Free Disease Process Of HIV/AIDS Research Paper Example
Definition of Disease Process: 3
Disease process of HIV 3
Acute infection stage 4
Clinical latency stage 5
Signs and Symptoms 6
Nursing Diagnosis 7
Immune System 7
Integumentary System 8
Respiratory System 8
Nervous System 9
GI System 9
Endocrine System 9
Urinary System 10
Cardiovascular System 10
Reproductive System 10
Musculoskeletal System 11
Works cited 12
Definition of Disease Process:
Disease process of HIV
Human Immunodeficiency virus (HIV) causes one of the most severe deficiency disorders affecting the immune system. HIV positive person has AIDS or Acquired immunodeficiency syndrome. If the HIV is treated at early chances, it can reduce the risk of development of AIDS.
HIV is a retrovirus that after entering the human body incorporates its genetic material into the genetic material of the host. First stage involves the attachment of the virus to CD4 cell wall receptors of monocytes and lymphocytes. This attachment results in the release of RNA and HIV-1 proteins into the cytoplasm of the host cell. It has the capability of altering proviral DNA and encoding regulatory and structural protein inside the cell. Retrovirus has a unique feature of reproducing inside the cell that is facilitated by its specific enzyme Reverse Transcriptase. The infection period of HIV involves several stages after that CD4 cells are killed, and the immune system is completely damaged. Reverse transcriptase induces transcription where viral RNA is transcribed into host DNA. This process also causes mutations. Following transcription, the integration takes place and mutated DNA inserts into the host gene. Now viral protein production is active, and HIV-1 protease modifies T cells. After m RNA and protein expression assemblage with host plasma membrane and budding of new virions takes place. According to the latest classification of HIV by Centers for Disease Control and Prevention (CDC), two types of HIV are present, HIV 1 and 2. HIV-1 is active in Asia, Europe and American regions while HIV-2 is spread in Western Africa. HIV-2 is milder with a long incubation period so reduced risk of AIDS (Christensen and Kockrow Ch. 11).
The infected DNA continually replicates inside the host and can deliver 50 million to 2 billion particles each day that infect other cells of the circulatory system, macrophages and lymphoid tissues. The cellular and humoral immunity of the infected person becomes very weak due to infected CD4+ cells, resulting high susceptibility towards opportunistic infections (OIs).
The transmission of HIV is not possible through casual contact or routine care. It transmits via body fluids, blood and tissues. Any fissure in membrane can act as an entrance for virus. The high chances of disease transmission involve unprotected sex, maternal-fetal exposure or sharing of syringe or surgical tools (Christensen and Kockrow Ch. 11).
Latest stats of global prevalence published by WHO and UNICEF, 2012 state 34 million people are infected with HIV in 2011, out of which 3.3 million are children with HIV and AIDS. Newly infected people estimated 2.5 million and estimated mortality due to AIDS is found around 1.7 million (Avert.org). Researchers believe that the virus first attaches itself to dendritic immune cells that are mainly found near mucocutaneous regions of mouth, vagina, penis, rectum, GI tract. These dendritic cells further transport the virus to lymph nodes (Aids.gov).
The HIV infection can be categorised into three main stages:
Acute infection stage
3-4 weeks post HIV infection flu-like symptoms develop that may include fever, sore throat, rashes, muscle and joint pain, headache and fatigue. It is denoted as acute retroviral syndrome, a primary response of the immune system to infection. At this stage, the virus production inside body occurs fast and CD4 count falls rapidly. At this point body’s immune system fights back bringing the virus count lower but cannot completely destroy. It is a suitable time to initiate antiretroviral therapy (ART) (Aids.gov).
Clinical latency stage
It is an asymptomatic Stage when the virus is developing and staying inside the body without any visible symptom. This time virus is transmissible and active but reproduces very slowly. Clinical latency stage can last for decades. ART can control this stage but if not prescribed on time CD4 level will again fall resulting in constitutional symptoms of HIV (eMedicineHealth; Aids.gov).
