AIDS/ HIV


AIDS ( Acquired Immune Deficiency Syndrome):

Initially named GRID ( Gay Related Immune deficiency) is an STD caused by HIV ( Human immuno deficiency virus) which is a ssRNA containing  retrovirus of lengtivirus ( slow acting virus) group having 2 similar strands of RNA genomes and hence diploid. To each molecule ( strand) of RNA, a reverse transcriptase enzyme ( RNA  dependent  DNA polymerase) is associated . Thus HIV  has 2  identical molecules of ss linear RNA and 2 molecules of reverse transcriptse.The protein coat ( capsid) is surrounded by  a lipid __ glycoprotein envelope .The capsid and envelope both are two layered. Envelope bears a coat containing  spikes of glycoproteins to recognise receptor site on host cell. This lipoprotein coat is  derived from first host cell. The size of HIV is 0.14 ųm ( 140 nm). The RNA has ( +) polarity and consists of only 9 genes. This virus belongs to lentivirus ( slow) group of retroviridae family. It is most mutable virus. Its RNA dependent DNA polymerase make error prone proteins of capsid show cubical symmetry. This virus shows  pinocytic reproduction in which the whole of virus except envelope, enters the host cell.

     It parasitizes on CD4  receptor site of helper T4  lymphocytes of the host so  that number of  T4   cells decreases and sufficient antibodies are not formed and human  immune  system is failed. The body becomes  susceptible to various infections  like kaposisarcoma, some type of pneumonia and TB. The AIDS patient dies due to these infections and not due to AIDS. AIDS is transmitted  by contaminated blood transfusion,  sexual contact, infected mother  of child during pregnancy  or through breast  feeding / sharing contaminated  needles / syringes/ shaving razors; organ transplantation,  artificial  contaminated insemination, denture  etc.


 AIDS is an acquired immune disorder of cell mediated immune system ( CMIS)  of body. AIDS is a global epidemic  HIV virus of AIDS was first reported  in african green monkey of Zaire and  was isolated  by Luc Montagnier et al in 1983 in France and later by Robert Gallo el al in USA in 1984. First AIDS patient  was recognised  in Hatai, USA in 1981 among a group of young homosexuals who were addicts of  heroin and other narcotics .AIDS virus is known by various  names but since 1986, it is HIV ( Human Immuno  Deficiency  Virus). The other names are HCLV III ( Human cell leukemia  virus) in USA; ARV ( Aids associated  retrovirus); LAV ( Lymphadenopathy associated  virus) in France; HTVL III ( Human  T Cell Lymphotrophic Virus). HIV is of 2 types __ HIV_ 1 and HIV__ 2. HIV _ 1 is predominant  and more dangerous. 


   Incubation period is 1__ 14 years  ( average  upto 6 years); latent period is about 5 years; a victim of full blow AIDS dies within 3 years after infection. Infection  with HIV ( HIV+ve)   does not necessarily  results  in AIDS. AIDS in India is maximum  in Tamil Nadu, Maharashtra Manipur, followed by Delhi and among cities, it is Mumbai. AIDS is not prevalent in Arunachal, Andaman, Dadar Nagar Haveli  Lakshadweep, Tripure and Chandigarh.It is more ( 79%) in males than females ( 21%). AIDS is not a contagious  disease.It is not transmitted by hugging taking, sneezing, hand shaking, kissing , through sharing food, utensils towels, bedding, swimming pool, mosquito bite because

(i) Infected people do not have constantly high level of HIV in their blood.

(ii) Mouth parts of insects retain only very small amount of blood  on their surface. 

(iii) Mosquito  after bite donot travel from one person to the next immediately  after taking blood but fly to a resting place to digest the blood meal.

Definition:

AIDS  ( Acquired Immune _ deficiency Syndrome) is a fatal illness. It is caused by  a virus known as human immunodeficiency virus ( HIV) .Once infected, it is probably  that a person will be  infected for life. AIDS breaks down the body's immune  system exposing the individual  to numerous life_ threatening infections, neurological disorders and malignancies. 

What is AIDS ?

It is a disorder  of cell mediated immune system of the body. There is a reduction in the number of helper T cells which stimulate antibody production by B__cells.This results in the loss of natural  defence against viral infection. 

Discovery:

AIDS was first noticed in USA amongst  homosexuals in 1981. Virus of AIDS was isolated  and identified  by Prof Luc Montagnier in France in 1983 and in 1984 by Prof Robert Gallo in USA .The virus of AIDS was officially named Human Immuno deficiency virus (( HIV) in 1986 by the International  Committee  on Viral  Nomenclature. AIDS infections  were detected  in India for the first time in prostitutes  of Chennai in 1986.

 The AIDS virus may have passed from a monkey host into human population in Africa during 1960s.

Pathogen ( Causative Agent) :

The virus was identified  and named by Americans as HCLV III ( Human cell leukemia virus  III), but the name of the virus was changed to HIV (Human immunodeficiency virus) .HIV  is a retrovirus that attacks  helper T cells.

STRUCTURE of HIV :

The virus is with a diameter  of about 90__ 120 nm. Its genome consists of two single _ stranded RNA  filaments and associated with a reverse transcriptase enzyme. The envelope consists of a lipid bilayer  formed of glycoprotein. It contains two protein coats.

Mode of Action of AIDS Virus:

After the entrance of the virus into the body of the person, the virus enters  into macrophages where RNA genome  of the virus replicates to form viral DNA with the help of reverse transcriptase enzyme. This viral DNA gets incorporated into the  host cell's DNA and directs the infected cells to produce  viruses. The macrophages produce virus and act like a HIV factory. Simultan_ 
 eously cells HIV virus enters into helper T lymphocytes where it replicates and produces other viruses. This is repeated  so that the number of T lymphocytes decreases in the body of the infected person. It is due to the fact that HIV destroys T_ lymphocytes. Since the number of helper T lymphocytes decreases in the body, the person starts suffering  from infections  of bacteria especially Mycobacterium, viruses , fungi and even parasites like Toxoplasma .The patient gets  immune deficiency and he/ she is unable to protect himself/ herself against  these infections. 

Magnitude of the problem

HIV continues  to be a major global public health issue. There were approximately  36.9 million people living  with HIV at the end of 2014 with 2 million people becoming newly infected with HIV. It claimed 1.2 million  lives globally . Sub_ Sabaran Africa is the most affected region. It is estimated  that currently only 51 per cent of the people with HIV knwon their status.

  In india the first case of AIDS was reported  in 1986 from Tamil Nadu. Based on new, more accurate estimates of HIV, approximately 2.09 million  people  in India were living with HIV during the year 2012, with national adult HIV prevalence  rate of 0.27 per cent. Although the proportion of people living with HIV is lower than previously estimated , India's  epidemic continues to affect large number of people. HIV is  prevalent  in almost all parts of the country. It is spreading from urban to rural areas; from high risk behavior  group to general population; one in every four cases reported is a women; about 89 per cent of the reported cases are form sexually active and  economically productive age group of 15 __ 44 years. Migration and mobility has increased the chances of the disease spreading to other areas/ persons; and social stigma attached to sexually transmitted infection also holds good for HIV/ AIDS with more disastrous consequences. 

AIDS  cannot  be Acquired by the following:

i) Insect bites,

(ii) Crowded Transport, 
(iii) Shaking  hands, 

(iv) Sharing towels,

(v) Coughing and sneezing, 

(vi) Kissing  and embracing, 

(vii) Sharing utilities and telephone,

(viii) Swimming  pools and toilets. 

Could a mosquito transfer of HIV  infected blood that it has  picked up to the next person it bites?

This cannot happen. The minimum amount of blood necessary  to transmit  HIV is almost a visible quantity, about a tenth of a millimeter. Given the size of a mosquito's  stinger, it would require  hundreds of mosquitoes biting simultaneously at the spot to transfer  that much tainted  blood. 

Incubation period: The Incubation period of AIDS rages between  6 month  to 10 years.

 

Epidemiological Factors:

1): Agent : Human immuno _ deficiency virus ( HIV).

2): Source of infection : HIV  cases and carriers. 

3): Age : Sexually active persons ( 20_ 49 years).

