Human immunodeficiency virus (HIV) is a systemic viral infection that weakens the body's ability to fight infection and can cause acquired immune deficiency syndrome (AIDS, the last stage of HIV disease). HIV preventative measures are a set of procedures that lower the risk of health care professionals being exposed to the virus.
Description
HIV is the most dangerous sexually transmitted disease (STD), affecting people of all ages. In 1999, HIV was considered the fifth cause of death among American men and women between 25 and 44 years of age. It is believed that 40,000 Americans are infected every year. There have already been 700,000 cases reported in the United States. Globally, over 36 million people have been infected with the AIDS virus.
Most HIV-positive people are men. According to a 2001 survey by the United States Centers for Disease Control and Prevention (CDC) (www.cdc.gov), of 3,000 gay and bisexual men in six major U.S. cities (interviewed in public places, such as gay clubs and bars), 4.4% of gay and bisexual men, ages 23 to 29, are infected with HIV every year. Another study in 2001, also conducted by the CDC, reported that HIV infections among gay men of all races in their 20s were common in large American cities. Thirty percent of blacks, 15% of Hispanics, 7% of whites, and 3% of Asians were affected with HIV. In the general population, one in seven blacks becomes HIV-positive each year.
The incidence of the HIV and AIDS is rapidly increasing in women and children, too. Like many other viruses, HIV remains in the body for life. As of 2001, there is no vaccine against HIV.
Causes and symptoms
HIV infection can present no clinical symptoms, cause a spectrum of conditions, or appear as full-blown AIDS. A unique virus, HIV continually reproduces after it enters the body, eventually overwhelming the immune system and weakening the body's ability to fight lethal infections and cancers.
Most people infected with HIV are not ill. Some are without symptoms for more than 10 years. A "carrier" can host the virus and pass it on to other people without knowing it. Once the virus is established in the body, the chances of getting AIDS increase.
Some of the frequently reported symptoms of HIV/AIDS infections are:
constant or rapid unexplained weight loss of more than 10 pounds in two months; lack of appetite
purplish growths or blotches on or under the skin, inside the mouth, or on the nose, eyelids, or rectum
swollen glands or enlarged lymph nodes in the neck, armpits, or groin for more than a month
Many HIV/AIDS symptoms are similar to those of tuberculosis, influenza, pneumonia, minor yeast infections, and other STDs. Basically healthy people tend to ignore their symptoms until they are ill enough to seeks medical care.
HIV is found in bodily fluids. It is most prevalent in blood, semen, vaginal secretions, and breast milk. HIV infection cannot be transmitted through casual contact. Rather, HIV is transmitted by sexual contact with an infected person, exposure to contaminated blood (e.g., by sharing needles or accidental exposure to contaminated needles) and maternal-fetal transfer.
Activities that spread HIV/AIDS to others are:
anal and vaginal intercourse (It is less commonly transmitted through oral sex.)
sharing contaminated needles for injecting illicit drugs
accidental pricks with contaminated needles while providing health care to infected patients
Diagnosis
Blood tests are used to detect the presence of HIV antibodies in the blood. Antibodies are developed two weeks to three months after infection. Other bodily secretions may also provide evidence of HIV infection. Even before the antibody test is positive, a person can pass the virus to others.
AIDS is the final stage of the HIV infection. The diagnosis is supported by the presence of a variety of conditions and opportunistic infections (i.e., conditions caused by a microorganism that does not ordinarily cause disease, but which becomes pathogenic under certain circumstances) related to HIV. During the disease process, the AIDS virus attacks certain white blood cells (T-lymphocytes). AIDS destroys the body's immune (defense) system and allows otherwise controllable infections to invade the body and cause additional diseases. These opportunistic diseases gain strength in the body and may eventually cause death.
The AIDS virus may also attack the nervous system and cause brain damage. It may take years for symptoms of brain damage to occur, manifesting as memory loss, loss of coordination, partial paralysis, or mental disorder. These symptoms may occur alone or in combination with any of the other symptoms associated with the disease.
HIV/AIDS can only be diagnosed by physicians or qualified health professionals. While AIDS patients are treated by physicians using established protocols for care, patients are often referred to medical specialists, known as epidemiologists, for consultation and monitoring the course of their disease. These specialists study the factors that influence the frequency and distribution of infectious diseases among populations of human beings. The physician specializing in epidemiology concentrates on research and management of infectious diseases.
Medical specialists utilize the support of pathologists in the diagnosis, management, and treatment of patients with the AIDS virus. The scientific study of bodily changes produced by AIDS, pathology is concerned with conducting research. This research is accomplished using comparative analyses of disease processes. Other research may include the practice of experimental pathology, whereby pathologic processes are artificially induced in the laboratory setting. Both methods, however, provide pathologists with the opportunity to learn about the fatal impact of AIDS.
