HIV & AIDS Cheat Sheet

Table of Contents: 1. Pathophysiology & Prevention 2. Diagnosis & Monitoring 3. Interventions 4. Medications HIV & AIDS 1. Pathophysiology & Prevention AIDS is the final stage of HIV infection; however, with strict medication adherence, clients may not progress to AIDS. HIV infection process HIV is a retrovirus, meaning it replicates itself “backward” by transcribing RNA into DNA. y HIV binds and fuses to the host’s CD4 T-cells  Viral RNA is converted into viral DNA using the enzyme reverse transcriptase  Viral DNA integrates into the genetic code of the host’s CD4 T-cells  HIV takes over the CD4 T-cell to replicate itself. FIGURE 1. HIV INFECTION PROCESS Transmission
Preventing HIV transmission = #1 priority.
HIV spreads when infectious bodily fluids, (particularly blood, semen, vaginal secretions, breast milk) come into contact with non-intact skin or mucous membranes.
Not spread by casual contact (hugging, sharing toilets) TABLE 1. HIV TRANSMISSION AND PREVENTION Transmission Method Prevention
Sharing needles during IV drug use: Poses the highest risk for HIV transmission due to direct blood-toblood contact
Advise clients never to share needles when using drugs. Unprotected sex: Multiple partnersrisk.
Promote safe sex practices, including use of barrier methods (see TABLE 2). Pregnancy, childbirth, or breastfeeding y Offer HIV testing during routine prenatal care. Needle stick injuries (health care workers) and exposure to infectious body fluids y Follow standard precautions with all clients. y Utilize safety devices on needles and dispose of sharps in a puncture-proof container. Immune HIV (Human Immunodeficiency Virus) is a chronic viral infection. HIV attacks CD4 T-cells, which fight infection. This weakens the immune system and reduces the body’s ability to fight infections and cancer. General guidelines toHIV transmission y Encourage routine HIV screening for all clients.
Recommend pre-exposure prophylaxis (PrEP) before sexual activity or drug use for high-risk clients.
Provide post-exposure prophylaxis (PEP) within 72 hr of potential HIV exposure (needle stick, unprotected sex with HIV-positive individual).  Preventing transmission: HIV prevention includes preventing exposure to infectious bodily fluids through consistent condom use during all sexual activity and avoiding needle sharing. © Bootcamp.com 6 1. Pathophysiology & Prevention, Continued FIGURE 2. CANDIDIASIS & KAPOSI SARCOMA TABLE 2. SAFE SEX PRACTICES
Always use condoms during genital or anal intercourse. y Use a latex barrier (dental dam) during oral sex. y Apply water-based lubricant with condoms to reduce friction (mucosal tears HIV transmission risk). 2. Diagnosis & Monitoring Monitoring
After an HIV diagnosis, frequent monitoring of CD4 count and viral load is a priority to assess HIV progression and treatment effectiveness. y CD4 count :as HIV progresses. y Normal: 800-1,200 cells/mm3 y Viral load: Measures HIV levels in the blood; levels = less active disease. y Treatment goal is for viral load to be undetectable.
New diagnoses must be reported to the health department.
AIDS is diagnosed when either the CD4 count drops <200 cells/mm3 or one of the following opportunistic infections occur: y Candidiasis y Kaposi sarcoma y Pneumocystis pneumonia (PCP) y Tuberculosis y Toxoplasmosis HIV progresses in three stages (FIGURE 3).
Stage 1 (acute phase) y Viral load is very high, making the person highly infectious. y Clients may experience flu-like symptoms (fever, myalgias, sore throat), weight loss, and swollen lymph nodes. y Stage 2 (chronic phase) y Asymptomatic phase y Lasts for months or years before progressing to AIDS
Stage 3 (AIDS) y End-stage HIV, marked by significant immunocompromise y Assessment findings include: y Persistent fever and night sweats y Chronic diarrhea y Recurrent infections (pneumonia, tuberculosis) Immune Initial diagnosis
There is a 3-week window after exposure where HIV is still undetectable, resulting in false negatives. y Retesting after this period is recommended. y HIV antibody or antigen testing detects HIV in blood or saliva to diagnose the infection.  Progression of HIV to AIDS: AIDS is the final stage of HIV and is diagnosed when the CD4 count drops below 200 cells/mm3 or when the client develops an opportunistic infection. © Bootcamp.com 2 2. Diagnosis & Monitoring, Continued FIGURE 3. UNTREATED HIV DISEASE PROGRESSION Nursing care for HIV and AIDS focuses on: 1. Promoting adherence to antiretroviral therapy (ART) 2. Preventing HIV transmission 3. Preventing and monitoring for opportunistic infections 4. Providing psychosocial support 1. Promote adherence to antiretroviral therapy (ART): y ART requires clients to take a daily combination of several drugs from different classes that interrupt various stages of HIV replication, for life (see TABLE 4).
Adhering to ART = #1 priority to delay disease progression.  Promoting ART adherence: ART adherence is the #1 priority; missing doses can lead to drug resistance and treatment failure. Reminders or pill organizers are tools to promote medication adherence.
Goal of ART:viral load to undetectable levels and CD4 count y Assess CD4 count and viral load when starting ART, then every 3-6 months to evaluate effectiveness. y U=U: Undetectable = Untransmittable through sexual contact but does not mean cured; it means the virus is below detectable levels. y Client must still follow safe sex practices.
Instruct clients to never skip doses; missing even a few doses can cause drug resistance.
Encourage the use of reminders or pill organizers to help prevent missed doses.
Instruct clients to report unmanageable side effects (anorexia, vomiting); do not stop taking medications.
