HIV / AIDS: Symptoms, Diagnosis, Management, Complications

HIV / AIDS AIDS:

Acquired Immuno Deficiency Syndrome is defined as the most severe form of contageous disease associated with human immuno deficiency virus (HIV) infection.

Etiology:

1.     HIV, is transmitted through blood, vaginal secretions, semen and breast milk.

2.     HIV is transmitted by injection of blood or blood component, sexual contact (vaginal/anal intercourse, oral sex) and perinatally from an infected mother to the child.

High risk Group:

1.     Homo sexual or bisexual.

2.     Intravenous drug users.

3.     Transfusion and blood product recipient

4.     Heterosexual contain of HIV positive individuals.

5.     Newborn babies of mother who are HIV positive.

Signs and symptoms:

1.     Pulmonary manifestation: Persistent cough with or without sputum production, shortness of breath, chest pain, fever.

2.     Gastrointestinal Manifestation: Diarrhea, weight loss, anorexia, abdominal cramping, rectal urgency.

3.     Oral manifestation: Appearance of oral lesions, while plaques an oral mucous, and angular stomatitis.

4.     While thickened    lesion on lateral margins of tongue form hairy leukoplakia.  

5.     Oral   warts    due to  human  papilloma  virus  (HPV)  and associated gingivits.

6.     Periodontitis progressing to gingival  neurosis.

Centralnervoussystem(CNS)manifestation:

Demonstrated by mental slowing, impaired memory and concentration, loss of balance, lower extremity weakness, ataxia, apathy and social withdrawal.

Malignancies: Kaposis sarcoma (aggressive tumor involving skin, lympn nodes, gastrointestinal tract and lungs)

Non-Hodgkin' s lymphoma and lympnode mass.

Cervical carcinoma

Diagnosis:

1.     History of risk factors.

2.     Positive blood test for HIV [Enzyme -linked immuno sorbent assay (elisa), western blot test used to confirm a positive result on elisa test]

3.     Lymptocyte panel shows decreased count.

4.     A complete blood count may show   anemia

5.     Diagnostic procedure (biopsy, imaging procedures etc)

6.     Neuropsychological testing.

7.     Viral load testing  monitors disease activity.

Management:

Specific therapy: Multiple drug regiments of antiviral agents are most effective.

Supportive care:

1.     Treatment of reversible illness.

2.     Nutritional support.

3.     Palliative care.

4.     Dental management.

5.     Evaluation and management of psychological and social aspects of AIDS.

6.     Treatment to relieve symptoms (cough, diarrhea)

7.     Antidepressant drugs, psychiatric interventions.

Nursing management:

1.     Help patient identify and strengthen personal resources such as positive coping skills, relaxation techniques strong support network, and optimistic look.

2.     Follow universal precautions for all patients.

3.     Administer and teach patient/family good skin care a break in a skin is a source of secondary infection, use position changes, emollient lotions, special pads and beds and attend to hydration and nutrition.

4.     Maintain cleanliness of environment.

5.     Use aseptic techniques when performing invasive procedures.

6.     Teach patient how to minimise the risk of disease. o Avoid exposure to persons with infections

7.     Do     coughing,    and    do      breathing    exercises     when confined to bed.

8.     Instruct visitor about hand washing before entering and leaving the room.

9.     Advise the patient/ family to wash hands before preparing the food and hygienic manner.

10.                        Advise patient not to eat raw or undercooked food. o Monitor nutritional status by recording weight.

11.                        Encourage small, frequent meals

12.                        Teach the patient for mouth rinses regularily using antifungal mouth wash liquid.

13.                        Perform or encourage oral care for two or three times a day.

14.                        Monitor intake and output chart

15.                        Administer fluids and electrolytes as prescribed.

16.                        Advice patient to eliminate the caffeine, alcohol, dairy products, food high in fats, fresh juices, and acidic juices if diarrhea persist.

17.                        Advise the patient to drink liquids at room temperature. o Advise the patient to avoid foods that increase intestinal motility and distention such as gas-forming fruits and vegetables.

18.                        Provide       safety for the patient (bed rails up; call signal available; things with in patient reach).

19.                        Encourage high fluid intake to replace insencible water

20.                        losses incurred by fever/ diaphoresis.         Administer antipyretics as prescribed.

21.                        Provide  supplemental oxygen as ordered.

22.                        Administer saline nebulization to induce sputum collection for culture and sensitivity.

23.                        Answer questions and support patients' decision

Complication:

1.     Repeated overwhelming opportunistic infection.

2.     Respiratory  failure.

3.     All systemic disease.