- Describe the clinical picture, laboratory findings, and management of HIV disease.
- Outline the importance of enhancing care coordination among the multidisciplinary team to ensure proper evaluation and management of HIV disease.
The human immunodeficiency virus (HIV) is an enveloped retrovirus that contains 2 copies of a single-stranded RNA genome. It causes the acquired immunodeficiency syndrome (AIDS) that is the last stage of HIV disease. Two to four weeks after HIV enters the body, the patient may complain of symptoms of primary infection. After that, a long chronic HIV infection occurs, which can last for decades. AIDS is mainly characterized by opportunistic infections and tumors, which are usually fatal without treatment.
The cause of this infectious disease is the human immunodeficiency virus (HIV) which can be classified into HIV-1 and HIV-2. HIV-1 is more globally expanded and virulent. It originated in Central Africa. HIV-2 is much less virulent and comes from West Africa. Both viruses are related antigenically to immunodeficiency viruses found primarily in primates.
The estimated number of people living with HIV/AIDS is 36.7 million worldwide as of 2016. In the United States, a critical risk factor for HIV propagation among young people is the use of drugs before having sex including marijuana, alkyl nitrites ("poppers"), cocaine, and Ecstasy. Other risk factors associated with a risk of acquiring HIV infection include men who have sex with men, unsafe sexual practices, the use of intravenous drugs, and unsafe blood transfusions or blood products.
Primary infection occurs 4 to 10 weeks after unprotected sexual practice with an HIV-infected person. The primary HIV infection is characterized by the following symptoms:
Chronic HIV infection is characterized by the following signs and symptoms and can last for decades:
When there is a possibility of acute or early HIV infection, the most sensitive screening immunoassay available (ideally, a combination antigen/antibody immunoassay) in addition to an HIV virologic (viral load) test is performed. RT-PCR based viral load test is favored. A positive HIV virologic test generally indicates HIV infection.
Detectable viremia does not develop until approximately 10 to 15 days after infection, and even the most sensitive immunoassays do not give a positive result until five days after that. Therefore, initial negative immunoassay and virologic tests can be misleading, and if the clinical suspicion for recent HIV exposure is high, repeat testing is done one to two weeks later.
Medical management focuses on the elimination of opportunistic infections and relieving pain:
Outcome goals for a patient with HIV/AIDS may include:
Monitor for side effects of medication. The most common side effects include nausea, vomiting, diarrhea, fever, loss of appetite, hair loss, cough, headache, stomach pains, tiredness, runny nose, insomnia (difficulty sleeping), joint pain, rash, dizziness, muscle pain, and hypersensitivity reaction. Liver toxicity is common to all treatment regimes and should be monitored by regular bloodwork including AST/ALT levels.
The management of an HIV-positive patient is complex, and it should be carried out by an interprofessional, health care team that includes nurses, a social worker, a family doctor, an internal medicine specialist, and an infectious disease specialist. If an opportunistic infection or a mass develops, the patient should be evaluated by an oncologist and/or surgeon. Psychological support must be provided once the diagnosis of HIV is made.
Principal facts for HIV prevention are patient education which includes the following:
Discharge planning includes written instructions on medication regime and adverse reactions to report. Patients who are not independent in activities of daily living may be referred to home care services for assistance with care. Physical Therapy and Occupational Therapy can be effective to increase strength and endurance. Patients often experience weakness and fatigue, requiring monitoring for safety. Including family and support, members to assist the patient's transition home is crucial to maintaining compliance with care. The patient should also be referred to as a social worker to ensure resources in the home are adequate for care. Community resources may also be considered for assistance with financial support to ensure the patient can pay for medications. It is important to remember that the person is "Living with HIV", and that the plan of care should include resuming activities of daily living. Patient teaching during the discharge process will include methods for healthy living, prevention of complications, and avoidance of transmission.
Brew BJ,Garber JY, Neurologic sequelae of primary HIV infection. Handbook of clinical neurology. 2018 [PubMed PMID: 29604985]
Capriotti T, HIV/AIDS: An Update for Home Healthcare Clinicians. Home healthcare now. 2018 Nov/Dec [PubMed PMID: 30383593]
Javadi S,Menias CO,Karbasian N,Shaaban A,Shah K,Osman A,Jensen CT,Lubner MG,Gaballah AH,Elsayes KM, HIV-related Malignancies and Mimics: Imaging Findings and Management. Radiographics : a review publication of the Radiological Society of North America, Inc. 2018 Oct 19 [PubMed PMID: 30339518]
Pires CAA,Noronha MAN,Monteiro JCMS,Costa ALCD,Abreu Júnior JMC, Kaposi's sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital. Anais brasileiros de dermatologia. 2018 Jul-Aug [PubMed PMID: 30066758]
Chadburn A,Abdul-Nabi AM,Teruya BS,Lo AA, Lymphoid proliferations associated with human immunodeficiency virus infection. Archives of pathology [PubMed PMID: 23451747]
Xu HF,Zhou HZ,Jiang LX,Zhang N,Zhang X,Guan XR, Trends in HIV infection in the First Affiliated Hospital of Harbin, China. BMC infectious diseases. 2014 Nov 25 [PubMed PMID: 25422121]