Human Immunodeficiency Virus (HIV) is a virus that only affects humans, HIV weakens your immune system by destroying the cells that fight and kill disease and infections. HIV reproduces by taking over cells in the host’s body and multiplying, with most viruses over time the immune system can rid the body of the present virus, with HIV the immune system is incapable of doing this, therefore it is a virus that will always be present once infected.
HIV is spread through bodily fluids such as blood, seamen, rectal fluids, vaginal fluids, and breast milk. In order for HIV to be transmitted via bodily fluids it “must come into contact with a mucous membrane or damaged tissue or be directly injected into your bloodstream (by a needle or syringe) for transmission to possibly occur.” (What is HIV/AIDS? 2014) Mucous membranes is the soft moist tissues around areas that openings to the body, such as the mouth, opening of the rectum, vaginal cavity, and opening of the penis.
The most common way HIV is transmitted is through unprotected sex with anal sex being the highest sexual risk. Other means of transmission is blood infusions, IV drug use, needle sticks (mainly a risk for health care workers), transmission from mother to infant, or direct contact with broken skin. There has been many myths on how HIV can be transmitted, it is important to know facts versus myths. Some common myths on transmission are HIV can be transmitted via touching, saliva, tears, sweat, air, water, and toilet seats. Once the virus is outside the body it doesn’t survive for long.
HIV weakens your immune system making infection the largest complication of the virus. The most common infections are tuberculosis, Salmonellosis, which is why all food needs to be clean thoroughly and cooked well, individuals infected with HIV should try to stay away from eating fresh fruit and vegetables when possible. Other illnesses include Cytomegalovirus, Candidiasis, Cryptococcal meningitis, Toxoplasmosis, and Cryptosporidiosis. Other illnesses are common to HIV infected individuals with the most common being Kaposi’s sarcoma and cancer that normally appears as pink, red, or purple lesions around the mouth or on the skin, this type of cancer can also affect organs including the digestive track or lungs. You may also see wasting syndrome, neurological complications, and kidney disease. (Mayo Clinic 2014)
Symptoms of HIV vary by individual, but normally appear as flu like symptoms one to two months after the virus has infected the body. These symptoms include fever, chills, cough, headache, rash, sore throat, mouth or genital ulcers, swollen lymph nodes, night sweats, and diarrhea. At times the primary symptoms may be mild and go unnoticed as the disease progresses individuals may experience shortness of breath, fatigue, and weight loss. This stage of the disease is referred to as HIV and lasts anywhere from 8-10 years, with advancements in treatment in may last even longer. The last stage of the virus, AIDS (acquired immune deficiency syndrome) happens when the body’s immune system has been severely damaged causing the person to be highly susceptible to opportunistic infections.
While there is no cure for the HIV virus there are medications to manage the virus and slow its progression. The classification of medications used is anti-viral medications, which include: Non-nucleoside reverse transcriptase inhibitors (NNRTIs), they disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). Nucleoside reverse transcriptase inhibitors (NRTIs) are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir). Protease inhibitors (PIs) disable protease, another protein that HIV needs to make copies of itself.
Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir). Entry or fusion inhibitor drugs block HIV’s entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells. (Mayo Clinic 2014) Treatment with theses medications can be difficult they cause nausea and vomiting, heart disease, weakening of the bones, and rashes. After starting these medications your physician will monitor how well they are working and make changes as needed.
The HIV virus is incurable the CDC estimates that 1,144,500 persons aged 13 years and older are living with the HIV infection, including 180,900 who are unaware of their infection. (CDC 2014) There is an estimated 50,000 new cases in the US yearly and an estimated 15,000 deaths per year. Of the one million diagnosed with HIV an estimated 600,000 have AIDS. While this virus in incurable and considered to most as a death sentence advancements are made daily with medication and the life span after diagnosis has greatly increased, in 1996 life expectancy was 36.1 years and in 2005 it had increased 13 years to 49.4 years. (Science-Based Medicine, 2013) These advancements can only continue to climb in the future.
Addressing individual’s determinants of health and how it relates to HIV is vital in disease prevention. While HIV can affect anyone regardless of ethnicity, social status, or income level it has a higher prevalence in lower social economic status. Individuals who live in poorer communities are at a higher risk for contracting HIV, with lower income comes lower education rates and decreased available resources. It is imperative as nurses that we are continually providing education and the means for sexual protection or the availability for help with substance abuse. The more education that can be provided the greater chances there is in decreasing transmission rates.
Understanding the epidemiologic triangle of HIV can help to determine who is at risk and how to prevent that risk. The triangle consists of three sections: the host, which includes the person and factors that may put them at risk like age, sex, genetic profile, occupation, marital status, and religious practices. The second part is the environment, a person’s living situation, what type of community they belong to, or if all of their human needs are being met such as food and safety. The third section is the agent, this pertains to what is needed to make the infection occur, risks such as unprotected sex or IV drug use would qualify as the agent in regards to the transmission of the virus. By understanding how a individuals fit into this triangle we can help to better educate them and provide the needed education and resources to aid in transmission prevention.
It is the role of the community nurse to access the community and patients as individuals and determine the risk factors if any and needs. Upon assessment there should be the formulation of a plan of care to help in determining the steps needed for health promotion and prevention of HIV. If an individual is at risk for HIV proper testing should be implemented to find out if they are positive or not, this requires a consent from the patient in California. When there is a positive result for HIV a second test is performed, when that test is positive there is mandatory reporting to the state, this reporting does not include personal information of the patient.
Mandatory reporting helps to analyze the rate of HIV diagnosis and what populations are affected more then others. Follow-up of patients diagnosed with HIV is imperative in their care; this is a life changing catastrophic diagnosis, its something that can cause loss of hope and depression. Newly diagnosed HIV patients should be offered counseling, resources within the community to help them cope with this new diagnosis, and follow-up calls or visits to address any concerns they may have. Along with the diagnosis comes learning how to live in a new way, they must be conscious of illness in the community so they do not acquire any other diseases or viruses, and they must also be conscious and well educated on how to prevent the spread of HIV.
Over the recent decades the spread of HIV has declined, but that is not enough with the deadly outcome it poses. As nurses we need to recognize a person’s risk to the virus and ways we can break the chain of infection. Through education, health promotions, and utilizing community resources hopefully the decline in HIV diagnoses can continue to fall with someday eradicating the virus totally.
What is HIV/AIDS? (2014). Retrieved September 28, 2014, from http://www.aids.gov/hiv-aids-basics/
HIV/AIDS. (2014). Retrieved September 28, 2014, from http://www.mayoclinic.org/diseases-conditions/hivaids/basics/complications/con-20013732
HIV in the United States. (2013, December 3). Retrieved September 28, 2014, from http://www.cdc.gov/hiv/statistics/basics/ataglance.html
HIV Treatment Extends Life Expectancy « Science-Based Medicine. (2013, January 1). Retrieved September 28, 2014, from http://www.sciencebasedmedicine.org/hiv-treatment-extends-life-expectancy/