Care of the Patient with HIV/AIDS

HIV is a virus, sometimes called a retrovirus. It can be caught and shared with other people.

For most viruses, our bodies respond by destroying the virus. Most viruses are destroyed by the body’s defender, the immune system. Unfortunately, HIV attacks and destroys the immune system. This leads the patients with HIV to have a suppressed immune system. Suppressed means the immune system does not work as well as it should.

The HIV virus is a fatal, person-to-person infection with no known cure whose final terminal stage is Acquired Immunodeficiency Syndrome (AIDS) (Myhre & Sifris, 2023). HIV and AIDS are the same disease, with AIDS being the final stage of the same viral infection right before death.

In the past few years, new medications have been developed that can extend the lifespan of an infected person by decades. So, HIV has changed from an acute terminal illness to a chronic, lingering condition requiring medication, monitoring, good nutrition, and care. Be aware HIV/AIDS remains a fatal disease.

There are two significant varieties of the HIV virus. Both of these are spread through sexual contact, body fluids, or blood-sharing activities. When you hear HIV referred to without clarification as to the type, HIV-1 is being discussed.

HIV-1 (type 1) is more infectious and the primary cause of infection worldwide (Burgess, 2023; Seladi-Schulman, 2021).

HIV-2 (type 2) is less common, mainly appearing in West Africa (Burgess, 2023; Seladi-Schulman, 2021).

Both varieties of the HIV virus are treated the same way by CNAs and HHAs. There are differences in treatment by doctors.

According to the U.S. government website, HIV.gov, around 1.2 million Americans are currently infected with the HIV virus (HIV.gov, 2022b). Around 13% of them are unaware of their infection and infectious state. The following table includes a breakdown of the most recent HIV/AIDS statistics.

Table 1: HIV/AIDS Statistics

Gay, bisexual, and other men who have sex with men (MSM) of all races and ethnicities account for 71% of all new cases of HIV (HIV.gov, 2022b). Young to middle-aged Black American MSM remain the population most affected by HIV, accounting for around 30% of all new infections (HIV.gov, 2022b). Latinx MSM comes in second at around 20% of new infections, and white MSM amounts to about 15% of new infections (Myhre & Sifris, 2022a).

Another behavior warranting following by public health is the use of illegal injectable medications (CDC, 2023; HIV.gov, 2022a). In the United States, injection drug use in all sex and age groups accounted for around 7% of all HIV cases in 2020.

Our HIV-positive patients can infect others unless they are careful. The understanding of how the HIV virus enters the body relates directly to the prevention of further cases of HIV.

HIV is tough, resilient, and currently impossible for the infected individuals’ body defenses to destroy. Outside the body, however, HIV is fragile and does not survive for long. Misleading rumors about the ease of viral spread have led the Centers for Disease Control and Prevention (CDC) to provide a list of ways HIV cannot be spread (CDC, 2021):

• HIV cannot be spread in air or water
• HIV cannot be spread by insects, including bed bugs, ticks, or mosquitoes
• HIV cannot be spread in saliva, sweat, or tears, and no documented case exists of HIV being transmitted by spitting
• HIV cannot be spread by casual contact, such as sharing dishes or shaking hands
• HIV cannot be spread by closed mouth or social kissing
• HIV cannot be spread from toilet seats

HIV can be transmitted when a person who has HIV-contaminated blood or another body fluid enters a puncture wound, open cut, or sore. This is called exposure. HIV is most often spread through anal or vaginal sexual activities. Male-to-male sexual contact, “men who have sex with men” (MSM), has several times the rate of sharing infection than dedicated heterosexuals.

HIV can also be spread during pregnancy, from mother to child, and during breastfeeding (Myhre & Sifris, 2022). Worldwide, this type of perinatal transmission accounts for most cases of childhood HIV and AIDS (Myhre & Sifris, 2022). HIV-contaminated fluid enters a break in the skin or mucous membranes that allows the virus to enter a person’s bloodstream, where the virus grows.

The HIV patients we are caring for may continue sexual activities. Refer the patient to the nurse or doctor for education if they ask about the risk of transferring HIV to a sexual partner.

