Managing a Human Immunodeficiency Virus Positive Patient Essay

The paper “Managing a Human Immunodeficiency Virus Positive Patient” is a perfect example of a case study on category. Statistics says by 2001, 40 million people were living with HIV /AIDS and more than 20 million had already died of AIDS, with above half of all new HIV infection was found to occur among young people, found to be increased from 3.9% in 1999 to 4.2 % in 2004. (Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Accessed March 7, 2004.). Managing a Human Immunodeficiency Virus Positive Patient Essay. Outline of the disease/ Health problem: The causative organism, Human immunodeficiency virus (HIV), a retrovirus primarily infects and destroys primarily white blood cells, resulting in a breakdown of the immune system.

The CD4+ T cells, that is crucial for the immune response and signaling is the main target of HIV, resulting in ion a weakened immune system, rendering it for the body unfit to fight certain infections. With the depletion of these cells, the immunity decline and with opportunistic infections occurs, resulting in an infected patient, described as having the acquired immune deficiency syndrome (AIDS). Managing a Human Immunodeficiency Virus Positive Patient Essay. (Fred Hutchinson Cancer Research, Center, 2007)   .generally the common secondary infections seen in AIDS are, infections of the lungs, intestinal tract, brain, eyes, and other organs, as well as debilitating weight loss, diarrhea, neurological conditions and cancers such as Kaposi’s sarcoma and certain types of lymphomas. The causative agent of AIDS is a human immunodeficiency virus (HIV) belongs to the family of human retrovirus and subfamily of lentiviruses.

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HIV is spread most commonly by sexual contact, infected blood, the sharing of needles or syringes, from mother to their fetuses during pregnancy or birth, or by breast milk that contains virus. The best care setting for the patient would, If he is asymptomatic – palliative outpatient care and home care It is symptomatic, palliative inpatient care followed by home based care. Palliative care‘ s basic ideology is to both provide the care and comfort, which is the best fitting in this stage. Managing a Human Immunodeficiency Virus Positive Patient Essay.

The decision as explained is based on the stage, the patient’ s mentality and the reaction of society to the particular case. The team that would provide overall care in this would involve Physical practitioner, Nurse practitioner, Technical person, psychiatrist or social counselor and as a major force the patient’ s friends and family.

The nurse practitioner in this scenario has a range of activities from attending to physical treatment and providing mental stability. (Kahn JO, Walker BD. Acute human immunodeficiency virus type 1 infection. N Engl J Med. 1998; 339:33-39.) Pathophysiology and Sympathology: HIV, a retrovirus primarily infects CD4+ lymphocytes and macrophages by attaching to the host cell by the association of a surface glycoprotein to the CD4 molecule. Thus on the entrance, the virus core enters the cell cytoplasm of the host and copies viral RNA to the DNA of the host by using viral reverse transcriptase.

The first cases of acquired immunodeficiency syndrome (AIDS) were reported in the United States in the spring of 1981. By 1983 the human immunodeficiency virus (HIV), the virus that causes AIDS, had been isolated. Early in the U.S. HIV/AIDS pandemic, the role of substance abuse in the spread of AIDS was clearly established. Injection drug use (IDU) was identified as a direct route of HIV infection and transmission among injection drug users. The largest group of early AIDS cases comprised gay and bisexual men (referred to as men who have sex with men(or MSMs). Early cases of HIV infection that were sexually transmitted often were related to the use of alcohol and other substances, and the majority of these cases occurred in urban, educated, white MSMs. Managing a Human Immunodeficiency Virus Positive Patient Essay.

Currently, injection drug users represent the largest HIV-infected substance-abusing population in the United States. HIV/AIDS prevalence rates among injection drug users vary by geographic region, with the highest rates in surveyed substance abuse treatment centers in the Northeast, the South, and Puerto Rico. From July 1998 through June 1999, 23 percent of all AIDS cases reported were among men and women who reported IDU (Centers for Disease Control and Prevention [CDC], 1999b).

IDU practices are quick and efficient vehicles for HIV transmission. The virus is transmitted primarily through the exchange of blood using needles, syringes, or other IDU equipment (e.g., cookers, rinse water, cotton) that were previously used by an HIV-infected person. Lack of knowledge about safer needle use techniques and the lack of alternatives to needle sharing (e.g., available supplies of clean, new needles) contribute to the rise of HIV/AIDS. Managing a Human Immunodeficiency Virus Positive Patient Essay.

