Human Immunodeficiency Virus (HIV) is a type of retrovirus that causes immunosuppression. Acquired Immunodeficiency Syndrome (AIDS) is considered late stage HIV when the body is severely damaged by HIV. There currently is no cure for HIV, but medication can help patients live a healthy life with a normal life expectancy.
HIV can be transmitted through sexual intercourse with an infected partner, needle-sharing, and to an infant during pregnancy, childbirth, or breastfeeding. HIV cannot be transmitted casually through a handshake, sharing utensils, kissing, or hugging.
The viral load is the amount of copies of the virus that are detectable in the blood. Antiretroviral therapy (ART) can keep the viral load very low, even undetectable, which prevents the virus from being transmitted.
HIV infection occurs in the following stages:
- Acute HIV Infection – 2-4 weeks after the initial infection the patient may develop a flu-like illness as the body attempts to fight off the virus. Symptoms include inflamed lymph nodes, fever, sore throat, malaise, muscle pain, diarrhea, rash, and night sweats.
- Chronic HIV Infection – This phase can last 10-15 years from the initial HIV infection. During this time, patients with HIV are often asymptomatic and may still infect others, especially if they continue high-risk behaviors without the knowledge that they are currently infected with HIV. If taking ART, the patient may remain in this stage for decades. If HIV is left untreated, it will advance to AIDS.
- AIDS – This is the phase when the patient’s immune system becomes severely compromised and they cannot fight off opportunistic infections. Their viral load is very high and they can easily transmit the virus to others. Patients in this stage will only survive a few years.
HIV infection is diagnosed through testing for HIV antigens or antibodies via the blood or saliva. For monitoring HIV progression, laboratory tests like CD4 cell count and viral load are performed routinely.
The Nursing Process
Interprofessional management for patients with HIV infection focuses on monitoring the immune function and disease progression, prevention, detection, and treatment of opportunistic illnesses, management of symptoms of the infection, prevention of complications, and prevention of HIV transmission to other people. These goals can only be achieved through ongoing assessment, consistent patient interaction, and patient education and support. Nurses take part in all of these aspects of patient care.
Antiretroviral therapy (ART) are medications prescribed for HIV infection to decrease the viral load, maintain CD4 cell counts at acceptable levels, prevent HIV-related symptoms, delay the progression of the disease, and prevent transmission of the infection. Nurses are instrumental in educating patients about their medication regimen including side effects and strict adherence.
Nursing Care Plans Related to HIV Infection
Imbalanced Nutrition: Less Than Body Requirements Care Plan
HIV infection affects the body’s ability to effectively absorb nutrients due to various infections. Malabsorption, altered metabolism, and weight loss caused by loss of appetite and mouth ulcers are common in patients with HIV infection.
Nursing Diagnosis: Imbalanced Nutrition
- Altered taste perception
- Depressive symptoms
- Difficulty swallowing
- Food aversion
- Inability to absorb nutrients
- Inability to digest food
- Insufficient dietary intake
As evidenced by:
- Body weight below ideal weight range for age and gender
- Mouth sores/ulcers
- Food intake less than recommended daily allowance (RDA)
- Muscle hypotonia
- Poor dentition
- The patient will consume an ideal amount of calories for height/weight and activity level
- The patient will report increased appetite and interest in food
Imbalanced Nutrition: Less Than Body Requirements Assessment
1. Assess the patient’s potential barriers to eating.
HIV patients often develop lesions in the mouth and throat caused by infections like candidiasis, limiting the patient’s ability to chew, swallow and ingest food.
2. Determine previous weight before HIV diagnosis.
Early wasting in patients with HIV cannot be determined by normal weight-to-height charts. It is vital to determine the pre-diagnosis weight and current weight to determine muscle wasting and assess nutritional needs.
Imbalanced Nutrition: Less Than Body Requirements Interventions
1. Educate the patient about the side effects of the current medication regimen.
Drug therapy for HIV often causes altered taste, anorexia, nausea, and vomiting.
2. Provide an environment conducive to eating.
Ensure uninterrupted mealtimes, provide small frequent meals and snacks, and remove noxious odors to help improve appetite and promote nutritional intake.
3. Encourage oral hygiene.
Patients with HIV infection often develop mouth sores, disrupting the patient’s ability to eat. Good oral hygiene can enhance appetite and promote a desire to eat.
4. Administer medications as indicated.
Antiemetics administered before meals can help reduce nausea and vomiting and promote appetite. Appetite stimulants may also be prescribed to enhance appetite.
5. Consult with a dietitian.
Collaborating with a dietitian ensures the formulation of a nutritionally balanced diet that prevents nutrient deficiencies in patients with HIV.
Disturbed Body Image Care Plan
Patients diagnosed with HIV infection often develop anxiety disorders, depression, and low self-esteem. Disturbed body image is often associated with poor self-care behaviors, poor ART adherence, and risky behaviors.