Instruct clients to consult their HCP before taking other medications or supplements; many interact with ART.  Monitoring viral load and CD4: Assess viral load and CD4 frequently to determine treatment effectiveness and decrease the risk of transmission. The goal of ART is to increase CD4 count and decrease viral load to undetectable levels. © Bootcamp.com 3 Immune 3. Interventions 3. Interventions, Continued y Promote ART adherence to viral load.
viral load =risk of infecting others. y Educate clients on the importance of monitoring viral load.
Administer ART during pregnancy, childbirth, breastfeeding, and to newborns of HIV-positive mothers to prevent perinatal transmission.
Practice safe sex (see TABLE 2). y Even if both partners are HIV-positive, different HIV strains or other STIs can still be transmitted. y Follow HIV prevention measures (see TABLE 1), and: y Never share personal items like razors or toothbrushes. y Wash dishes and utensils in hot, soapy water or a dishwasher. y Wear gloves when handling bodily fluids or items contaminated with these fluids. 3. Prevent and monitor for opportunistic infections: y Prevent infection.
Infection prevention is a high priority because opportunistic infections are a leading cause of death in clients with HIV and immunosuppression. y Promote ART adherence to increase CD4 count, which fights infections. y Provide infection control teaching (see TABLE 3). y Administer prophylactic antibiotics as prescribed to prevent opportunistic infections (pneumonia). y Monitor for infection.
Instruct the client to immediately report signs of infection such as fever, cough, or skin changes.
Encourage routine tuberculosis (TB) testing; clients with HIV are at high risk for TB.
Monitor for reddish-brown lesions, which may indicate Kaposi sarcoma, an opportunistic cancer. y Assess respiratory status frequently due to  risk for pneumonia.
TABLE 3. INFECTION CONTROL TEACHING
Perform frequent hand hygiene. y Perform frequent skin and oral care to prevent candidiasis. y Receive recommended vaccines. y Avoid crowds and wear a mask when in crowded areas. y Avoid pathogen exposure (gardening, changing litter box). y Monitor temperature to check for fever. y Cook food thoroughly; do not consume raw or undercooked foods. y Avoid traveling to areas with poor sanitation. y Encourage proper nutrition and rest to support the immune system. 4. Provide psychosocial support:
Clients often need significant psychosocial support to manage depression, anxiety, and social isolation associated with HIV. y The terminal nature of the disease and the associated social stigma can intensify these challenges. y Consult mental health services to manage anxiety, depression, or suicidal ideations. y Refer clients to HIV support groups to reduce stigma and social isolation. y Ensure clients have advance directives in place stating their wishes.  Preventing and monitoring for infection: Immunosuppression places clients at high risk for opportunistic infections. Clients should be regularly screened for tuberculosis and closely monitored for reddish-brown skin lesions, which indicate Kaposi sarcoma. © Bootcamp.com 4 Immune 2. Prevent HIV transmission: 4. Medications TABLE 4. ANTIRETROVIRAL THERAPY (ART) y ART does not cure HIV but helps delay disease progression and prevent transmission.
Hepatotoxicity: Monitoring liver enzymes is a high priority for ART clients. Drug Mechanism & Considerations Entry inhibitors Blocks HIV from entering CD4 cells enfuvirtide fostemsavir Nucleoside reverse transcriptase inhibitors (NRTIs) Inhibits reverse transcriptase to prevent HIV replication y Can cause renal toxicity: Monitor BUN and creatinine. y Can cause lactic acidosis: Monitor serum lactate. tenofovir zidovudine Non-nucleoside reverse transcriptase inhibitors (NNRTIs) doravirine nevirapine dolutegravir bictegravir Protease inhibitors (PIs) atazanavir darunavir Blocks integrase enzymes, preventing HIV DNA from inserting into CD4 DNA y Can cause hyperglycemia: Monitor glucose levels. Immune Integrase inhibitors Blocks protease, preventing replicated HIV from maturing y Can cause hyperglycemia: Monitor glucose levels. FIGURE 4. ART MECHANISMS OF ACTION © Bootcamp.com 5  HIV prevention includes preventing exposure to infectious bodily fluids through consistent _____ use during all sexual activity and avoiding _____ sharing.  _____ is the final stage of HIV and is diagnosed when the _____ drops below 200 cells/mm3 or the client develops an _____ infection.  ART adherence is the #1 priority; missing doses can lead to _____ resistance and treatment failure. What tools can the client use to promote medication adherence?  Assess _____ count and _____ load frequently to determine treatment effectiveness and _____the risk of transmission. The goal of ART is to _____ (increase/decrease) CD4 count and _____ (increase/decrease) viral load to undetectable levels.  Immunosuppression places clients at high risk for _____ infections. Clients should be regularly screened for _____ and closely monitored for reddish-brown skin lesions, which indicate _____. Immune Answers: 1. condom, needle 2. AIDS, CD4, opportunistic 3. drug, reminders and pill organizers 4. CD4, viral, decrease, increase, decrease 5. opportunistic, tuberculosis, Kaposi sarcoma References: Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A concept-based approach to learning (4th ed., Vol 1). Pearson. Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.). (2023). Lewis’s medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier. Ignatavicius, D., Heimgartner, N., & Rebar, C. (Eds.). (2024). Medical-surgical nursing: Concepts for clinical judgment and collaborative care (11th ed.). Elsevier. Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D., Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medicalsurgical nursing in Canada: Assessment and management of clinical problems (5th ed.). Elsevier. Attributions: y HIV Infection Process: Created with BioRender.com y Candidiasis & Kaposi Sarcoma: OpenStax College, via Wikimedia Commons and James Heilman, MD, via Wikimedia Commons y Untreated HIV Disease Progression: Created with BioRender.com y ART Mechanisms of Action: Created with BioRender.com © Bootcamp.com 6