Another route of HIV transmission among injection drug users is through sexual contacts within relatively closed sexual networks, which are characterized by multiple sex partners, unprotected sexual intercourse, and exchange of sex for money (Friedman et al., 1995). The inclusion of alcohol and other noninjection substances to this lethal mixture only increases the HIV/AIDS caseload (Edlin et al., 1994; Grella et al., 1995). A major risk factor for HIV/AIDS among injection drug users is crack use; one study found that crack abusers reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetimes, and greater frequency of paying for sex, exchanging sex for drugs, and having sex with injection drug users (Word and Bowser, 1997). Managing a Human Immunodeficiency Virus Positive Patient Essay.

Following are the key concepts about HIV/AIDS and substance abuse disorders that influenced the creation of this TIP:

• Substance abuse increases the risk of contracting HIV. HIV infection is substantially associated with the use of contaminated or used needles to inject heroin. Also, substance abusers may put themselves at risk for HIV infection by engaging in risky sex behaviors in exchange for powder or crack cocaine. However, this fact does not minimize the impact of other substances that may be used (e.g., hallucinogens, inhalants, stimulants, prescription medications).
• Substance abusers are at risk for HIV infection through sexual behaviors. Both men and women may engage in risky sexual behaviors (e.g., unprotected anal, vaginal, or oral sex; sharing of sex toys; handling or consuming body fluids and body waste; sex with infected partners) for the purpose of obtaining substances, while under the influence of substances, or while under coercion.
• Substance abuse treatment serves as HIV prevention. Placing the client in substance abuse treatment along a continuum of care and treatment helps minimize continued risky substance-abusing practices. Reducing a client’s involvement in substance-abusing practices reduces the probability of infection.
• HIV/AIDS, substance abuse disorders, and mental disorders interact in a complex fashion. Each acts as a potential catalyst or obstacle in the treatment of the other two–substance abuse can negatively affect adherence to HIV/AIDS treatment regimens; substance abuse disorders and HIV/AIDS are intertwining disorders; HIV/AIDS is changing the shape and face of substance abuse treatment; complex and legal issues arise when treating HIV/AIDS and substance abuse; HIV-infected women with substance abuse disorders have special needs. Managing a Human Immunodeficiency Virus Positive Patient Essay.
• Risk reduction allows for a comprehensive approach to HIV/AIDS prevention. This strategy promotes changing substance-related and sex-related behaviors to reduce clients’ risk of contracting or transmitting HIV.

The first part of this chapter provides a basic overview of the origin of HIV/AIDS and the transmission and progression of the disease. The second part of the chapter presents a summary of epidemiological data from the CDC. This second part discusses the impact of HIV/AIDS in regions of the United States and the populations that are at the greatest risk of contracting HIV.

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Overview of HIV/AIDS

Origin of HIV/AIDS

Of the many theories and myths about the origin of HIV, the most likely explanation is that HIV was introduced to humans from monkeys. A recent study (Gao et al., 1999) identified a subspecies of chimpanzees native to west equatorial Africa as the original source of HIV-1, the virus responsible for the global AIDS pandemic. The researchers believe that the virus crossed over from monkeys to humans when hunters became exposed to infected blood. Monkeys can carry a virus similar to HIV, known as SIV (simian immunodeficiency virus), and there is strong evidence that HIV and SIV are closely related (Simon et al., 1998; Zhu et al., 1998).

AIDS is caused by HIV infection and is characterized by a severe reduction in CD4+ T cells, which means an infected person develops a very weak immune system and becomes vulnerable to contracting life-threatening infections (such as Pneumocystis carinii pneumonia). AIDS occurs late in HIV disease.