4): Infective material : Blood and semen of infected persons.

5):High  _  risk  groups : Prostitutes, homosexuals, intravenous drug users, etc.

6): Immunity : Man has no natural immunity. 

7) Mode of transmission  : AIDS is transmitted by:

(i) Sexual transmission : This is the usual method of transmission. 

(ii) Transmission  through  blood: e.g., blood transfusion, using unsterilized injection equipment,  etc.

(iii) Perinated transmission  : Mothet _ to _ foetus before or during birth.

8): Incubation period: 6 years or more.

AIDS Symptoms: 

The symptoms of HIV infection include fever, lethargy, pharyngitis, nausea, headache, rashes, etc. The patient loses immunity. 

a): Diagnostic Tests:

1):   ELISA ( Enzymes linked Immune  Sorbent Assay),
 2):    Western blot test, 
3):    Viral load test to count CD 4 numbers , 

4): Rapid Immune  precipitation  Assay ( RIPA).

ELISA is preliminary test and Western Blot and other tests are confirmative.

Diagnosis : HIV antibodies can be detected  by ELISA* test .A positive  ELISA should be confirmed using another test called the Western Blotting test.

(b) Warming  Signs of HIV Infection:


Fever higher than 100°F for several weeks, penumonia, dry cough, shortness of breath, night sweat, memory loss, persistent  white spots/ lesions on the tongue or in the mouth, headache, blurred / distorted vision, weight loss, swelling of lymph nodes for more than 3 months. 

 In AIDS, T4 lymphocytes  count falls from 600__ 1000/ml to less than 200/ ml blood.

WHO case definition for AIDS surveillance:

   For th purpose of AIDS  surveillance  an adult or adolescent ( >12 years of age) is considered to have AIDS if at least 2 of the following  major signs are present in combination with at least 1  of the minor signs listed below, and if these signs are not known to be due to a condition unrelated to HIV infection.

Major signs

●  weight  loss > 10% of body weight.

● Chronic diarrhoea for more than 1 month.

● Prolonged fever for more  than 1 month ( intermittent or constant)


Minor Signs

● Persistent cough for more than 1 month.

● Generalized pruitic dermatitis. 

● Recurrent herpes zoster.

● Oropharyngeal candidiasis .

● Chronic progressive  or disseminated herpes simplex infection. 

● generalized  lymphadenopathy.

  The presence of either generalized Kaposi sarcoma or cryptococcal meningitis is sufficient for the  diagnosis  of AIDS for  surveillance  purposes.  For patients  with tuberculosis,  persistent  cough for more than one month should not be considered  as a minor sign.

Control Of AIDS

There are four basic approaches to the control of AIDS: 

1): Eduction: 

Until a vaccine or cure of AIDS is found, the only means at present available is health education to enable  people to make life_ saving choices ( e.g., avoiding indiscriminate  sex, using condoms). However, there is no guarantee that the use of condoms will give full protection. One should also  avoid the use  of shared razors and tooth brushes. Intravenous drug users should be informed that the  sharing of needles and syringes  involves special risk. Women suffering from AIDS  or who are at high risk of infection  should avoid becoming  pregnant  since infection can be transmitted  to the unborn or newborn. Educational  material and guidelines for prevention should be widely available. All mass media channels should be involved in educating  the people on AIDS, its nature transmission  and prevention; this includes international  travellers.

2): Prevention of  blood _ borne HIV transmission:

  People in high _ risk groups should be urged to refrain from donating  blood, body organs, sperm or other tissues .All blood should be screened  for HIV 1 & HIV 2 before transfusion. Transmission of infection to haemophiliacs can be reduced by introducing heat treatment  of factors VIII and IX . Strict sterilization practices should be ensured in hospitals and clinics. Pre_ sterilized disposable syringes  and needles should not used as far as possible.  One should avoid injections unless they are absolutely necessary. 

Virus  of AIDS is transmitted via and semen.

(i) Transfusion of infected  blood or blood products.

(ii) Use of contaminated needles  and syringes to inject drugs or vaccines. 

(iii) Use of contaminated razors. 

(iv) Use of contaminated  needles  for boring pinnae.

(v) Sexual  intercourse with an infected partner without a condom.

(vi) From infected mother to child through placenta. 

(vii) Artificial insemination. 

(viii) Organ transplant. 

3. Treatment:


There is no cure for AIDS at this time but certain treatments are available  that can delay the  progress of HIV and improve the quality  of life 

(i): Antiretroviral therapy slowing down the growth and replication  of HIV at various  stages of the virus life cycle. These drugs are mainly reverse transcriptase inhibitors e.g., Retrovir, ( AZT or ZDV; Azido thymidine/ Zidovudine), epivir ( Lamivudine), Amantadine, Acyclivir, Ziagen, Rescriptor, Sustive etc. Acyclovic inhibits viral DNA polymerase of HIV. AzT inhibits replication of HIV by blocking synthesis  of provial DNA. All these antiviral drugs have several  toxic side effects including  bone marrow depresstion.


(ii): HAART ( Highly active Anti retro viral therapy ) involves  a combination  of 3 or more antiretro viral  agents that reduce the number of HIV particles in blood stream, increase CD4 count to  more than 200/ ml.


(iii) AIDS  vaccine  like MVA ( Modified  Vaccine  Ankara) is being developed. 

(iv) Chicoric acid from green coffee beans and X Q 9302 ( a chinese herbal medicine) are found effective  against  AIDS.

(v) 0.5% lysol, 0.5% paraformaldehyde or 0.3% H2O2 in activate AIDS virus. 1 Dec is celebrated  as World's  AIDS day/ Red Ribbon Day. NACO is National AIDS control organisation.

Treatment: Although  there is no cure for AIDS, yet use of certain  drugs can prolong  the life of AIDS patient. AZI ( Azidothymidine) was the first drug used and continues to be the drug of choice for the treatment of AIDS. Other drugs are DDI ( Dideoxyinosine) and DDC ( Dideoxycytidine).

Prevention ( Prophylaxis) : No vaccine  has been prepared  so far against AIDS virus.
The following  steps may help in preventing the AIDS.

(i) People  should be educated  about AIDS. Every year, December 1 is recalled  as the World AIDS Day.

(ii) Blood test must be done in  blood donors, donors of semen, donors of organs ( kidneys, lung, liver), patients undergoing haemodialysis, and pregnant women. 

(iii) Disposable needles and syringes should be used. Used needles and syringes must be destroyed. 

(iv) In sexual relationships one should be monogamous. 

(v) Dentist should use sterilized equipments. 

(vi) Avoid tattoos, ear and nose piercing from unqualified people. 

(vii) Avoid use of common blades in barber's shop.

NACO (National  AIDS control organization) and other NGOs (Non _ government of organizations) are doing good work to educate people about AIDS.

AIDS _ Related  Complex ( ARC) : It is mild form of AIDS. Its symptoms are swollen  lymph nodes, fever, sweating at night and weight loss. Patients with ARC have a high possibility  of early development of AIDS. ARC  is also known  as Prodromal AIDS.


4): Primary  health  care

Because  of its wide_ ranging health implications,  AIDS touches all aspects of primary health care, including  mother and child heath, family planning  and education. It is important , therefore , that AIDS control programmes  are not developed  in isolation. Integration into  countries ' primary health care system  is essential. 


Sub Viral Agents:

These are viruses  which lack one of the essential  component e.g. viroids, virusoids, prions, virinos, and satellite viruses. 


(a) Viroids ( Virus + eidos= resemblance). These are smallest known sub viral agents* of infectious disease, smaller ( 1/10 th) than the  size  of smallest  ribo virus. They  are  called  infective nucleic acid entity/ metavirus/ pathogens.  They are naked ssRNA  molecule of low molecular weight ( 1.1 to 1.3 × 10⁵ daltons), lacking protein coat ( capsid) and envelope; causing diseases only in cultivaled  higher plants like spindle tuber disease  of Potato ( PSTD), Chrysanthemum chlorotic mottle stunt, cadang  of coconut,  cucumber  pale fruit, tomato bunchy top, citrus, expocortis ( CED) etc. These viroid diseases  are persistent  infections i.e., there is no recovey  of  infected plants and viroids can be isolated  from the diseased  plant as long as plant survives. These viroids are transmitted  by mechanical means. They were discovered by Diener and Raymer ( 1971). PSTVd ( Potato Spindle tube Viroid) causing PSTD ( Potato Spindle tuber disease) was first viroid discovered. 