Treatment
As of mid-2001, there is no known cure for, or vaccine against, HIV/AIDS. However, using new drug combination therapy can allow infected persons to remain symptom-free for longer periods, provided the disease is detected early. When HIV is detected early in pregnancy, its treatment with antiretroviral drugs might reduce the risk of transmitting the virus to the child. However, the an HIV-positive, pregnant woman's doctor will frequently advise delivery by cesarean section (cs) to eliminate the chance of transmitting the virus during childbirth.
Success with new, highly active antiretroviral therapy (i.e., HAART, also known as a drug "cocktail") and the decline in the number AIDS cases newly reported, as well as the number of deaths, are good news. A number of HIV-infected people who are still alive due to HAART, and that number is growing.
Drug therapies include TMP-SMX (trimethoprimsulfamethoxazole [tri-METH-o-prim-sul-fa-meth-OX-uh-zole]). Brand names for these drugs are Bactrim, Septra, and Cotrim. The long-term effectiveness of HAART is unknown; HIV may develop resistance to these drugs. Further, this combination drug therapy is very expensive, and a vast number of HIV-infected persons do not have health insurance or the financial means to purchase medication.
Patients also have difficulty maintaining a complicated drug treatment schedule that involves taking a large numbers of pills. Many of these drugs have unpleasant or intolerable side effects, interact with other medications, and cause serious medical problems. Patients might even forget to take all of their medications, or skip doses.
Patients who feel healthy have been known to take "drug holidays," by not taking their medications for days or weeks. Treatment regimes are less effective in the overall population when there is an increased possibility of developing a drug-resistant strain of HIV. If drug resistance is developed by the evolving virus and is coupled with a relaxation in treatment regimens, resistant strains may be transmitted to others, and thus spread widely. Prevention remains the best and most cost-effective approach to controlling the HIV/AIDS epidemic and saving lives.
Prognosis
HIV infections and many AIDS-related conditions, such as pneumonias, cancers, and a variety of infections that take advantage of weakened immune systems, can be managed to some extent with different treatments. Improved treatment options are continually being developed by scientists and pharmaceutical companies. However, no one has ever recovered from full-blown AIDS. As of 2001, the disease is still considered fatal.
Assessment
Nurses and allied health professionals are likely to be the first medical contact for HIV-infected patients. Information obtained about the patient's signs and symptoms, lifestyle, and social behavior must be documented by the medical staff.
Surveillance
There has been recognition by researchers that behavior that places an individual at risk for other STDs increases the risk of HIV infection. Sexually-transmitted disease (STD) surveillance can provide important indicators of sites to which HIV infection may spread, as well as point to targets to which efforts to promote safe sexual behavior should be aimed.
Monitoring
Patient care activities, patient progress, and response to symptomatic or preventive therapies need to be documented by nurses. Medical record information is vital to
Epidemiological studies—Medical research that deals with the incidence, distribution, and control of disease in a population; the sum of factors controlling the presence or absence of a disease, or pathogens.
Highly active antiretroviral therapy (HAART)—Also known as drug "cocktail," this is a combination of powerful drugs prescribed to arrest HIV infection and delay the onset of AIDS. It is not a cure for HIV/AIDS.
Human immunodeficiency virus (HIV)—The virus that causes AIDS. HIV weakens the body's ability to fight infections.
Opportunistic infection (OI)—Condition caused by a microorganism that does not ordinarily cause disease, but which becomes pathogenic under certain circumstances.
Sexually transmitted disease (STD)—Also called venereal disease; any disease transmitted through sexual contact.
continued research in the field. All information must be kept confidential and maintained in compliance with state and federal laws.
Education
Education about HIV prevention has been proven cost-effective when compared with the rising cost of lifetime medical management of people with AIDS. Different types of preventive messages, skills, and support are needed to help reduce sexual and drug-related risks.
Drug injectors should be educated about their high-risk behavior. Drug counseling may help them stop using drugs or sharing needles. These individuals need to be taught how to protect themselves from sexual transmission if their partners have ever been IV drug users and may have shared needles.
Substance abuse is a major problem. The combination of substance abuse and sexual HIV transmission must be given serious attention. Substance abuse prevention and intervention are sorely lacking for users of morphine, cocaine, marijuana, and alcohol. These substances not only alter users' behavior, but weaken their immune systems. This weakening may make them more susceptible to infection with HIV. Counseling and treatment should be available to those who abuse drugs and alcohol. They, too, are in need of assistance in helping them stop using drugs and to help them prevent HIV infection.
Comprehensive health education programs need to be directed toward generation-specific behavior and epidemiology. Programs for children and young adults should involve parents and educators. The most effective programs begin educating young people at an early age and are designed to promote healthy behaviors—such as exercising, eating healthy food, avoiding drug use, excessive alcohol consumption, smoking, and premature sexual activity.
Occupational HIV transmission
Although it is not a primary means of transmitting the spread of HIV, there are documented cases of HIV seroconversion among health workers. Responsibility for preventing occupational exposure to HIV and other bloodborne pathogens is that of the nurse. Precautions include the routine use of gloves for one-time use, goggles, and disposable protective clothing. These function as preventive barriers when there is the possibility of coming in contact with infectious materials. Good hand-washing practices are essential. It is necessary that sharp instruments and contaminated materials are handled and disposed of in a proper manner.
