Human immunodeficiency virus (HIV) is a
retrovirus that is transmitted through blood and
body fluids (semen, vaginal secretions).
HIV targets CD4+ lymphocytes, also known
as T‑cells or T‑lymphocytes. T‑cells work in
concert with B‑lymphocytes. Both are part
of specific acquired (adaptive) immunity. HIV
integrates its RNA into host cell DNA through
reverse transcriptase, reshaping the host’s
HIV is found in feces, urine, tears, saliva,
cerebrospinal fluid, cervical cells, lymph nodes,
corneal tissue, and brain
tissue, but epidemiologic
studies indicate that these are
unlikely sources of infection.
All clients who are pregnant
are screened for HIV.
Disease Process Stages
HIV infection is one continuous
disease process with
Progression of HIV infection
Manifestations occur within 2 to
4 weeks of infection.
Manifestations are similar
to those of influenza and can
include a rash, night sweats, and
a sore throat.
This stage is marked by a
rapid rise in the HIV viral load,
decreased CD4+ cells, and
increased CD8 cells.
The resolution of manifestations
coincides with the decline in viral
throughout the disease process.
Chronic asymptomatic infection
This stage can be prolonged and asymptomatic.
The client can remain asymptomatic for 10 years or
more, but can develop generalized lymphadenopathy.
Anti‑HIV antibodies are produced (HIV positive).
Over time, the virus begins active replication using the
host’s genetic machinery.
CD4+ cells are destroyed.
The viral load increases.
Dramatic loss of immunity begins.
This stage is characterized by life‑threatening
This is the end stage of HIV infection. Without
treatment, death occurs within 5 years.
All people with AIDS have HIV, but not all people who have HIV have AIDS.
Health Promotion and Disease Prevention
The virus is transmitted through blood and body fluids.
Ways to prevent infection include the use of condoms,
abstinence, and avoiding sharing needles.
Maintain up‑to‑date immunizations, including
yearly seasonal influenza and pneumococcal
Providers should use standard precautions when caring
for the client.
Unprotected sex (vaginal, anal, oral)
Multiple sex partners
Occupational exposure (health care workers)
Blood transfusions (not a significant source of infection
in the U.S.)
IV drug use with a contaminated needle
Older adult clients
HIV infection can go undiagnosed in older adult clients
due to the similarity of its manifestations to other
illnesses that are common in this age group.
Older adults are more susceptible to fluid and electrolyte
imbalances, malnutrition, skin alterations, and wasting
syndrome than younger adults.
Older adult women experience vaginal dryness
and thinning of the vaginal wall, increasing their
susceptibility to HIV infection.
Anorexia, nausea, weight loss
Weakness and fatigue
Headache and sore throat
CBC and differential: Abnormal (anemia,
Platelet count: Less than 150,000/mm3
Positive result from an HIV antibody screening test
(enzyme‑linked immunosorbent assay [ELISA])
confirmed by a positive result from a supplemental
HIV antibody test (Western blot or indirect
immunofluorescence assay [IFA])
Home test kits are also available using a drop of blood.
These provide anonymous registration and counseling
before the test via a telephone call.
Two noninvasive tests are available using either
mucosal fluid or urine.
Client who has a positive result from a confirmatory
test, such as Western blot, should then be tested for
HIV RNA quantification (HIV viral load test)
Determines viral load before beginning treatment
Can be repeated at intervals to monitor disease
progression, identify compliance with treatment and
determine HIV medication resistance
Treatment is needed for levels greater than 5,000 to
10,000 copies/mL depending on CD4 counts.
HIV drug resistance testing (HIV genotype or HIV tropism)
Guides changes in medication therapy when
Useful with CD4 counts fall despite therapy
Liver profile, biopsies, and testing of stool for parasites
Prepare the client for the test.
Inform the client about the details of the test (length,
what to expect).
Allow the client time to ask questions or
A positive Western blot or IFA test means the AIDS
virus is in the body but does not mean the client has
Use safe sexual practices.
Brain or lung MRI or CT scan
Detailed image of the brain or lung to detect abnormalities
Prepare the client for the procedure.
The test takes up to 1 hour.
CD4+ cell count
Used to confirm progression from HIV infection to AIDS.
The expected reference range for the CD4+ count is
800 to 1,200 mm3. A CD4+ count less than 200/mm3
or a percentage of CD4 lymphocytes less than 14%
Collect data on risk factors (sexual practices,
IV drug use).
Monitor fluid intake/urinary output.
Obtain daily weights to monitor weight loss.
Monitor nutritional intake.
Monitor skin integrity (rashes, open areas, bruising).
Monitor pain status.
Monitor vital signs (especially temperature).
Check lung sounds/respiratory status (diminished
Check neurological status (confusion, dementia,
Encourage activity alternated with rest periods.
Administer supplemental oxygen as needed.
Provide analgesia as needed.
