison of emerging themes.

• Results
• In all countries, the national reference laboratory was monitoring the quality of HIVST kits entering the

public sector. In Malawi, there was no legal mandate to regulate medical devices, in Zambia one regulatory

body with a clear mandate had started developing regulations and in Zimbabwe the mandate to regulate was

overlapping between two bodies.

 CONTD…
• Conclusion
• Regulation of in vitro diagnostic devices, including HIVST, is
now being recognized as important by regulators after a
regional focus on pharmaceuticals. HIVST is providing an
opportunity for each country to develop similar regulations to
others in the region leading to a more coherent regulatory
environment for the introduction of new devices.
 SUMMARY
• HIV is a virus that attacks cells that help the body top fight infection.
AIDS is the final stage of infection with HIV. Not everyone with HIV
develops AIDS.
• HIV most often spreads through unprotected sex with a person who has
HIV. It may also spread by sharing drug needles or through contact
with the blood of a person who has HIV. 
• The first signs of HIV infection may be swollen glands and flu-like
symptoms. A blood test can tell if you have HIV infection.
• There is no cure, but there are many medicines that fight HIV infection
and lower the risk of infecting others. 
 CONCLUSION
• The family is greatly affected in all cases of HIV/AIDS, regardless of where
the person might live. Issues such as safe sex practices, planning for care of
children during parents' illness and after death, dealing with prejudices and
unmet expectations within the family unit, coming out as a homosexual,
admitting to intravenous drug use, or to sexual activity with multiple partners,
are often on the forefront during this difficult time. Until a vaccine is approved
and widely disseminated, people must avoid risky behaviors in order to curb
the spread of this devastating disease. One of the primary issues is to support
extended family members who are taking in children orphaned by AIDS, while
grieving the great loss of loved ones.