Prevention
Sustained, comprehensive efforts of the 1980s have had a significant impact on slowing the spread of HIV/AIDS in the United States. Although it is difficult to determine exactly how many thousands of infections were prevented as a result of deliberate effort, the mid-1980s witnessed an epidemic growing at an annual rate greater than 80%. As of mid-2001, this rate has stabilized. Nationally, 30 of every 100,000 men and nine of every 100,000 women have AIDS. Despite the occurrence of 40,000 new cases per year, fewer people are dying from AIDS and AIDS-related complications. This is indicative of tremendous progress. In general, previous preventive efforts resulted in many behavioral changes, thereby helping to slow the epidemic overall.
The decline in the number of deaths from AIDS and the effectiveness of antiretroviral therapies increase the number of HIV infected people in the general population. These successes may contribute to a person's false sense of security when he or she believes and behaves as if preventing the spread of HIV is no longer important. Complacency about the need for prevention adds a complex dimension to disease management for health care professionals and the at-risk population. The complicated nature of HIV/AIDS strongly supports valuable opportunities for prevention and intervention.
Primary HIV prevention means keeping people from becoming infected with HIV in the first place. Intervention must focus on preventing the spread of HIV by infected individuals as well as on acquisition by uninfected populations. Infected individuals need to develop skills to reduce the risk of infecting others. It is essential that there be easy access to voluntary blood testing; this will enable early detection of HIV infection.
Comprehensive school-based HIV and sex education programs are suspected to delay initiation of sexual activity in teenagers, reduce the frequency of intercourse for those who are sexually active, decrease the number of sexual partners they have, and increase the use of condoms and other contraceptives.
Stringent screening of donor blood supply for HIV antibodies, and heat-treating blood products used to treat hemophilia have nearly eliminated HIV transmission through transfusions.
Secondary HIV prevention is keeping HIV-infected people safe and healthy by helping them avoid opportunistic infections and stopping the infection from progressing to AIDS.
Scientists are exploring the possibility that combination drug therapies may reduce the infectious nature of the disease. With the lines between prevention and treatment beginning to merge, ongoing services for people who are HIV positive must balance medical advances with the behavioral and social support needed to preserve their quality of life and prevent the spread of infection.
A focus on behavioral change is paramount. Vaccines are not able to prevent disease if people are not vaccinated. No vaccine for lifelong immunity has yet been developed. Further, medical advances are unsuccessful unless their implementation parallels that of effective prevention strategies. People must be receptive to both in order for HIV rates to be reduced.
Pregnant women who may not know they are infected with HIV cannot reduce the risk of transmitting the disease to their unborn children unless that they get prenatal care, routine HIV counseling, and submit to voluntary testing. Infected patients must have access to anti-retroviral drugs. Programs that identify and treat HIV-infected pregnant women have shown dramatic success in reducing HIV transmission to their babies. A woman who is HIV-positive and pregnant may be advised by her doctor to deliver by cesarean section (cs) to eliminate the chance of transmitting the virus during childbirth.
Efforts to reduce the risk for HIV infection of injection drug users through public attitudes and policies have been very effective. State health departments have reported significant reductions in the sharing of drug injection equipment after implementing programs to increase access to sterile injection equipment.
Infected individuals need assistance developing skills to use the new medical treatments. Highly active antiretroviral therapy (HAART) involves complex treatment regimens and requires compliance-related skills. Patients need to learn how to deal with the side effects of medications and drug interactions. They must learn how to decrease the risk of developing drug resistance by taking their medications as recommended and also learn how to work with complicated medication schedules. HIV-positive individuals also depend on the support of family and friends to continue their drug regimens and to encourage prevention of transmission to others.
BOOKS
Koop, Everett. Surgeon General's Report on Acquired Immune Deficiency Syndrome. U.S. Department of Health and Human Services, Centers for Disease Control.
Sexually Transmitted Infections: The Facts. Planned Parenthood Federation of America, 1999.
Sinclair, Barbara Peterson. STDs in the Era of AIDS: Safeguarding Your Sexual Health. Association of Women's Health, Obstetric and Neonatal Nurses, 2001.
PERIODICALS
Centers for Disease Control & Prevention. CDC's HIV/AIDS Prevention Activities. CDC Update: November 1999.
Centers for Disease Control & Prevention. Preventing Occupational HIV Transmission to Health Care Workers. CDC Update: June 1999.
"It Hasn't Gone Away." New York Times <http://www.nytimes.com/2001/05…/31Herb.html>. (June 3, 2001).
"New Study Sees AIDS Rate Jump." New York Times May 31, 2001. <http://www.nytimes.com/a…/AP=CDCAIDS.html>. (June 3, 2001).
"Number of New HIV Cases Increases in Young Gay Men." New York Times May 31, 2001. <http://www…/healthhiv.html>. (June 3, 2001).
