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What Are HIV and AIDS?

Published July 9, 2021 by thewriterlyroad_2o62in

What is HIV?

Human immunodeficiency virus (HIV) is a blood-borne virus transmitted through body fluids (i.e., blood, semen, and vaginal secretions). As the name states, HIV infects the cells that help keep our immune system strong. Without a healthy immune system, our bodies are susceptible to a whole host of infections we wouldn’t usually get. It is important to remember that HIV doesn’t only affect a specific segment of society. Anyone can be infected with HIV regardless of their age, sex, race, ethnicity, or sexual orientation (AIDS Healthcare Foundation).

There are only a handful of ways to spread HIV. The first is through anal or vaginal sex. The second is by sharing infected needles or syringes to inject drugs or cookers used to make drugs. Lastly, babies can contract HIV during pregnancy, birth, or if they are breastfed by a mother who has HIV. In rare cases, patients can contract HIV from an organ donation or blood transfusion. This scenario is highly unlikely in the United States because of the thorough testing of organ and blood donors. Regardless of the route of transmission, the disease progression is the same. Many people don’t recognize the initial symptoms of HIV infection because they can be similar to the flu. 

Symptoms can include:

 * Sore throat 

  • Swollen glands 
  • Muscle aches
  • Skin rash
  • Nausea, vomiting, and diarrhea
  • Night sweats

It is not uncommon for patients to experience weight loss with a new HIV infection. If a patient presents with any of these symptoms, the clinician should complete a physical assessment, order blood tests, and obtain a complete medical and sexual history. Blood work would reveal HIV in the blood and a decrease in the white blood cell count. These findings are significant and different from other kinds of infection. 

In most cases, the body will produce more white blood cells to fight a new or growing infection. In the case of HIV, the virus is suppressing the bone marrow’s ability to make white blood cells. Additionally, another cell called a CD4 will also decrease. CD4s are often called “helper cells” because they help the immune system fight various infections; however, HIV prevents the helper cells from doing their job. As the disease progresses, the virus level will rise, and the CD4 cell and white blood cell levels will continue to fall, which further compromises the immune system.

HIV infection has three stages. Stage 1 is known as the acute phase. Some patients may have flu-like symptoms, but others may not have any symptoms at all. Because there is a large amount of HIV virus in the blood during this stage, patients are highly contagious. If a patient has flu-like symptoms with no other explanation, they should have an antigen/antibody test or nucleic acid test (NAT) to determine if they have HIV.

Stage 2 is the chronic phase. Patients still have HIV virus in the blood but at lower levels. However, they are still able to spread the infection to others. “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” (Centers for Disease Control). Stage 3 is acquired immunodeficiency syndrome (aids). Although the progression of the disease can vary greatly among patients, stage 2 generally lasts for about ten years.

Clinicians should offer emotional support to a patient newly diagnosed with HIV infection. Significant strides in medications and treatments mean that patients with HIV can live a long and healthy life but there is still no cure, so the diagnosis can be a life-changing event. Clinicians need to be sensitive to the stigma some HIV patients may face with friends, family, and the public, and we should offer other community-based resources if required. These might include referrals to an HIV clinic, a social worker, a therapist, or a support group.

What is AIDS?

Acquired immunodeficiency syndrome (AIDS) is the third stage of HIV infection. At this point, the patient’s immune system is severely compromised, and they are at risk of contracting a variety of illnesses (known as opportunistic infections). 

Some examples of these opportunistic infections are 

*Candidiasis 

  • Cytomegalovirus (CMV) 
  • Herpes simplex virus (HSV) 
  • Lymphoma 
  • Tuberculosis
  • Kaposi’s sarcoma (KS)
  • Invasive cervical cancer 
  • Pneumocystis pneumonia (PCP)

As in the other stages, patients are contagious and can infect their sexual contacts. Even with proper treatment, the general survival period is about two years, although this can vary from patient to patient based on other co-morbidities. Patients are diagnosed with aids when their CD4 count falls below 200 cells per cubic millimeters of blood, or when they develop opportunistic infections.

Patients in the third stage suffer significant disability and physical challenges. The opportunistic infections may also cause multiple emergency room visits and hospital admissions. They may become unable to work, drive a car, or eat enough to maintain their weight. Fungal infections in the mouth may make it difficult to eat. In some cases, parenteral nutrition may be necessary. “Poor nutritional status and HIV infection interact with each other leading to the development of opportunistic infections, malignancies, debilitation and death” (Enwereji et al., 2019). Because patients can also develop a condition called HIV encephalopathy, they can have a cognitive impairment, making it difficult for them to perform their activities of daily living.

Treatment and Medications

As previously stated, there is no cure for HIV and AIDS, but medications and testing are advancing substantially. The main category of drugs currently in use is called antiretroviral therapy (ART). It is not uncommon for patients to be on a multi-drug regimen or “cocktail” of three or more medications to treat the disease. Each category has a different mechanism of action and works on different cells in the body. The multi-drug approach has effectively kept patients free from opportunistic infections, stabilizing or significantly reducing their viral load, and improving their CD4 counts. According to the Mayo Clinic, the classification of drugs is as follows:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant), and doravirine (Pifeltro).
  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen), tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).
  • Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).
  • Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy), raltegravir (Isentress) and dolutegravir (Tivicay).
  • Entry or fusion inhibitors block HIV’s entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

Like all other medications, side effects are possible. 