Tracking of the disease in the United States began early after the discovery of the pandemic, but even to date, tracking data reveal only how many individuals have AIDS, not how many have HIV. The counted AIDS cases are like the visible part of an iceberg, while the much larger portion, HIV, is submerged out of sight. Many States are counting HIV cases now that positive results are to be gained by treating the infection in the early stages and because counting only AIDS cases is no longer sufficient for projecting trends of the pandemic. Managing a Human Immunodeficiency Virus Positive Patient Essay. However, because HIV-infected people generally are asymptomatic for years, they might not be tested or included in the count. The CDC estimates that between 650,000 and 900,000 people in the United States currently are living with HIV (CDC, 1997c).

In 1996, the number of new AIDS cases (not HIV cases) and deaths from AIDS began to decline in the United States for the first time since 1981. Deaths from AIDS have decreased since 1996 in all racial and ethnic groups and among both men and women (CDC, 1999a). However, the most recent CDC data show that the decline is slowing (CDC, 1999b). The decline can be attributed to advances in treating HIV with multiple medications, known as combination therapy; treatments to prevent secondary opportunistic infections; and a reduction in the HIV infection rate in the mid-1980s prior to the introduction of combination therapy. The latter can be attributed to improved services for people with HIV and access to health care. In general, those with the best access to good, ongoing HIV/AIDS care increase their chances of living longer.

HIV/AIDS is still largely a disease of MSMs and male injection drug users, but it is spreading most rapidly among women and adolescents, particularly in African American and Hispanic communities. HIV is a virus that thrives in certain ecological conditions. The following will lead to higher infection rates: a more potent virus, high viral load, high prevalence of STDs, substance abuse, high HIV seroprevalence within the community, high rate of unprotected sexual contact with multiple partners, and low access to health care. These ecological conditions exist to a large degree among urban, poor, and marginalized communities ofinjection drug users. Thus, MSMs and African American and Hispanic women, their children, and adolescents within these communities are at greatest risk.

HIV Transmission

HIV cannot survive outside of a human cell. HIV must be transmitted directly from one person to another through human body fluids that contain HIV-infected cells, such as blood, semen, vaginal secretions, or breast milk. The most effective means of transmitting HIV is by direct contact between the infected blood of one person and the blood supply of another. (See Figure 1-1 for an illustration of the structure of the virus.) This can occur in childbirth as well as through blood transfusions or organ transplants prior to 1985. (Testing of the blood supply began in 1985, and the chance of this has greatly decreased.) Using injection equipment that an infected person used is another direct way to transmit HIV. Managing a Human Immunodeficiency Virus Positive Patient Essay.

Figure

Figure 1-1: Parts of HIV.

Sexual contact is also an effective transmission route for HIV because the tissues of the anus, rectum, and vagina are mucosal surfaces that can contain infected human body fluids and because these surfaces can be easily injured, allowing the virus to enter the body. A person is about five times more likely to contract HIV through anal intercourse than through vaginal intercourse because the tissues of the anal region are more prone to breaks and bleeding during sexual activity (Royce et al., 1997).

A woman is eight times more likely to contract HIV through vaginal intercourse if the man is infected than in the reverse situation (Center for AIDS Prevention Studies, 1998). HIV can be passed from a woman to a man during intercourse, but this is less likely because the skin of the penis is not as easily damaged. Female-to-female transmission of HIV apparently is rare but should be considered a possible means of transmission because of the potential exposure of mucous membranes to vaginal secretions and menstrual blood (CDC, 1997a).

Oral intercourse also is a potential risk but is less likely to transmit the disease than anal or vaginal intercourse. Saliva seems to have some effect in helping prevent transmission of HIV, and the oral tissues are less likely to be injured in sexual activity than those of the vagina or anus. However, if a person has infections or injuries in the mouth or gums, then the risk of contracting HIV through oral sex increases.

Role of circumcision in male infectivity

A possible link between male circumcision and HIV infectivity was first observed during studies conducted in Kenya in the late 1980s (Cameron et al., 1998; Greenblatt et al., 1988; Simonsen et al., 1988). Since then, numerous studies have been done on the possible relationship between male circumcision and HIV infectivity. Managing a Human Immunodeficiency Virus Positive Patient Essay. Data have not revealed a direct causal link between circumcision and HIV transmission, and scientific opinion has been divided on this topic. While some studies indicate that circumcision can play a protective role in preventing HIV infection (Kelly et al., 1999;Moses et al., 1998; Urassa et al., 1997), the bulk of recent scientific research has concluded that the reverse is true and that circumcision can actually increase the rate of HIV transmission (Van Howe, 1999). Clearly, further research and analysis of circumcision as a prophylactic against HIV transmission is needed.