Transmission of HIV can occur because blood and certain body fluids from a patient infected with HIV can be involved in the following (Sharkey, 2023):

1. Needle sharing 
2. Blood sharing rituals 
3. Unsterilized equipment exposed to blood
4. Improperly cleaned tools
   1. Cosmetic
   2. Body piercing
   3. Tattooing
   4. Manicure, pedicure

Report all exposures to the patient’s blood. An exposure is being stuck with a bloody needle or tool, getting splashed in the eye or mouth, or getting a patient’s blood in an open cut or sore.If that happens to you, wash the exposed area immediately. Then, report the exposure to the person in charge as soon as possible.

A patient may test negative for HIV but still have HIV that is just not yet showing up on a test.

PEP, or post-exposure prophylaxis, can be used in an emergency after a high-risk exposure (Huynh & Gulick, 2022). PEP is made up of anti-HIV or antiretroviral medications. Starting PEP as soon as possible after a potential HIV exposure is very important. Prevention of HIV infection involves taking antiretroviral medications as soon as possible. It is recommended to begin within three days of exposure.

Currently, there is no cure for HIV infection. Yet, with lifelong treatment, it is possible to slow the disease from progressing from one stage to the next.

HIV infection has three distinct stages, as defined by the CDC:

1. HIV Primary or Acute infection
2. HIV Chronic or Asymptomatic infection
3. HIV as AIDS

The first stage can develop quickly with symptoms you might have if you have the flu, including generalized aches, headache, fever, and even a rash (Leonard, 2023; Myhre & Sifris, 2023).

The second stage often includes the patient feeling and looking healthy without any symptoms.

Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection. AIDS occurs when the body’s immune system has been so severely damaged that the individual is highly vulnerable to diseases, infections, and even infection-related cancers.

Common problems of individuals with HIV include:

• Consistently taking medication
• Avoiding other infections
• Nutrition needs
• Diarrhea
• Nausea and vomiting
• Sore mouth

Ryan is a patient in your unit currently. You notice that Ryan is very quiet, keeps to himself, and has no visitors. You have a few extra moments during your busy shift and sit down with Ryan to see if you can get him to open up.

At first, Ryan is not interested in talking with you. You make a funny comment about the movie he is watching that you have seen before, and you notice he cracks a smile. Right before you walk out of the room to move on to check the vitals of your patient in the next room, Ryan speaks up.

After some light, friendly conversation, Ryan tells you that he really does need someone to talk to because he has been shutting out his family and friends. Ryan shares with you that he was diagnosed with HIV about 6 months ago, and he is still having a hard time processing it all. He explains that his doctor wants him to take all of these medications, and he is feeling overwhelmed. He tells you that some of his medications are causing nausea and diarrhea, which is making his life so uncomfortable lately. He does not really understand why he has to take these medications if they are not going to cure him.

What can you do?

This is a great opportunity to sit and listen to this patient, even for a little while, or even for a bit with a promise to return when you have another moment to spend with him. This patient has received a life-altering diagnosis, he is afraid, and it sounds like he might be unsure about why he must take his antiretroviral medications. Ryan seems to be shutting his family and friends out, likely because he is not feeling well physically and/or emotionally, and he is struggling with his diagnosis. Having someone to talk to and empathize with them, however you can, can be so valuable. This is also a great time to encourage your patient to take his medications. It might be helpful to reach out to the RN and let them know that the patient could benefit from some additional patient teaching about their medication, the side effects, and why it is important to take. You can also let the RN know that Ryan is suffering from nausea and diarrhea that are really affecting his life. Based on what you know too, you can encourage Ryan to take small, frequent sips of fluids, try to eat smaller, more frequent meals, and maybe try snacking on dry, salty carbs like crackers or pretzels.

Your HIV-infected patients need you! HIV is a viral disease that those infected will have until they succumb to it in its final deadly stage of AIDS, or death comes first from another cause. There is no cure for HIV. It is very important for the CNA or HHA to carry out the care plan to make the patient feel better and keep the patient from worsening.

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