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HIV and AIDS Etiology and Management

Introduction

HIV and AIDS are two different disease processes that are related but occur at different stages. HIV is short for Human Immunodeficiency Virus. This virus infects the human immune system and may cause adverse damage over time. This virus, unlike viruses that cause flu and the common cold, never goes away. Once infected, one will always be HIV positive. HIV infections destroy the white blood cells and render a human being vulnerable to infections and cancers.

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AIDS, on the other hand, is short for Acquired Immunodeficiency Syndrome. A person is said to have AIDS when the count of white blood cells (CD4) is lower than 200. Healthy individuals have a CD4 count of 600 to 1200. AIDS occurs after the individual’s immune system has been greatly weakened by HIV (Cheung, Pantanowitz, & Dezube, 2005). AIDS may be thought of as an advanced stage of HIV infection. Once a person is said to have AIDS, no amount of increase in CD4 count would change this definition. The person will always be said to have AIDS.

HIV

Pathophysiology

Upon exposure, HIV becomes attached to the host T-cell where it can penetrate. When it is attached, the RNA of the virus is released into the host. Viral replications then occur. This produces proviral DNA. However, the process by which they are replicated (reverse transcriptase) is prone to errors. Therefore, this causes frequent mutations that lead to the generation of HIV. HIV is resistant to the processes of the human immune system. They may also resist antiretroviral drugs. The proviral DNA finds its way into the nucleus of the body cells where it integrates into the DNA of the cells. This process is referred to as HIV integrase. Therefore, the alien DNA duplicates during each cell division. The alien DNA is then transcribed and translated. Finally, an enzyme is released to cause the virus to mature.

Clinical Manifestation

During the initial stages, an HIV-infected person may not show any noticeable symptoms. On other occasions, the symptoms may not be very specific. However, the acute retroviral syndrome may start within the first four weeks of infections. The symptoms may include fever, rash, aseptic meningitis, arthralgia, and malaise. These symptoms may be mistaken for other diseases. When these initial symptoms disappear, an individual may go for several years (2-15) without showing any symptoms or with only mild ones. The symptoms of this disease may result from two sources. These include the HIV infection itself and the opportunistic diseases. They may include the following:

  1. White blemishes in the mouth
  2. Swollen lymph glands
  3. Persistent diarrhoea
  4. Exhaustion
  5. Painful rashes
  6. Fever (sweating)

Nursing or Medical Management

Treatment of HIV may require combining several antiretroviral drugs. Sometimes, prophylaxis is required especially when opportunistic infections are detected. Research indicates that adequate antiretroviral therapy may increase morbidity (Cheung, Pantanowitz, & Dezube, 2005). Therefore, it is not recommended for everyone. A combination of antiretroviral drugs is usually used to reduce the level of plasma HIV RNA. It also restores the CD4 count. When the CD4 count increases, the chances of acquiring opportunistic infections are lowered. This restoration of the immune system may also cause a significant improvement in the health of the critically ill.

The highly active antiretroviral therapy (HAART) is important since it significantly suppresses viral replication (Maschke, Kastrup, Esser, Ross, Hengge, & Hufnagel, 2000). A patient requires taking medication faithfully to reduce the replication as much as possible. These levels may reduce to undetectable ones. Therefore, this may lead to partial suppression, which may give opportunity for HIV mutation and cause resistance to subsequent treatments.

Prognosis

An HIV-positive individual whose CD4 count is still within the normal range is not considered to have AIDS. However, there is the risk of getting AIDS or dying if the CD4 count goes below the healthy level. This risk is predicted by both the white blood cells count and the HIV RNA level. When the viral load increases, mortality increases. HIV-related death occurs when the CD4 count goes below 50.

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At this point, however, it is possible to reduce the risks of death or illness through decreasing HIV RNA levels using medication. Some individuals with high CD4 count and low HIV levels in the body show no symptoms at all. Their immune system may be responding effectively to the HIV strain. However, when such individuals acquire a second train of HIV, their immune system is challenged. Subsequent strains of HIV are acquired when one has unsafe sex or shares needles with the infected. Therefore, HIV-infected individuals should be counselled to avoid this.

