a. End result of infection with a retrovirus—the human
immunodeficiency virus (HIV)
b. Progression from HIV infection to AIDS is highly variable:
It may take weeks to years, with median rate of 9 to
11 years after infection in the absence of antiretroviral
therapy (United Nations Programme on HIV/AIDS
[UNAIDS] & World Health Organization [WHO], 2007).
c. Defined by the Centers for Disease Control and Prevention
(CDC) as presence of HIV infection with at least one other
i. CD4 T-cell count below 200 cells/μl
ii. CD4 T-cell percentage of total lymphocytes at less than
iii. Presence of opportunistic infection (OIs) or AIDSdefining
a. Primary HIV infection: unprotected sex, anal intercourse,
contaminated blood products, occupational exposure
b. OIs are major contributors to morbidity and mortality in the
HIV-infected client (Powderly, 1999)—undiagnosed HIV,
CD4 T-cell count below 200 cells/μl, not taking antiretrovirals,
drug resistance or failure of antiretroviral therapy
i. Infecting microbes: candidiasis, coccidioidomycosis,
cryptococcosis, cryptosporidiosis, cytomegalovirus (CMV),
herpes simplex, histoplasmosis, isosporiasis, mycobacterium,
Pneumocystis jiroveci (Pneumocystis carinii pneumonia
[PCP]), polyomavirus JC (causes progressive multifocal
leukoencephalopathy), salmonella, toxoplasmosis
ii. Other AIDS-defining illnesses: HIV-related encephalopathy,
Kaposi’s sarcoma (KS), invasive cervical cancer,
Burkitt’s lymphoma, wasting syndrome due to HIV
III. Statistics (CDC, 2007)
a. Morbidity: As of 2005, an estimated 984,155 individuals
had been diagnosed with AIDS, with 433,760 living with
AIDS in the United States.
b. Mortality: In 2005, 17,011 deaths resulted from AIDS in
the United States, and there have been more than 550,394
deaths since it was first diagnosed.
c. Cost: Yearly healthcare costs average $34,000 per individual
with an AIDS diagnosis, with approximately $24,000
going toward antiretroviral therapy (Saag, 2002).
The interventions listed here are appropriate for community
care as well as an inpatient or hospice setting. Most of the
signs and symptoms and psychosocial issues happen long
before inpatient care, which currently, is usually of very
Fluid and electrolyte imbalances
The HIV-positive client
Psychosocial aspects of care
Total nutritional support: parenteral/enteral feeding
Upper gastrointestinal/esophageal bleeding
Ventilatory assistance (mechanical)
1. Prevent or minimize development of new infections.
2. Maintain homeostasis.
3. Promote comfort.
4. Support psychosocial adjustment.
5. Provide information about disease process, prognosis,
and treatment needs.
1 Infection prevented or resolved.
2. Complications prevented or minimized.
3. Pain and discomfort alleviated or controlled.
4. Dealing with current situation realistically.
5. Diagnosis, prognosis, and therapeutic regimen understood.
6. Plan in place to meet ongoing needs.