   The RNA is short single stranded, circular, highly folded mimicing   DNA and contains  less than 400 nucleotides ( 360 in PSTVd, 371 in CEVd). It shows RNA➡️ RNA replication  in the host cell using host  machinery  and RNA polymerase. The RNA of viroid has inverted base sequences as their ends and thus resembling retroviruses  and transposable elements ( Jumping  genes). They are supposed to be escaped introns.Physiologists considered them as abnormal products of plant metabolism. They differ from viruses  in having much smaller genome, no capsid and  no dormant  phase.


( b) Vorusoids: These are viroids containing small circular RNA linked with larger RNA of a true virus. They replicate within their host and do not cause infection.  These were discovered  by Randies et al ( 1981).



(c) Prions ( Proteinaceous  infectious particles  slow viruses subviral entities devoid of their own genetic material).The prions were discovered  by Alper et al ( 1966) Stanley B. Prusiner  studied, isolated  and identified  the causal agent of scrapie, Kuru and mad cow disease in 1982 and was awarded   Nobal Prize for prions in 1997. Prusiner called this infectious  agent as Prion. Prions are produced by  mutation in the normal prp gene of host DNA. It produces abnormal glycoprotein called prion protein ( PrP) that  induces  the normal glycoprotein to fold incorrectly , causing it to form aggregates/ amyloids ( called  prion rods) of 10__ 20 nm size. These accumulation  in the brain cells and slowly and progressively  damage  and destroy brain cells. Actually prions replicate very slowly ( incubation period 1_4 years) in the spleen and lymphatic system form where they pass to brain and damage the cells.The PrP protein can be transmitted to other individuals of same or different  species by infection or ingestion of infected brain tissue.  Prions causes a number of neurological disorders damaging cells of central  nervous system in mammals like scrapie in sheep ( sheep rub their skin against  fixed objects  and scrape ( scratch) much of their wool), mad cow disease  ( BSE__ Bovine Spongiform encephalopathy), TME ( transmissible  mink encephalopathy) in cattle ( bovines) maedi, GSS ( Gerstmann_ Straussler _ Schleinker disease), CJD  ( Creulz feldt __ Jakob disease) and Kuru ( laughing  death in women of tribes in New Guinea) in humans, FFI ( Fatal Familial insomnia). Prions are resistant  to nucleases, heat, proteases, radiations and disinfectants ( phenol).



Kuru is a slow virus disease  of women  in tribes of New Guinea. It is a degenerative  disease  of CNS found in those women who participated  in the cannibalistic consumption  as a ritual of their  dead relatives as a mark of respect and mourning  and tested the brain tissue  of the dead. The  infected persons  were called Kuru ( i.e., dancers). The disease finally culminated  into the dance of death  ( laughing  death). The infection passed on to children  from their mother who did not wash their hands before washing their children  or while wiping their nose or eyes. It was first reported by Gajdusek in 1957 who was awarded  Nobal Prize in 1976 for the discovery of infectious Kuru made cow and Alzheimer disease.  Now this cannibalistic ritual has been banned by New Guinea government. 

Nowadays  prion is called virio that has  tiny nucleic acid coated with PrP  protein. The nucleic acid  interacts with hot cells to causes disease  but is not transmitted . The PrP protein brings about the production of their own  mRNA . Thus flow of information  is from protein ➡️RNA➡️DNA.


(d) Virinos:   It is a subviral agent having  a noncoding   nucleic acid  genome packaged in a protein  coat derived from the host.



(e) Satellite or Incomplete Viruses ( Vassanis 1963). It is that virus which lacks the  power of multiplication without the presence  of a second virus ( called activator or helper virus). These are Riboviruses e.g., RSV ( Rous  Sarcoma vorus)  TNV ( Tobacco  necrosis  virus).


Important points 

● Study of viruses  is called  virology. Father of virology is Stanley .STNV is parasite on another virus.