Nursing Diagnosis: Disturbed Body Image
- Altered body function
- Altered self-perception
- Distrust of body function
- Fear of disease progression
- Low self-efficacy
- Low self-esteem
- Cultural or religious beliefs
As evidenced by:
- Altered social involvement
- Loss of interest in activities
- Expresses concerns about sexuality
- Expresses fear of rejection by others
- Preoccupation with past strengths and functions
- Preoccupation with changes/loss
- Perceptions that reflect an altered view of appearance
- Nonadherence to treatment
- The patient will demonstrate acceptance of body changes by adhering to their medication and treatment plan
- The patient will verbalize acceptance of their progressive disease
Disturbed Body Image Assessment
1. Assess factors that contribute to perceptions of disturbed body image.
Meticulous assessment of factors and psychological issues can help identify patients who are at risk for developing disturbed body image due to a permanent condition.
2. Observe the patient’s description of self.
Listen to the patient talk about their body and self and observe for positive and negative comments and how they believe others perceive them.
Disturbed Body Image Interventions
1. Allow the patient to express emotions and feelings.
Expression of feelings and emotions relieves anxiety and reduces depressive behavior. It also helps nurses better understand what the patient is going through.
2. Provide education and support.
Patients with HIV infection often feel rejected or stigmatized by society. Provide support to the patient about their disease and educate them that patients can live normal lives with treatment.
3. Interact as you would with any other patient.
Patients can sense if a healthcare provider is judgmental or stereotyping them. Patients with HIV deserve the same care and interaction as all patients. Contact with a patient with HIV does not require anything beyond standard precautions and the nurse must educate themselves if they recognize feelings of assumption or prejudice.
4. Encourage support groups.
Social support is important in learning to live with HIV. Encourage the patient to interact with others who are HIV positive by joining online groups and community programs to gain confidence and recognize their diagnosis does not define them.
Risk for Infection Care Plan
HIV infection causes immunosuppression, placing patients at risk for illness. Opportunistic infections such as pneumonia can be life-threatening in patients with HIV/AIDS.
Nursing Diagnosis: Risk for Infection
- Chronic illness
- Disease process
- Insufficient knowledge to avoid exposure to pathogens
- Nonadherence to ART
- Low CD4 count
- High viral load
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet and nursing interventions are directed at the prevention of symptoms.
- The patient will remain free of symptoms of infection and demonstrate appropriate behaviors that reduce the risk of infection
- The patient will maintain a CD4 count above 500 cells/mm3 and an undetectable viral load
Risk for Infection Assessment
1. Assess for signs of infection.
Signs of infection with HIV include fever, rashes, swollen lymph nodes, weight loss, and fatigue.
2. Monitor viral load and CD4 count.
The viral load measures the amount of HIV cells in the blood. Over 200 copies/mL is a high viral load and signals HIV progression. CD4 cells are a type of white blood cell. Levels above 500 cells/mm3 are normal. A CD4 count below 200 cells/mm3 is a diagnosis of AIDS.
Risk for Infection Interventions
1. Perform hand washing before and after care of the patient.
Handwashing reduces the risk of introducing bacteria to the patient. Instruct the patient and family members to wash their hands as indicated.
2. Screen visitors and primary caregivers for signs of infection.
This helps reduce the possibility of nosocomial infection. Family members who are sick should not interact with the patient.
3. Administer medications as indicated.
Adhering to antiretroviral drug therapy can help reduce the risk of infection in patients diagnosed with HIV. Educate patients about the importance of adhering to their treatment regimen. Some over-the-counter drugs and herbal remedies have significant interactions with ART drugs and should be taken with caution.
4. Educate about routine testing
Patients with HIV require viral load testing with medication changes. Once they reach an undetectable viral load, testing will be less frequent.
5. Maintain a relationship with the HIV treatment team.
It is very important patients adhere to routine infectious disease appointments. Patients with HIV may have a team of providers including chronic disease nurses, physicians, social workers, and mental health professionals that help them navigate their disease.
References and Sources
- About HIV. Centers for Disease Control and Prevention. Page last reviewed: June 30, 2022. From: https://www.cdc.gov/hiv/basics/whatishiv.html
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- HIV/AIDS. Mayo Clinic. Updated: July 29, 2022. From: https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524
- Role of nutrition in HIV infection: a review of the evidence for more effective programming in resource-limited settings. Food and nutrition bulletin, 31(4), S313–S344. de Pee, S., & Semba, R. D. (2010). From: https://pubmed.ncbi.nlm.nih.gov/21214036/
- Overview HIV and AIDS. NHS. Page last reviewed: 22 April 2021. From: https://www.nhs.uk/conditions/hiv-and-aids/
- What Are HIV and AIDS? HIV.gov Updated: June 15, 202. From: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids