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Care of the Patient with HIV/AIDs

1 Contact Hour
This peer reviewed course is applicable for the following professions:
Certified Medical Assistant, Certified Nursing Assistant (CNA), Home Health Aid (HHA)
This course will be updated or discontinued on or before Thursday, March 24, 2022
Outcomes

 ≥90% of participants will know how to care for patients with HIV/AIDS

Objectives

After completing this course, the learner will be able to:

  1. Define HIV/AIDS
  2. Describe ways HIV is transmitted
  3. Discuss what to do after being exposed to blood
  4. Discuss basic care frequently needed by HIV/AIDS sufferers
CEUFast Inc. did not endorse any product, or receive any commercial support or sponsorship for this course. The Planning Committee and Authors do not have any conflict of interest.

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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    David Tilton (RN, BSN)

What is HIV?

HIV is a virus, sometimes called a retrovirus. It can be caught from 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), sometimes referred to as “the wasting disease.1,2”  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, which 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. New medications merely push back the deadly end.

Know the Rights of the HIV infected

At times our patients refuse to consider that they may have this disease because HIV is terrifying. This is a real and justified fear given the history of HIV and AIDS in the United States, and globally. HIV infection is a very serious medical condition, though no longer the sentence of an agonizing, wasting death that it was during the 1980s and 1990s. There are now medications that can slow the progression of the disease by years, even decades, in many cases.

Having HIV brings with it an unwanted stigma or a bad reputation. Federal laws exist to protect them from discrimination and to ensure that benefits such as social or medical services will not be withheld.

The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of health information. Information about HIV/AIDS cannot be discussed except with the care team members for that patient. You cannot discuss information about HIV/AIDS with family and friends unless the patient agrees to share the information.3

Two Types of HIV

There are two significant varieties of the HIV virus. Both of which are spread through sexual or blood sharing activities. Type 1 (HIV-1) and type 2 (HIV-2).4 When you hear HIV referred to without clarification as to the type, HIV-1 is being discussed.

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

HIV and AIDS is Common

The CDC estimates the total number of Americans living with HIV as of 2016, the latest year with good public health statistics, at 1,008,929.5 Of those, 156,300 (12.8%) are unaware of their infection.5

Latest Statistics5, 6, 7The United States 2016Worldwide 2018
HIV annual new cases38,700

1,800,000

Total estimated living with HIV/AIDS

1,008,929

37,900,000

Annual AIDS deaths

15,807

770,000

Gay, bisexual and other men who have sex with men (MSM)* of all races and ethnicities remain the population most profoundly affected by HIV.6

Terminology Time8:

*For assessing disease risk, the term MSM (men who have sex with men) is used instead of gay, homosexual or bisexual because it refers to a risk behavior rather than an identity that may or may not be tied to the behavior.

Other behaviors warranting following by public health include2,5,6:

  • Injection drug use in all sex and age groups
  • MSM sexual activities simultaneous with injection drug use

Transmission and Prevention of HIV Infection

Our HIV positive patients can infect others unless 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 ease of viral spread have led the CDC to provide a list of ways HIV cannot be spread9:

  • 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’s 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 28 times the rate of sharing infection than dedicated heterosexuals.2  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 are on the following:

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

Post-Exposure Prophylaxis (PEP)

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.

Starting PEP as soon as possible after a potential HIV exposure is important. Prevention of HIV infection involves taking antiretroviral medications as soon as possible.

The Stages of HIV Infection

Currently, there is no cure for HIV infection.

HIV infection has three distinct stages, as defined by the CDC (Centers for Disease Control): HIV Primary or Acute infection, HIV Chronic or Asymptomatic infection, and HIV as AIDS.

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

Care for the Complications of HIV/AIDS

Common problems of individuals with HIV infection are:

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

Medication Adherence

Treatment for HIV and AIDS is medication based. The correct blend of antiretroviral medications started early in the infection and continued daily throughout the course of the disease can extend the patient's life expectancy by decades. Be aware, in general, HIV medication is harsh, causing stomach and bowel upset in many people. Undesirable medication effects compounded by high prices and the sheer number of medications being taken, lead many to stop their life-extending medicines. Having someone to talk to, empathize with them, and encourage medication compliance makes a world of difference in many patient’s lives. If you think someone is not taking their HIV medications, notify the RN. There are things the RN can do to help the patient regularly take their medications.

Avoiding Other Infections

Patients with HIV have suppressed immune systems. HIV causes our patients to catch infections that would not bother someone with a normal immune system. The patient with HIV will also be sicker than someone with a healthy immune system, and simple infections can be fatal to some who have a suppressed immune system. Report any sign of fever, redness, or swelling to the RN.

The care plan may include the following to help prevent infections:

  • Encourage and help achieve and maintain a clean, orderly environment, and good personal hygiene.
  • Avoid events or large groups of people during the cold and flu season.
  • Make sure food is washed before preparation and cooked well. 
  • Avoid raw or undercooked eggs or meat.
  • If a cat owner, keep pets indoors to minimize germs carried inside and have someone else handle kitty litter or dog waste.
  • If your patient is a gym member, remind them to use a towel on shared equipment, and a different towel to dry themselves.
  • Reverse isolation

Nutrition Needs

HIV places the body under stresses that rob the body of the nutritional materials needed to maintain the best health possible. Pay attention to the patient’s diet and watch for lack of appetite. If you see a bad diet, notify the RN. She can do some things to help the patient and can make referrals to dieticians.