● Defective virus: A virus that lacks one or more functional genes required for virus replication. 

●  Pseudo virion: A pseudo virion contains host cell DNA instead of the viral genome. Such virions  are formed during viral replication  and they don't  replicate.


● Small pox eradication programme  was started by WHO in 1967.

● An effective vaccine  against  common cold is not developed because  as many as 76 strains of cold viruses cause cold. Cold is most contagious  viral disease  caused by rhino and Adeno viruses. 


● Viruses  can be  cultured on living  cells by 

(i) host tissues  culture method.

(ii) Chick embryo method : Chorioallontoic membrane is widely  used tissue to culture animal viruses. 

● Virucides: Most of chemical  used as antiviral agents are Pyrimidine analogues, used to treat DNA virus infections. They prevents replication  and transcription of viral DNA e.g., Iodo _ deoxyuridine and cytosine arebinoside for  herpes simplex I, adenovirus,  vaccine virus, Vidarabine for encephalitis and Herpes Zooster; Zovirax for HIV  and Amantadine for influenza  virus. Zovirax ( Acyclovir) a derivative of guanine  is best antiviral agent. X_ rays/ gamma_ rays break genome; uv_ rays  form dimers to inactive ural  genome. Oxidising  agents like lodine,,  H2 O2, KMNO4, HCHO,HCIO destroyed . But viruses  are resistant  to phenols. Temperature of 56°C for 30 minutes,  alkaline pH also inactivate viruses. 


● Hepatitis A virus ( HAV) is most stable virus infecting humans. It can withstand heating at 56°C for 30  minutes  and treatment  with diethyl ether.

● Most mutable virus is HIV . Second most mutable  is infleunza virus.TMV is most resistant virus. 
 
● Shoot apex  ( shoot tip) is widely  used in tissue culture to get virus free plants because  this region is  not affected  by viral attack. There are many reasons for it 

(a) Shoot apex  cells lack Plasmodesmata required for the movement  of viruses

(b) These meristematic cells divide at a very fast rate and viruses  remain upto subapical region.

(c) Auxin level is very high in shoot tip cells which inhibit viral multiplication.


● Water of Holy Ganges is pure because of presence of bacteriophages and Bdellovibrio  (a bacterium) that kills harmful  bacterio in water.


● Polio virus destroys motor nerve cells of ventral   horn in spinal cord.



Pulse Polio Programme is carried  out with an aim to eradicate  Pilio from world.



● Chicken Pox is a life viral disease .Its virus remains  inactive in nerve cells and activate at later stages of life causing painful skin condition called shingles.


●  In Simian vacuolating virus 40 ( SV__ 40), the nucleoid contains histones which is derived from the host.



Nursing care:

The number of people infected with HIV/ AIDS is going to increase  greatly over the coming years. As the time passes, a great percentage  of nurses will become involved in the care of people with  HIV and AIDS.



  At various  stages of HIV infection different problem call for specific services and nursing skills.

  1): Efforts must be made to reduce the fear and discrimination towards HIV _ infected  persons in the community. As a role model, nurses, can provide examples  of supportive and caring responses to the needs of infected individuals. 

2):Educate and counsel patients on preventing the spread of HIV infection.

3): Counsel the  women who are HIV positive or who have an infected partner to  avoid pregnancy. The potential risk to the infant and to the mother must be  carefully  explained .If pregnancy  does occur, strict antenatal  care is desirable and delivery should be conducted in a institution with high level  of perinatal  support. During  delivery  full infection control precautions must be observed to prevent transmission of the disease. 

4): Nuring care in symptomatic HIV patients: The overall goal of patient care is to relieve physical symptoms and maximize the level of functioning. Nursing intervention should be appropriate referral should be made. The commonly  occurring problems  in the patient with AIDS and respective nursing interventions are as follows :

(a) Diarrhoea: Diarrhoea  should be treated  immediately to avoid dehydration either using oral rehydration salts or home__ made ORS. Ensure that the patient drinks more than usual and continues eating  frequently small amounts of low _ fibre food.