Common side effects of ART include: 

  • Bleeding
  • Bone loss 
  • Damage to the kidneys, liver, or pancreas
  • Lactic acidosis 
  • Heart disease
  • Hyperglycemia which can lead to diabetes

Treatment also involves regular blood testing to assess the viral load, white blood cells, and CD4 cells. As much as possible, patients should maintain a strong immune system by avoiding others who are ill, taking medication as prescribed and not missing any doses, eating a well-balanced diet, and minimizing stress.

Another positive step in the treatment and possible prevention of HIV is PrEP, or pre-

exposure prophylaxis. These medications are taken before potential exposure to HIV or if a patient is at high risk of exposure to HIV. PrEP is effective if it is taken regularly. PrEP can reduce the risk of HIV infection from sex up to 90% and in I.V. drug users up to 70% (Medline Plus).

According to the website HIV.gov, there are currently two approved medications for PrEP:

The side effects of PrEP are similar to ART and include:

*Nausea and diarrhea 

*Headache

  • Possible damage to the liver or kidneys
  • Loss of bone density

There is another class of drugs for patients who believe they have been exposed to HIV. These are known as PEP, or post-exposure prophylaxis. PEP may be ordered if a patient feels they were exposed to HIV during sex, after sharing potentially contaminated needles or syringes, and after being sexually assaulted. To be effective, patients must start PEP within 72 hours of exposure, and they must take the drug for 28 days. Just like PrEP, PEP is only effective if taken as prescribed.

Patient Teaching

Like other chronic diseases, patients with HIV and AIDS need ongoing education about the progression, treatment, and management of their illness. Clinicians play a crucial role in helping patients understand symptoms, side effects of medications, the need for regular blood tests, and how to handle and treat opportunistic infections. Teaching should empower the patient in taking their medications as scheduled and report side effects to their provider. Clinicians should strive to build rapport with their patients. In doing so, they stand a good chance of obtaining an accurate and thorough medical and sexual history.

Another critical component of teaching for this patient population is safe sex practices. It cannot be overstated how important it is for patients to understand behaviors that increase their risk of contracting his as well as actions that can decrease their risk. 

Behaviors that increase the risk of contracting HIV are:

 *Sharing needles and syringes 

*Having sexual contact with someone who has a high viral load the presence of another sexually transmitted infection

* Using drugs and alcohol during sexual encounters.

Behaviors that reduce the risk of contracting HIV include:

 *Abstinence 

*Less risky sexual behaviors

*Using condoms and lubricants 

*Reducing the number of sexual partners

*Taking medication to prevent HIV or reduce the viral load 

It is essential that sexual partners have an honest conversation about each other’s sexual practices and whether the relationship will be monogamous. Sexual partners can also agree to only engage in safe sex practices and remain committed to these guidelines during the relationship.

Lastly, partners should always be honest about their HIV status, especially if they plan to engage in sexual activity or become pregnant. Having HIV does not mean that sex or pregnancy is not possible, but extra precautions are needed to reduce the risk of transmission.

Medication Compliance

As researchers and health care providers learn more about antiretroviral therapy, it is clear that strict adherence to the dosing regimen is essential to keep the HIV viral load under control, increase CD4 production, and support the immune system. Clinicians play a pivotal role in ensuring that patients understand their medication regimen and the rationale for strict adherence to its guidelines. As health care providers, we should never assume that patients know what to do to keep themselves healthy. Therefore, assessing the patient’s knowledge level and willingness to follow the medication dosing is crucial to the successful treatment of HIV infection.

Conclusion

The progress made in the battle against HIV and AIDS is nothing short of phenomenal. A disease that at one time would have meant a sure and quick death is now being held at bay by advances in both testing and treatment. If handled properly and conscientiously, HIV patients can expect to live long, quality-filled lives. More than ever, HIV patients can hope that they won’t suffer disability and devastating illness because of the virus. This hope extends to friends, family, and the community as well.

Clinicians can help this patient population by not being afraid to have open conversations about medical and sexual history, medication compliance, and overall health status. Additionally, offering emotional and psychological support will help these patients better navigate their journey of living with the virus. HIV and AIDS once may have been the worst-case scenario for many, but that is not the reality now. We can hope the next phase is a cure.

References

AIDS Healthcare Foundation. What is HIV? HIV Basics. HIV Care. (n.d.). https://HIVcare.org/hiv-basics/?gclid=EAIaIQobChMIgaaX__3x8AIVZz2tBh0WuAUCEAAYASAAEgJ_MvD_BwE

Centers for Disease Control. About HIV. https://www.cdc.gov/HIV/basics/whatisHIV.html

Enwereji, E.E., Ezeama, M.C., Onyemachi, P.E.N. (2019). Basic principles of nutrition, HIV, and aids: making improvements in diet to enhance health. DOI:10.5772/intechopen.84719

HIV: PrEP and PEP. https://medlineplus.gov/HIVprepandpep.html

HIV.gov. What drugs are approved for prEP? https://www.HIVgov/HIV-basics/HIV-prevention/using-HIV-medication-to-reduce-risk/pre-exposure-prophylaxis

Mayo Clinic. HIV/AIDS. https://www.mayoclinic.org/diseases-conditions/HIV-AIDS/diagnosis-treatment/drc-20373531

Published in Health and Safety, Nursing and Patient Advocacy

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