HIV Infection (human immunodeficiency virus) damages the immune system. AIDS (acquired immune deficiency syndrome) is the disease caused by the damage incurred by HIV. Many of the clinical features of HIV Infection and AIDS can be attributed to the profound immune deficiency that develops in HIV-infected patients. AIDS is the most serious stage of HIV, leading to death over time.
Stages of HIV Infection
Rapid Initiation of Antiretroviral Therapy (ART) & Management of Early HIV Infection
- provide prompt treatment through initiation of antiretroviral therapy (ART) following the diagnosis of acute and early HIV infection
- choose one of the following antiretroviral regimens: REGIMEN 1: dolutegravir plus tenofovir & emtrictabine OR lamivudine bictegravir-tenofovir alafenamide-emtricitabine; REGIMEN 2: ritonavir-boosted darunavir plus tenofovir and either emtricitabine or lamivudine
- chosen treatment needs to be continued indefinitely
NOTE: individuals who choose not to commit to lifelong ART need to be closely monitored: CD4 cell count and viral load testing every 3 months + provided with counseling on the high risk of transmission when viral RNA levels are very high.
Chronic HIV Infection Without AIDS
AIDS and Advanced HIV Infection
Advanced HIV Infection is confirmed when the CD4 cell count is <50 cells/microL.
AIDS is the outcome of chronic HIV infection and consequent depletion of CD4 cells. AIDS is confirmed when the CD4 cell count is <200 cells/microL OR there is presence of any AIDS-defining condition as listed further below.
AIDS-defining conditions are opportunistic illnesses which occur more frequently or increasingly severe due to immunosuppression. These conditions are mainly opportunistic infections, but do also include malignancies as well as conditions without clear alternative etiology.
AIDS-Defining Conditions
Complications Medical Management
| Complication | Medical Management |
| Pneumocystis Pneumonia | trimethoprim-sulfamethoxazole (TMP-SN) |
| Mycobacterium Avian Complex | azithromycin OR clarithromycin |
| Cryptococcal Meningitis | IV amphotericin B |
| Severe Chronic Diarrhoea | octreotide acetate (Sandostatin) |
| Depression | psychotherapy + imipramine OR desipramine OR fluoxetine |
| Weight Loss | appetite stimulants + oral supplements |
NOTE: When the patient achieves immune reconstitution (eg. increase in CD4 cell count of >200 cells/microL) with antiretroviral therapy and shows no signs of AIDS-defining conditions, they are considered as no longer having AIDS.
AIDS Nursing Care Plan
- Promote Skin Integrity – encourage skin care: teach patients to avoid scratching and to use non-abrasive non-drying soaps and to apply non-perfumed moisturisers; encourage regular oral care; encourage washing of the perineal area following bowel movements using non-abrasive soap and water
- Monitor for Normal Bowel Patterns – monitor for frequency and consistency of the patient’s stools and note any patient complaints of abdominal pain or cramping
- Prevent Infection – monitor for physical signs of infection as well as through laboratory test results
- Promote Activity Tolerance – encourage the patient to plan daily routines with the aim of maintaining balance between activity and rest
- Maintain Thought Processes – encourage the patient’s relatives and friends to speak to the patient in simple, clear words, and to allow sufficient time for the patient to respond to questions
- Improve Airway Clearance – teach and promote coughing exercises, deep breathing, postural drainage, percussion and vibration exercises in 2-hour intervals so as to prevent secretion stasis and to promote airway clearance
- Relieve Pain and Discomfort – encourage use of soft cushions and foam pads for comfort, and if necessary, administer NSAIDs and Opioids to lessen pain
- Improve Nutritional Status – encourage the patient to consume foods which are easy to swallow, and to avoid rough, spicy and sticky foods
Transmission Means of HIV Infection
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