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Nursing Review: Learn More About the 3 Stages of HIV Infection

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HIV (Human Immunodeficiency Virus), is a virus that strikes mainly the CD4 and T cells of the body. If left untreated, it will progress to acquired immunodeficiency syndrome (AIDS).

There is no cure for HIV. Once a person contracts the virus, he or she will carry it for life. Yet, if medicated, infected people will live longer lives and protect the people they love.

Quick Facts About HIV and AIDS

  • First reported to CDC in June 1981
  • Compromises the immune system’s fight against viral, bacterial, and parasitic infections
  • First seen in homosexual men
  • Groups at risk are:
    • Intravenous (IV) drug users
    • Hemophiliacs
    • Blood transfusion recipients
    • Sexual partners who are HIV positive
    • Infants of mothers who have HIV
  • The virus came from a chimpanzee found in Central Africa. Humans got infected when they touched the chimpanzee’s infected blood
  • The HIV virus attacks CD4 and T-cells

Signs and Symptoms

The infected person may develop flu-like symptoms within 2-4 weeks after exposure. This is also called acute HIV infection. Symptoms can be:

  • Chills
  • Fever
  • Rash
  • Muscle ache
  • Sore throat
  • Fatigue
  • Swollen lymph nodes
  • Night sweats
  • Mouth Ulcers

Stages of HIV

According to CDC, there are 3 stages of HIV disease progression. These are:

Stage 1 or Acute HIV infection

  • People are very contagious.
  • Some have symptoms like flu. This is the natural way your body reacts to the infection. Yet, for some, they don’t feel sick right away.
  • Antigen/antibody tests or nucleic acid tests (NATs) are the tests that can detect acute HIV.

Stage 2 Chronic HIV infection

  • Otherwise known as asymptomatic HIV infection, also called clinical latency.
  • HIV is active at this stage yet reproduction is at lower levels.
  • During this phase, people will not get sick or develop any symptoms yet.
  • This stage may last for a decade or more, but for some, it may progress faster if not properly treated.
  • Viral load (amount of HIV in the blood) goes up while the CD4 cell count is down. Later on, the person will have symptoms when the virus levels go up or increase in the body. They will progress to Stage 3.
  • If the person is taking HIV medicine, they will not progress to Stage 3.

Stage 3 or Acquired Immunodeficiency Syndrome (AIDS)

  • Also known as the severe stage of HIV.
  • People with AIDS will develop opportunistic infections due to their damaged immune system.
  • CD4 cell count drops below 200 cells/mm.
  • People in this stage are very infectious and with high viral load.
  • Patients may survive for three years without HIV medications.

Mode of Transmission

  • Anal or vaginal sex
  • Sharing of needles or syringes
  • Drug injection equipment (cookers)

Diagnosis

The CDC recommends people between age 13 and 64 to get an HIV test at least once. Here are the approved tests:

  • NAT (nucleic acid test): blood specimen is taken from the patient (blood drawn from the veins). This can detect HIV infection 10 to 33 days after getting exposed.
  • Antigen/antibody test: blood is taken from the patient through a vein or needle prick. It looks for both antibodies and antigens. The laboratory technicians will look for antigen p24 if it is present. This is produced in the body when a patient has HIV. The patient will get the result in 30 minutes or less. This test can detect HIV within 18 to 45 days after exposure when blood is taken from the vein. If by a needle prick, the detection will take longer about 18 to 90 days after exposure.
  • Antibody tests: Test is done through blood drawn from a vein or from a needle prick or through body fluids such as saliva. This can detect HIV infection in 23 to 90 days after exposure.

Self-tests

  • Rapid Self-test
  • Mail-in Self Test

Test Results

  • Negative test: This means that the patient has no HIV. Only in these conditions, the patient has no exposure to any HIV-infected blood or body fluid. 
  • Positive test: A test came in positive. Before confirming, there is a confirmatory test done in the laboratory. Start HIV treatment right away so it won’t progress to AIDS.

Treatment

  • HAART (active antiretroviral therapy): Medication regimen used to treat HIV-1. This includes a combination of 3 antiretroviral drugs that reduce the levels of RNA. Also known as combination antiretroviral therapy (cART) or antiretroviral therapy (ART). These drug categories are:
    • Nucleoside/nucleotide reverse transcript inhibitors (NRTIs)
    • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
    • Protease inhibitors (PIs)
    • Integrase strand transfer inhibitors (INSTIs)
    • Fusion inhibitors (FIs)
    • Chemokine receptor antagonists (CCR5 Antagonists)
  • Pre-exposure chemoprophylaxis: daily intake of antiretroviral medications to protect high-risk individuals from HIV. This is only effective in HIV. But, doesn’t give protection from other STI (sexually transmitted infections).

Fixed-dose of tenofovir (300 mg) and emtricitabine (200 mg) is the approved dose by CDC.

Antiretroviral therapy is always done with combination regimens.

Things to consider when taking antiretroviral therapy:

  • Avoid Elvitegravir-cobicistat/Tenofovir Fumarate/Emtricitabine and Elvitegravir-cobicistat/Tenofovir Alafenamide/Emtricitabine in patients with CKD (chronic kidney disease).   
  • Avoid regimens containing Tenofovir Fumarate for patients with osteoporosis.
  • Avoid Efavirenz for patients who have HIV dementia and psychiatric illness.
  • Patients with high cardiac risk should avoid Dolutegravir.
  • The medications that can worsen dyslipidemia are:
    • Dolutegravir
    • Efavirenz
    • Elvitegravir/cobicistat
    • Protease inhibitors

Nursing Interventions

  • Educate the patient about the process of taking HIV tests. The tests protocols may vary in any state.
  • Inform the patient about the window period of HIV and how it could affect the result. The patient should not engage in risky behaviors while waiting for the result. It could give them false-negative results if they did otherwise.
  • Assess the patient’s ability to ingest food and nutritional needs. Most patients may have lesions on the mouth, esophagus, and throat. This may be due to STI. Others may experience a metallic taste often from medications.
  • Educate the patient about the drug and its effect when taken.
  • Inform the patient about the different ways HIV is being transmitted.
  • Check patient’s side effects if they are taking combined medication and therapy. For example, patients taking HIV medications and TB medication. The nurse may need to track the patient’s blood tests.
  • Inform the patient about the waste handling procedures. Having waste handling procedures standardized provides healthcare workers protection in the job. To add, this may also avoid setting stigma on other patients that may be the cause of depression.
  • Educate the patient who is at high risk of transmission to take precautions.
  • Check for signs of depression, such as anxiety, loss of appetite and not engaging with others.