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HIV Aids.pptx

  2. Introduction Acquired Immunodeficiency Syndrome (AIDS) is caused by a retrovirus known as the Human immunodeficiency Virus (HIV). To date there are two types of HIV; HIV-1 and HIV- 2. HIV-1 is known to cause AIDS, however HIV-2 may eventually lead to an immunodeficiency state; however, perhaps the development of severe immunodeficiency due to HIV-2 may require a longer latent period. It is thought that 80% of people infected with HIV-1 will progress to clinical AIDS within 10 years. Management of HIV infection will require a prolonged period of follow-up and monitoring of these HIV-infected individuals. The chronic nature of the infection and the social stigma associated with AIDS makes management of HIV infection more than just providing medical care to these patients. Not only are we, the medical professionals, providing medical care to them, we may also have to be their confidante, for seldom will they have anyone else to confide in regarding issues related to the illness, their jobs, fears, anxieties, etc. Therefore, it is necessary to have a multidisciplinary approach to the care of HIV-infected patients. In order to develop this, we need dedicated people working in this area as care givers, and also to provide support to our other colleagues working in this area
  3. Objectives of the management • To identify early HIV infection • To provide continuous care to asymptomatic • To provide early intervention • To provide adequate medical care with therapy when required • To delay progression to full-blown AIDS
  4. Medical management Clinical management of HIV infection will depend on the stage at which the disease process has developed. This can be broadly classified into 2 clinical stages: 1. Asymptomatic HIV infection 2. Advanced HIV disease. 3. AIDS-related Opportunistic Infections and Tumours. 4. Neuropsychiatric illness In the process of assessing the possibility of HIV infection, the following steps are recommended. 1. Risk Assessment 2. Establish Diagnosis 3. Ascertain Stage 4. Useful laboratory tests 5. Initiate antiretroviral therapy 6. Initiate PCP prophylaxis Risk Assessme nt Establish Diagnosis Ascertain Stage Useful Laborato ry tests Initiate antiretro viral therapy Initiate PCP prophyla xis
  5. Risk Assessment In the initial evaluation of a patient, a full history including a detailed sexual and drug history should be obtained. Questions asked should be: 1. Open-ended Questions 2. Non-Judgemental 3. Not to stigmatise A complete physical examination has to be done to look specifically for relevant signs that might indicate the stage of the disease. Initial laboratory tests will include: a. A Full Blood Count with differential count, particular attention to be given to platelet and Lymphocyte counts b. A Monteux Test with 1 Tuberculin unit intradermal c. A Chest Radiograph
  6. Establish Diagnosis HIV antibody Testing: ELISA and or Particle agglutination tests Confirmed by supplementary test These tests can be done on a: a. voluntary basis b. anonymously c. confidential basis Pre-test Counselling should be given and consent obtained from the patient. Whether the test is positive or negative, post-test counselling should follow. During the post-test counselling, discussion on partner notification should be done by the physician or counsellor*. However if the patient is from out of town and there is no way in getting the partner to be seen by the counsellor or physician, then the medical officer of Health of that state should be notified and follow-up and counselling will be done by the health department. Patient confidentiality should be maintained at all times, however, where the possibility of a spouse or regular sexual partner may be at risk of being infected, the physician/counsellor should discuss the need for the patient to inform the partner and further counselling given.
  7. Ascertain Diagnosis To ascertain the stage of the disease process, a complete history and physical examination and the initial investigations are helpful; however certain other tests may help with staging the disease. The most commonly used surrogate marker to assess progression of the disease is by measuring the CD4+ T lymphocyte count and percentage. Therefore, it is recommended that all HIV infected individuals should have a baseline CD4+ count done at the initial follow-up, when he is found to be HIV positive. Infants born of HIV-infected mothers may be ELISA positive. If the infant is not HIV infected, the ELISA titres will fall within 18 months after birth. Therefore, a better indicator of HIV infection in an infant younger then 18 months will be the measurement of p24 antigen, by doing a polymerase chain reaction (PCR) test, or detection of the virus itself.
  8. Antiretroviral Therapy
  9. Initiate PCP prophylaxis Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection occurring in HIV infected individuals. In 80% of cases it is the first indicator of the development of AIDS. Usually these patients will have a CD4+ T lymphocyte counts of less then 200/uL or a CD4+/CD8+ ratio of less then 20%. Early PCP may be asymptomatic, therefore a high index of suspicion should be developed in physicians caring for HIV-infected individuals. Symptoms of PCP may include dry cough of more then 5 days, fever and difficulty in breathing. Physical examination may show minimal signs. More advanced infection will include acute breathlessness, cyanosis and presence of respiratory rates. The chest X-ray may be normal.
  10. Management of mild PCP can be done on an outpatient basis, if the patient is compliant, however in moderately severe infections it is advisable to admit the patient to the hospital for more intensive management. 25 If the patient is not acutely ill, oral cotrimoxazole, 4 tablets 6 hourly for 14 days is adequate. In severe PCP infection, intravenous cotrimoxazole, 20 mg trimethoprim and 100 mg sulphamethoxazole/kg/day (diluted 1:25 in 0.9% saline or 5% dextrose) should be given for 14 days. In patients with severe PCP infection, a short course of steroids can be used together with the cotrimoxazole. Prednisolone is used when the pA02 is less then 70 mmhg. may lead When using high doses of cotrimoxazole, the side effects may include: nausea, fever, rashes, which d to Steven-Johnson's syndrome, raised liver enzymes, bone marrow suppression, and hypernatremia.
  11. Follow –up Management Regular out-patient follow-up of HIV-infected patients is the key in providing good medical and health services. Follow-up management requires dedicated health care professionals who will provide continuity of care and link-up with other services that the patient requires. The concept of "holistic medicine" and "total care" should be provided to people with HIV and AIDS. Supportive counselling and medical care will help detect problems earlier. In the medical follow-up management of AIDS patients, it is useful to monitor the following: Clinical Weight gain General well-being Free from infections Laboratory Full Blood Count & ESR CD4+ cells A Karnofsky score chart
  12. Nursing Management Health education – The healthcare worker must: Know the patient Avoid fear tactics Avoid judgmental and moralistic messages Be consistent and concise Use positive statement Give practical advice Practice universal/standard precaution There is a need for a thorough medical handwashing after every contact with patient and after removing the gown and gloves, and before leaving the room of an AIDS suspect or known AIDS patient. Use of universal barrier or Personal Protective Equipment (PPE) e.g., cap, mask, gloves, CD gown, face shield/goggles are very necessary.
  13. Prevention Care should be taken to avoid accidental pricks from sharp instruments contaminated with potentially infectious materials form AIDS patient. Gloves should be worn when handling blood specimens and other body secretions as well as surfaces, materials and objects exposed to them. Blood and other specimens should be labelled with special warning “AIDS Precaution”. Blood spills should be cleaned immediately using common household disinfectants, like “chlorox”. Needles should not be bent after use, but should be disposed into a puncture-resistant container. Personal articles like razor or razor blades, toothbrush should not be shared with other members of the family. Razor blades may be disposed in the same manner as needles are disposed. Patients with active AIDS should be isolated. The Four Cs in the Management of HIV/AIDS Compliance – giving of information and counselling the client which results to the client’s successful treatment, prevention and recommendation. Counselling/education Giving instruction about the treatment Disseminating information about the disease Providing guidance on how to avoid contracting STD again Sharing facts about HIV and AIDS Contact tracing Tracing out and providing treatment or partners Condoms Promoting the use of condom, giving instructions about its use, and giving away available condoms
  14. Alternative Therapies in treatment of patients with HIV Many people use alternative (sometimes known as complementary) health treatments in addition to the medical care they get from their provider. These therapies are sometimes called "alternative" because they don't fit into the more mainstream, Western ways of looking at medicine and health care. They are called "complementary" therapies because usually they are used alongside the more standard medical care you receive (such as your VA provider visits and the anti-HIV drugs you might be taking). Some common complementary therapies include: Physical (body) therapies, such as yoga, massage, and acupuncture Relaxation techniques, such as meditation and visualization Herbal medicines (from plants) With most complementary therapies, your health is looked at from a holistic (or "whole picture") point of view. Think of your body as working as one big system. From a holistic viewpoint, everything you do--from what you eat to what you drink to how stressed you are--affects your health and well-being.
  15. Physical (body) therapies of these types of therapies. Yoga Yoga is a set of Physical, or body, therapies include such activities as yoga, massage, and aromatherapy. These types of therapies focus on using a person's body and senses to promote healing and well-being. Here you can learn about examples exercises that people use to improve their fitness, reduce stress, and increase flexibility. Yoga can involve breathing exercises, stretching and strengthening poses, and meditation Many people, including people with HIV, use yoga to reduce stress and to become more relaxed. Some people think that yoga helps make them healthier in general, because it can make a person's body stronger. There are many different types of yoga and various classes you can take. Before you begin any kind of exercise program, always talk with your health care provider. Massage Many people believe that massage therapy is an excellent way to deal with the stress and side effects that go along with having an illness, including HIV. During massage therapy, a trained therapist moves and rubs your body tissues (such as your muscles). There are many kinds of massage therapy. You can try massage therapy for reducing muscle and back pain, headaches, and soreness. Massages also can improve your blood flow (circulation) and reduce tension.
  16. Acupuncture Acupuncture is part of a whole healing system known as traditional Chinese medicine. During acupuncture treatment, tiny needles (about as wide as a hair) are inserted into certain areas of a person's body. Most people say that they don't feel any pain from the needles. Many people with HIV use acupuncture. Some people think that acupuncture can help treat symptoms of HIV and side effects from the medicine, like fatigue and nausea. Some people say that acupuncture can be used to help with neuropathy (body pain caused by nerve damage from HIV or the medicines used to treat HIV). Others report that acupuncture gives them more energy. If you are interested in trying it out, ask your VA provider to recommend an expert. At the end of this guide are links to websites where you can read more about the history of acupuncture and how it works. Aromatherapy Aromatherapy is based on the idea that certain smells can change the way you feel. The smells used in aromatherapy come from plant oils, and they can be inhaled (breathed in) or used in baths or massages. People use aromatherapy to help them deal with stress or to help with fatigue. For example, some people report that lavender oil calms them down and helps them sleep better. At the end of this guide are links to websites where you can learn more about aromatherapy. Please remember! The oils used in aromatherapy can be very strong and even harmful. Always talk with an expert before using these oils yourself.