When I found myself struggling to communicate a patient’s HIV status during a rapid response, it was a wake-up call that I needed to expand my knowledge.
This podcast episodes delves deeper into HIV/AIDS than nursing school did, covering common hospital presentations, labs, medications, and opportunistic infections.
By enhancing my own understanding, I hope to equip others to improve care for patients living with HIV/AIDS.
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Defining our terms: HIV v. AIDS
HIV is a virus that attacks the immune system, particularly CD4 cells, weakening the body’s ability to fight off infections and diseases.
AIDS is a late stage of HIV infection. Requirements for diagnosis are:
- A significant drop in CD4 cell count, typically below 200
- The presence of specific opportunistic infections or cancers
Key Labs
CD4 Count
- CD4 cells are a type of leukocyte that command the immune system to launch an attack against infectious agents
- The standard range for CD4 count is 500-1200
- CD4 < 200 qualifies as AIDS criteria
When caring for an HIV/AIDS patient, it’s important to know their CD4 count to have an understanding of their disease progression.
Viral Load
- This test measures the amount of virus, or HIV, in the patient’s blood
- If the patient is receiving HIV treatment, the goal is for the viral load to be undetectable
Treatment
Antiretroviral therapy (ART)
Combination of antiretroviral medications with the goal to:
- Suppress viral load
- Prevent resistance
- Restore immune function
Opportunistic infections
Patients with untreated HIV/AIDS are vulnerable to opportunistic infections
The most common opportunistic infections include:
- Mycobacterium avium complex (MAC)
- Treatment:
- Cytomegalovirus (CMV)
- Can cause pneumonia, gastroenteritis, encephalitis, retinitis
- Treatment: Valganciclovir (Valcyte)
- Pneumocysitis jiroveci (PCP) pneumonia
- Treatment: Atovaquone (Mepron)
- Herpes simplex virus (HSV)
Patient Education
Patient education is really going to be focused on medication adherence.
Luckily, your patient will likely be very motivated to adhere to their antiretroviral therapy because their qualitfy of life very much hinges on it.
As described earlier, ART medications
- Reduces risk of transmission
- Reduces risk of drug resistance
- Prevents opportunistic infections and HIV-related hospitalizations, making these potentially life-threatening complications a relic of the past.