AIDS develops after the complete destruction of the immune system and susceptibility towards infections or OIs increases. Count of CD4 below of 200 cells per cubic millimetre indicates onset of AIDS. Without treatment and care, life expectancy remains around three years (eMedicineHealth; Aids.gov).
Test can be performed by health practitioners, local and community health centers. Now a self-test kit, Home Access HIV-1 Test system is available approved by FDA. The diagnosis of HIV involves blood tests such as RNA tests, CD4 and PCR tests, HIV antibody screening tests (Enzyme-linked Immunosorbent Assay, ELISA) and a test that can simultaneously detect antibodies and virus particle p24 protein. Western blot test is prescribed when screening tests result in positive (eMedicineHealth).
HIV testing is two-step processes, first an antibody-based screening test is performed and if it is positive, followed by Western blot test to confirm. The antibody tests can identify bacteria in the blood, saliva, vaginal and penile secretions and urine. RNA test detects viral RNA in blood and helpful for early detection in window period (Christensen and Kockrow Ch. 11).
Earlier HIV has been considered a fatal disease with few treatment options like comfort measures and hospital care. Though not complete cure is discovered yet for HIV, but the condition is in control with novel approved medications if diagnosed at an early stage. Now HIV is chronic, controllable disease with proper obedience toward suggested schedules and prescribed medications and tests. Medications are effective in extending life expectancy but need proper adherence. It supports immune system to recover and respond to OIs (Christensen and Kockrow Ch. 11).
WHO has set strict criteria and mandated genotyping blood tests for identifying HIV strain before commencing drug therapy. It is required to check whether the strain is resistant and require close monitoring. ART are prescribed with proper implications and interventions. A three-drug regimen is prescribed that include two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-NRTI. Protease inhibitor can be suggested. Antiretroviral medication blocks viral replication and hinders the development of AIDS. (eMedicinehealth.com; Christensen and Kockrow Ch. 11).
Signs and Symptoms
No symptoms are visible for many years, and it also depends on the condition of the patient and his humoral as well as cellular immunity. In the starting, only flu-like symptom is observed. Sometimes HIV tests may be negative at this stage. After the damage of the immune system, the sentinel infections or OIs occur that indicate immunosuppression. HIV has various clinical manifestations and latency period without obvious symptoms. The development of disease is different for each individual and it may last for decades. On the basis of visibility of symptoms, this stage is further classified into four stages depending upon symptoms. Clinical stage 1 is asymptomatic, Clinical stage 2 exhibits symptoms such as moderate weight loss, minor mucocutaneous appearance, respiratory tract infection, but they are fully ambulatory. Clinical stage 3 can be described as “in the bed more than normal” such as severe weight loss and severe bacterial infections. Clinical stage 4 shows more than half time on bed due to the severity of the condition such as pneumonia, diarrhea, cryptococcosis, HIV wasting syndrome, etc. (emedicinehealth.com; Christensen and Kockrow Ch. 11).
HIV causes immunosuppression that affects CD4 cells. Progressive depletion of the immune system is highly susceptible to OIs through diminishing the humoral, as well as a cellular level immune system. It is estimated that 90% morbidities and mortalities occur due to the OIs. Early prophylaxis of OIs has proved an improvement in the condition and lengthened the life of HIV positive person. OIs require administration of drugs. Therefore, the symptoms associated with each body system for OIs are necessary to address. To address possible drug interactions and toxicities developed through administered drugs are an essential part of nursing diagnosis. Patients on ART and TB DOTS need more caution and proper management.
At high risk due to damaged cellular and humoral immunity that makes the body more prone to the secondary infections of the immune system.
Weak Immune system AIDS patient requires more attention because high susceptibility towards even minute infection. These patients should be given isolated treatment to avoid environment acquired infection like cold, fever, etc. Malaria infections are higher in among people with low CD4 count or high viral loads, so anything can be fatal.