Risks of transmission

Several factors can increase the risk of HIV transmission. One factor is the presence of another STD (e.g., genital ulcer disease) in either partner, which increases the risk of becoming infected with HIV through sexual contact. This is because the same risk behaviors that resulted in the person contracting an STD increase that person’s chance of contracting HIV. STDs also can cause genital lesions that serve as ports of entry for HIV, they can increase the number of HIV target cells (CD4+ T cells), and they can cause the person to shed greater concentrations of HIV (CDC, 1998a). For this reason, all sexually active clients, especially women, should be checked regularly for STDs such as gonorrhea and chlamydia. Many STDs that cause symptoms in men are asymptomatic in women. When genital ulcers are treated and heal, the risk of HIV transmission is reduced.

Another factor that increases risk is a high level of HIV circulating in the bloodstream. This occurs soon after the initial infection and returns late in the disease. New drug therapy can keep this level (called viral load) low or undetectable, but this does not mean that other individuals cannot be infected. The virus still exists–it is simply not detectable by the currently available tests. Because the correlation between plasma and genital fluid viral load varies, transmission may still occur despite an undetectable serum viral load (Liuzzi et al., 1996).

Once HIV passes to an uninfected person who is not taking anti-HIV drugs, the virus reproduces very rapidly. It is known that drug-resistant viruses can be transmitted from one person to another. The treatment implications for a person infected with a drug-resistant virus are not yet known, but treatment will likely be difficult. Managing a Human Immunodeficiency Virus Positive Patient Essay.

There are many misconceptions regarding HIV transmission. For example, HIV is not passed from one person to another in normal daily contact that does not involve either exposure to blood or sexual contact. It is not carried by mosquitoes and cannot be caught from toilet seats or from eating food prepared by someone with AIDS. No one has ever contracted AIDS by kissing someone with AIDS, or even by sharing a toothbrush (although sharing a toothbrush still is not advised). Other misconceptions people may have include the following:

• “It can’t happen to me.“–HIV can infect anyone who has sex with, or shares injection equipment with, someone who is infected.
• “I would know if my sex partner (injection partner) were infected.“–Most people infected with HIV do not look or feel sick and do not even know they are infected.
• “As long as I get treated for any sexual infections I pick up, I’ll be safe.“–No current form of treatment can cure or prevent HIV, and although treating other infections reduces risk, there is still a high chance of getting HIV through unprotected sex or sharing injection equipment.
• “If I’m only with one sexual partner, and don’t share injection equipment, I don’t need to worry about HIV.“–This is true only if the partner is uninfected and has no ongoing risk of infection. If the partner is or becomes infected, then anyone who has sex with him or shares his injection equipment is at high risk for HIV, and the only way to detect infection is to be tested.
• “If I douche or wash after sex, I won’t get HIV.“–Douching and washing will not prevent HIV.
• “If I don’t share my own syringe, I won’t get HIV.“–HIV can also be spread through shared cookers, filters, and the prepared drug.
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Life Cycle of HIV

It is possible to prevent transmission even after exposure to HIV. In San Francisco, postexposure prophylaxis is being offered to people who believe they have high risk for HIV transmission because of exposure with a known or suspected HIV-infected individual. Treatment is started within 72 hours of exposure and includes combination therapy, which may include a protease inhibitor, for a period of 1 month and followup for 12 months.

Once an HIV particle enters a person’s body, it binds to the surface of a target cell (CD4+ T cell). The virus enters through the cell’s outer envelope by shedding its own viral envelope, allowing the HIV particle to release an HIV ribonucleic acid (RNA) chain into the cell, which is then converted into deoxyribonucleic acid (DNA). The HIV DNA enters the cell’s nucleus and is copied onto the cell’s chromosomes. This causes the cell to begin reproducing more HIV, and eventually the cell releases more HIV particles. These new particles then attach to other target cells, which become infected. Figure 1-2 illustrates how HIV enters a CD4+ T cell and reproduces.  Managing a Human Immunodeficiency Virus Positive Patient Essay.