AIDS

Pathophysiology

AIDS occurs when the HIV infection goes through several stages. Therefore, these stages are related to those of HIV infection. During the first six weeks of infection, seroconversion illness is experienced. At this stage, the individual feels as if he has a bout of flu. The HIV level is usually low and it replicates slowly. Since the CD4 and CD8 levels are normal at this stage, no symptoms are seen. The next stage is characterized by persistent generalised lymphadenopathy (PGL). This is whereby the infected person’s lymph nodes appear swollen for about 3 months. The cause of the swelling is usually nothing other than the HIV infection.

The next stage is characterised by symptomatic infections. This is whereby infections are manifested and opportunistic infections may occur. This is referred to as the AIDS-related complex. This is also considered a precursor of AIDS. The last stage is where an individual is said to have AIDS. This is whereby there is severe immunodeficiency. This stage is characterised by a CD4 count of less than 200 and life-threatening infections and tumours may occur at this stage.

Clinical Manifestation

The clinical manifestation of AIDS is mainly due to the deteriorated immune system and the decline in CD4 count, which is vital for fighting bodily infections (Umberto, Gaidano, Emaneula, Silvia, & Antonino, 2000). When one is infected by HIV, the body cells start to be destroyed. Some of the clinical manifestations (some of them similar to those of HIV infection) include the following:

  1. Rapid weight loss
  2. Pneumonia
  3. Dry cough
  4. Persistent diarrhoea (usually more than a week)
  5. Recurring fever (one may sweat a lot at night)
  6. Swelling of the lymph glands in the neck, armpit region or groin
  7. Reddish or brownish blotches under the skin or on soft skin (eyelids, mouth)
  8. Spots inside the mouth or tongue

Due to the low immune system, opportunistic infections are almost certain to occur. The organisms that usually do not cause disease in healthy individuals would greatly affect such victims. The symptoms of these opportunistic infections include fever, extreme fatigue, difficulty swallowing, coma, shortness of breath, nausea, seizures and lack of coordination, impaired vision, severe headaches, persistent diarrhoea and various mental symptoms.

Nursing or medical management

Management of AIDS usually involves fighting the HIV in the body and some of its complications. However, there is no cure for AIDS. Therefore, there are several approved drugs (such as anti-retroviral drugs) for the treatment of HIV and AIDS. Victims are required to take the medication as prescribed by a doctor to live healthy lives.

Prognosis

With advancements in the medical field, prospects of recovery have greatly improved. However, its success depends on the availability of drugs and specialists in the field. Individuals who adhere to medication live longer and healthier lives. Those who begin treating it at an early stage improve their prognosis. Similar to HIV infections, HAART has also been determined to greatly improve prognoses (Cheung, Pantanowitz, & Dezube, 2005). However, lack of adherence may lead to death within a relatively short time.

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Conclusion

HIV and AIDS are two different disease processes that show similarities and differences when it comes to Pathophysiology, clinical manifestation, treatment and prognosis. HIV infects the immune system and starts to destroy it. When HIV is not properly managed, it destroys the white blood cells and reduces the CD4 count. When this number goes below 200, the individual is said to have AIDS. Both of these disease processes require proper management to achieve success. This could be achieved through adopting the highly active antiretroviral therapy (HAART).

References

Cheung, M., Pantanowitz, L., & Dezube, B. (2005). AIDS-related malignancies: Emerging Challenges in the Era of highly active antiretroviral therapy. The Oncologist, 10(6), 412-426.

Maschke, M., Kastrup, O., Esser, S., Ross, B., Hengge, U., & Hufnagel, A. (2000). Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry, 69(1), 376-380.

Umberto, T., Gaidano, G., Emaneula, V., Silvia, F., & Antonino, C. (2000). Epidemiological, biological and clinical features of HIV-related lymphomas in the era of highly active antiretroviral therapy. AIDS, 14(12), 1675-1688.

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