Highly sensitive as it acts as entry zone for infections through any fissure on skin
Mucocutaneous layer of skin facilitates the transmission of the virus. Skin, mucous membrane nails and hair are prone to bacterial, fungal, viral and prurigo infections. HIV patients need appropriate management to avoid contractual probabilities. For examples, Kaposi’s sarcoma and rashes on the skin indicate immune dysfunction.
Difficulty in breathing and congestion indicates infection
High risk of infections mostly evident in the form of lesions on neurons, imbalance in body and risk of injury, chances of memory loss and confusion
The evident signs are meningitis, encephalitis, myelitis, and spinal root problems. OIs of CNS are highly fatal and can occur at any time of viral acquisition.
After the confirmation through imaging techniques, HAART can be introduced at early stage.
Most frequent problem including diarrhea, less nutrition and weight loss
The GI associated OIs are apparent with diarrhoea, nausea and vomiting that can cause dehydration. Symptoms may arise from problems in any section of GI tract that may include mouth, oesophagus, throat, stomach, gall bladder, intestines, liver, rectum and anus. The chances of drug interactions and pathogenic infections exist in HIV-seronegative population. With appropriate medication requires proper nutrition and fluid intake.
Possible imbalances in hormonal levels, as secondary effects from other OIs, Insulin resistance, risk of malignancy of gonads
Beta islet destruction or islet cell autoimmunity can result in Insulin resistance causing diabetes. Abnormality in growth hormone and its resistance induces Insulin resistance.
Low testosterone levels due to illness and medication cause Hypogonadism. Imbalances of adrenal gland may result in Addison's disease.
Risk of infection and injury, high urinary frequency and retention
High risk of heart attack, increased levels of cholesterol and triglycerides
Risk of infections and acute pain, Ineffective sexual activity and low self-esteem, Itching and irritation in vaginal, white fluid discharge
Reproductive organs are most vulnerable to virus and involve in the transmission. Sexually transmitted diseases are very common and cause reproductive malignancies. Reproductive disturbances result in further hormonal imbalances and can result in life-threatening problems. Uterine TB and cancers of reproductive organs are common side effects of HIV.
Stiffness in muscles, body pain and difficulty in walking, activity intolerance and risk of injury
Problems developed in CNS can result in fatigue and musculoskeletal system as secondary effects. Introduce seizure precautions if CNS involvement is suspected. Ensuring proper motion and encouragement of exercise is necessary (Christensen and Kockrow 750 Ch 11).
HIV is a killer virus that has been a reason of AIDS and millions of death per year. AIDS has targeted a massive crowd including adults, children and neonates. Now world’s health organisations have become worried and developed various supportive plans and interventions to combat this epidemic. Nursing care and diagnosis are the core part of health promotion for HIV. This research paper focussed on the disease process of HIV and AIDS. It describes prognosis, diagnosis and treatment options with nursing diagnosis for OIs associated with each body system. Any powerful treatment regimen to completely cure AIDS has not been discovered. Proper prophylaxis and appropriate treatment has sufficiently effective to slow down the infection and virus development, providing a quality improvement and longer life expectancy.
Aids.gov,. 'Diabetes'. N.p., 2015. Web. 11 Mar. 2015.
Avert.org,. 'Worldwide HIV & AIDS Statistics | AVERT'. N.p., 2015. Web. 12 Mar. 2015.
eMedicineHealth,. 'HIV/AIDS Causes, Symptoms, Treatment - HIV/AIDS Prognosis - Emedicinehealth'. N.p., 2015. Web. 11 Mar. 2015.
Mann, Jonathan M., and Daniel Tarantola, eds. AIDS in the World Two. Oxford University Press, 1996.
Christensen, Barbara Lauritsen, and Elaine Oden Kockrow. Adult health nursing. Elsevier Health
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