Provide skin care as needed.
Reinforce client teaching.
Transmission, infection control measures, and safe
Importance of maintaining a well‑balanced diet
Self‑administration of prescribed medications and
potential adverse effects
Findings that need to be reported immediately
Assist the client with identifying primary
Highly active antiretroviral therapy involves using
three to four HIV medications in combination with
other antiretroviral medications to reduce medication
resistance, adverse effects, and dosages.
Fusion inhibitors: Enfuvirtide blocks the fusion of HIV
with the host cell
Entry inhibitors: Maraviroc
Nucleoside reverse transcriptase inhibitors: Zidovudine interferes with the virus’s ability to convert RNA into DNA.
Non‑nucleoside reverse transcriptase inhibitors: Delavirdine and efavirenz inhibit viral replication in cells.
Protease inhibitors: Atazanavir, nelfinavir, saquinavir,
and indinavir inhibit an enzyme needed for the virus
Integrase inhibitors: Raltegravir
Antineoplastic medication: Interleukin is an
immunostimulant that enhances the immune response
and reduces the production of cancer cells (used
commonly with Kaposi’s sarcoma).
Monitor laboratory results (CBC, WBC, liver function
tests). Antiretroviral medications can increase alanine
aminotransferase, aspartate aminotransferase,
bilirubin, mean corpuscular volume, high‑density
lipoproteins, total cholesterol, and triglycerides.
Monitor total CD4+ T lymphocyte count, CD4 percentage,
and ratio of CD4 to CD8 cells.
Normal CD4‑to‑CD8 ratio is 2. A ratio less
than 1 indicates more severe disease manifestations
Low CD4 T lymphocyte counts and steadily decreasing
counts indicate poor prognosis or medication
Reinforce teaching to the client about the adverse effects
of the medications and ways to decrease the severity of
Take medications on a regular
schedule and do not miss doses. Missed medication doses
can cause medication resistance.
Infectious disease services can manage HIV.
Respiratory services can improve respiratory status and
provide portable oxygen.
Nutritional services can be consulted for dietary
supplementation. Food services are indicated for clients
who are homebound and need meals prepared.
Rehabilitation services can be consulted for
strengthening and improving the client’s level
Refer the client to local AIDS support groups as
Home health service are indicated for clients who need
help with strengthening and assistance regarding
ADLs. Home health services can also provide assistance
with IVs, dressing changes, and total parenteral
Long‑term care facilities can be indicated for clients
who have chronic HIV.
Hospice services are usually indicated for clients who
have a late stage of HIV.
Vitamins, herbal products, and shark cartilage can
help alleviate manifestations of HIV. Ask if the client
is taking herbal products. These can alter the effects of
Practice good hygiene (including frequent hand hygiene)
to reduce the risk of infection.
Avoid crowded areas or traveling to countries with
Avoid raw foods (fruits, vegetables) and undercooked
foods (meat, fish, eggs).
Avoid cleaning pet litter boxes to reduce the risk
Keep the home environment clean and avoid being
exposed to family and friends who have colds or
Wash dishes in hot water using a dishwasher
Bathe daily using antimicrobial soap.
Adhere to the antiretroviral dosing schedules.
Frequent follow‑up monitoring of CD4+ and viral load
counts is needed.
Use constructive coping mechanisms.
Report manifestations of infection immediately to
Bacterial diseases, such as tuberculosis, bacterial
pneumonia, and septicemia (blood poisoning)
HIV‑associated malignancies, such as Kaposi’s
sarcoma, lymphoma, and squamous cell carcinoma
Viral diseases, such as those caused by
cytomegalovirus, herpes simplex, and herpes
Fungal diseases, such as Pneumocystis jirovecii
pneumonia (PCP), candidiasis, cryptococcosis, and
Protozoal diseases, such as PCP, toxoplasmosis,
microsporidiosis, cryptosporidiosis, isosporiasis,
Implement and maintain antiretroviral
Administer antineoplastics, antibiotics, analgesics,
antifungals, and antidiarrheals.
Administer appetite stimulants (to enhance nutrition).
Monitor for skin breakdown.
Maintain fluid intake.
Report indications of infection
immediately to the provider.
Maintain nutrition orally or by TPN.
Monitor weight, calorie counts, and I&O.
Provide between‑meal supplements/snacks.
Decrease fat content of foods to prevent complications
of fat intolerance.
Rinse the client’s mouth several times daily with saline
or sodium bicarbonate and sterile water to reduce mouth
pain and increase appetite.
Serve at least six small feedings with high protein
value per day.
Monitor fluid/electrolyte status.
Report abnormal laboratory data promptly.
Encourage the client to drink 2,000 to 3,000 mL
Make dietary adjustments to reduce diarrhea.
Seizures (HIV encephalopathy)
Maintain client safety.
Implement seizure precautions.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, Sexual Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention August 3, 2017