A balanced healthy diet will help to maintain a patient’s weight despite symptoms common to HIV that make nutrition difficult. 
The care plan may include the following to help with dietary needs:

  • Intake and output measures
  • Record food eaten (calorie count)
  • Smaller, more frequent meals
  • Frequent nutritional snacks 

Good conversation during meals may distract from food aversion, and food that looks good can make eating a more positive experience. 

During times when the patient has trouble moving around, be sure that both fluid and food are within easy reach.

Diarrhea

For many patients fighting the HIV virus, diarrhea is an unwanted gift that simply keeps on giving. During the AIDS stage of HIV, abdominal cramping with loose, watery stools is much too common. If diarrhea is new for your patient, notify the RN.

The care plan may include the following to help with diarrhea:

  • Encourage patients to continue drinking, eating as best they can.

Nausea and Vomiting

Some medications make nausea worse; others decrease nausea. Vomiting can quickly lead to dehydration, so encourage small, frequent drinks of water, juice, or other fluids. If vomiting is new for your patient, notify the RN.

  • The care plan may include the following to help with nausea and vomiting:
  • Having the person sit up when eating, even snacking.
  • Drinking plenty of fluids after a meal.
  • Remaining upright for one or two hours after eating.
  • Try the odor of lemon peel or fresh oranges at the start of nausea to distract the body.
  • Snack lightly on dry, salty carbohydrates such as crackers, toast, or dry unsweetened cereal.

Sore Mouth

Having a sore mouth is a frequent situation once the HIV stage of AIDS gets worse. Mouth and swallowing pain make it difficult to eat and even take medication. If it is new for your patient to have a sore mouth, notify the RN.

  • The care plan may include the following to help with mouth sores:
  • Cold fluids, chilled soups, chilled vegetable and fruit juices, or popsicles.
  • Use a straw for drinking fluids.
  • Smooth, moist, or soft foods are more palatable to a sore mouth.
  • Toothpaste for sensitive mouths and/or rinsing the mouth with mouthwash for painful mouths.

Summary

The HIV infected 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 getting worse.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

References

  1. Wolitski R. Seizing the Opportunity to End the Scourge of HIV/AIDS. HIV.gov. 2016:1-4. Visit Source.
  2. Shikongo M. City of Windhoek (NAMIBIA) HIV/AIDS Service Directory. City of Windhoek (Namibia) HIV/AIDS Service Directory. Visit Source. Published 2004.
  3. HIV.gov. Laws Protect People Living with HIV and AIDS. U.S. Department of Health & Human Services MHAF Minority HIV/AIDS Fund. Visit Source Published 2017. Accessed January 1, 2020.
  4. Bennett NJ. HIV Infection and AIDS. Medscape. Visit Source. Published 2019. Accessed January 1, 2020.
  5. CDC. Statistics Overview | Statistics Center | HIV/AIDS | CDC. Visit Source. Published 2019. Accessed January 4, 2020.
  6. CDC. HIV in the United States and Dependent Areas | Statistics Overview | Statistics Center | HIV/AIDS | CDC. Visit Source. Published 2019. Accessed January 3, 2020.
  7. WHO. Global Health Observatory Data | HIV/AIDS. Visit Source. Published 2019. Accessed January 4, 2020.
  8. Avert. Men who have sex with men (MSM), HIV and AIDS | Avert.org. Visit Source. Published 2019. Accessed January 7, 2020.
  9. CDC. HIV Transmission | HIV Basics | HIV/AIDS | Centers for Disease Control and Prevention, US Department of Health and Human Services. Visit Source. Published 2019. Accessed January 7, 2020

Resources

  1. Legg T. Global HIV Rates for Men Who Have Sex with Men: Facts, Issues & More. Healthline. Visit Source. Published 2018. Accessed January 7, 2020.
  2. CDC. Information for Providers to Share with Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, Sexually Transmitted Infections, and Other Health Outcomes.; 2018. Visit Source. Accessed January 7, 2020.
  3. Sax P. The natural history and clinical features of HIV infection in adults and adolescents - UpToDate. UpToDate Inc. Visit Source. Published 2018. Accessed January 7, 2020.
  4. Mayer K, Krakower D. Administration of pre-exposure prophylaxis against HIV infection - UpToDate. UpToDate Inc. Visit Source. Published 2019. Accessed January 7, 2020.
  5. CDC. About HIV/AIDS | HIV Basics | HIV/AIDS | Centers for Disease Control and Prevention, US Department of Health and Human Services. Visit Source. Published 2019. Accessed January 7, 2020.
  6. Merlin J, Pahuja M, Selwyn P. Issues in HIV/AIDS in adults in palliative care - UpToDate. UpToDate Inc. Visit Source. Published 2019. Accessed January 8, 2020.
  7. HHS. Guide for HIV/AIDS Clinical Care. Rockville, MD: U.S.; 2014. Visit Source. Accessed January 8, 2020.