(b) Nausea and vomiting: If the patient is having vomitings, give the patient ice chips, clear liquids and then progress to soft diet as tolerated and administer anti_ emetics  as prescribed. 


(c) Fever : Monitor temperature every four hours.Give tepid baths, ice or cooling  pack. Encourage fluid intake and give antipyretic.


(d) Dyspnoea: Assess respiratory status every two hours and note respiratory rate and equality , presence  of cough and skin colour. Raise the head and upper part of the body on pillows to assist breathing. Teach the patient how to make breathing  easier by relaxation techniques to decrease anxiety.Give oxygen and  medication as necessary. 

(e) Pain: Assess location, type and intensity of pain. Evaluate patients perception of pain and administer analgesics as ordered. Reposition the patient to alleviate pressure  on pressure points and give light massage.

(f) Cognitive Impairment: Assess baseline mental status. If patient  is confused, speak in calm manner, give one instruction at a  time and repeat information if necessary . Avoid  disagreement  with patient as this may cause anxiety. 


(g) Fatigue    and Weakness: Encourage  frequent  rest periods and intermittent  activity . Identify supportive deceive and means of conserving energy  like commode, walker  cane. Refer to occupational or physical  therapy  available  for assistance  in daily living  and mobility. 


(h) Skin problems  : Reposition patient every two hours and keep skin  clean and dry. Moisturize skin with lotions to prevent drying. Message to improve circulation to area of skin over bony prominences. Assess skin for reddened pressure area which are fore_ warning  of bed sores. Use pillows to protect bony areas. If bed sores develop treat the sores by washing  daily with salty water and covering  with  a clean dressing. 

 (i)  Depression: Set  time aside to talk to the patient and allow him or her to express fears and concerns. Give psychological support.


  The focus of nursing  care at the end of life is concentrated on palliative care. Palliative  care  is intended  to relieve symptoms rather than to cure the underlying  disease. During this time, physical  and emotional  comfort, counselling  and spiritual  care may be needed by both the patient and family.

Guidelines for safety of nurses: The risk of acquiring infection from HIV infected patients is low.In instances where nurses get acquired HIV infection in their work, the route of infection  has been either parenteral or through exposure  of mucous membranes ( splashes to the eye or mouth) or skin lesions to HIV _ infected blood. The preventive measures  consists of :

(a)    precaution in handling infected blood and other body fluids.


(b)     Precautions  in relation to injection and skin piercing.

(c)     effective  use of  sterilization  and  disinfection. 


    Hand_ washing  is a single most important  procedure  for the prevention of  infection. Nurses should  wear gloves for all direct contact with blood and body fluids. A grown or apron and protective  glasses or face shield  should be worn for  procedures which may result  in the  generation  of droplets or  splashing  of blood or other  body fluids  such as performing  or  assisting  vaginal or caesarean deliveries and handling  placenta, when cleaning  blood from infant's skin until post _ delivery care of the umbilical cord is complete. 


  Methods should be devised to reduce  the risk of needle _ stick and other injuries  from sharp instruments. The handling  of anything sharp should be  minimized. To prevent needle_ stick injuries, needles should NOT be recapped, bent, broken, removed from disposable  syringes  or otherwise manipulated by hand.After use, needles and other sharp proof containers and incinerated .Solid waste, dressing and laboratory and pathology  wastes should be considered  infectious and treated by incineration or burning. 

National  AIDS Control Programmes  :

  Realizing the gravity of epidemiological situation of HIV infection prevailing in the country,  Government  of india launched  a National  AIDS Control programmes in 1987.The Ministry of Health  and Family  Welfare  had set up a National  AIDS Control  Organization ( NACO) as a separate Wing to implement the programme. The overall objective of the programme is to arrest the spread of HIV/ AIDS in the country. 

The components of the programme  are :

(a) Information, education  and communication 

(b) Blood safety 

(c) Control of sexually transmitted diseases. 

(d) Condom promotion 

(e) Surveillance and 

(f) Clinical  management  . 


The WHO has launched a " Global Programme on AIDS" on Feb, 1. 1987 to provide global leadership and to support the development of national  AIDSZ programmes. 

There is no specific  cure or vaccine  against AIDS, as of data.




























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