The Human immunodeficiency virus (HIV) is a highly prevalent virus which acts by weakening an individual’s immune system. Without treatment, HIV may lead to acquired immunodeficiency syndrome (AIDS) when the immune system is unable to effectively fight off even simple infections, creating a high risk of acquiring of infections, tumors and eventual death. An estimated 1.2 million individuals aged 13 and older are believed to have HIV, with 161,800 of them not yet diagnosed. Approximately, 38,000 are diagnosed with HIV per year (CDC, 2020). Globally, approximately 38 million are living with HIV, with 1.7 million infections annually, and nearly 700,000 deaths from AIDS-related illnesses (UNAIDS, 2020).
Signs and Symptoms
HIV does not concretely present itself as a disease and only can be identified through a specific test. Individuals experience symptoms based on the stage of infection. Upon encountering HIV, within 2-4 weeks, the acute reaction will occur, and people experience a flu-like illness with fever, chills, fatigue, with symptoms lasting from a few days to several weeks. The second stage, known as clinical latency, the virus slowly multiplies with people typically having little to none signs of sickness. This is known as chronic HIV infection, and can last for years, up to 15 years, but the individual can transmit the virus nevertheless.
Finally, the third stage is AIDS at which point the person becomes extremely ill with rapid weight loss, extreme fatigue, recurring fever, pneumonia, and neurological disorders. A person is virtually exposed to most diseases and viruses at this stage, and death is expected from complications of other illnesses (HIV.gov, 2020).
There are currently three types of diagnostic tests used to find the infection. However, no test can identify HIV immediately after infection, requiring 10 to 90 days after exposure. The first test is the nucleic acid tests (NAT) which search for the virus in the blood, requiring the shortest time of exposure. However, it is complex and expensive, used only in high-risk situations. There are blood antigen tests which look for HIV antigens called p24, produced by the immune system when encountering the virus, 18-45 days after exposure. There are also antibody tests, from blood or oral fluid which identify antibodies to HIV, effective 23-90 days after exposure (CDC, 2020b).
HIV is major global public health issue due to risk behaviors that contribute to its spread. HIV can only be spread via sexual intercourse (STI) and direct contact of bodily fluids, sharing of objects that have come in contact with blood (i.e. needles), and in rare forms, through direct contact when having open wounds or passing of the virus from mother to child in pregnancy. The most common contributing factors to the spread of HIV are unprotected sex and the sharing of intravenous paraphernalia (such as needles during drug use) in a non-sanitary manner (Gilroy, 2020).
Major risk factors for HIV are preventable and avoidable. Prevention strategies include regular testing of oneself and sexual partners to ensure HIV is not being spread unknowingly. It is recommended to use appropriate protections during sexual intercourse and avoid large numbers of sexual partners whose status is unknown. Drug use with intravenous paraphernalia should be avoided, but those patients at risk should use sanitary equipment, including needles. Many states utilize needle exchange programs for this purpose to limit the spread of disease among drug users (Gilroy, 2020).
Advanced Practice Nursing Role and Management Strategies
With the availability of effective treatment, HIV is a chronic condition that requires complex, speciality primary care and preventive medicine delivered by a multidisciplinary team. APRNs have a vital role in maximizing the effectiveness of the care provision and providing quality and cost-effective care for HIV in the U.S. With the scope of practice expanding in many states, APRN’s with their training and education have the ability to provide competent care to HIV patients. APRN’s can practice to the full extent of their training, with consultation of medical support if necessary in diagnosing, testing, and treatment of HIV. APRN’s also have the authority to prescribe medication, recommended to consult with expert HIV physicians as part of multidisciplinary care when prescribing for the HIV infection (HIVMA, 2014).
There are several areas of practice where APRN’s play a role. This includes building a network of care and support for newly diagnosed patients, including initial assessment, with meeting psychosocial and medical needs. Monitoring and support, with promotion of self-management and retention in care is vital for ongoing support with treatment adherence and improving accessibility.
Proactive support is critical to facilitate re-engagement in care for those who are at risk of disengaging and venerable patients. It is necessary to coordinate multidisciplinary packages of care for patients, particularly for those with complex needs and involvement of multiple participants if necessary, to ensure comprehensive care. Finally, APRN’s play a vital role in public health promotion of HIV, including risk reduction, prophylaxis, testing, and partner notification if applicable (NHIVNA, 2016).
Pharmacological care for HIV consists of an antiretroviral therapy (ART). The therapy cannot cure HIV but with modern medication, individuals can live longer and healthy lives, likely matching that of a natural lifespan. ART consists of a medication regimen taken every day such as fosamprenavir, indinavir, lopinavir, ritonavir, and others. These medications are aimed at preventing the HIV virus from multiplying and destroying immune system cells, reducing the viral load in the body (HIV.gov, 2020).
Due to the serious nature of HIV, diagnosed patients may require consistent follow-up care throughout their lives. This includes consistent monitoring of the spread of HIV in the body and the health of the patient’s immune system. Patients have to adhere to strict medication and treatment regiments as well as control their nutrition, physical health, while limiting risky behaviors such as drug and alcohol use. Major changes to the body such as pregnancy and medical procedures such as surgery also have to be undertaken with precautions to reduce the risk of HIV spread and maintaining the safety of the patient (HIV Info, 2020).
HIV is highly prevalent virus and global public health issue. It often does not present evident symptoms but works to destroy the immune system, eventually resulting in AIDS and death. HIV can only be identified by a specific test but easily spread through sexual contact or sharing of intravenous objects. HIV is commonly spread through risk-based behavior and can be prevented through caution and protection. The condition cannot be cured but is treated with antiretroviral drugs for the rest of the person’s life. Overall, HIV is manageable but due to the scope of its prevalence many people are not receiving their diagnosis and treatment in a timely manner. Currently research efforts are aimed at finding a cure for the virus and making tests and treatments more accessible.
CDC. (2020a). HIV surveillance report. Web.
CDC. (2020b). HIV testing. Web.
Gilroy, S. A. (2020). What are the risk factors for exposure to HIV? Web.
HIVMA. (2014). The role of advanced practice registered nurses and physician assistants in HIV care policy statement. Web.
HIV. (2020). Symptoms of HIV. Web.
HIV Info. (2020). Living with HIV. Web.
NHIVNA. (2016). Advanced nursing practice in HIV care. Web.
UNAIDS. Global HIV & AIDS statistics — 2020 fact sheet. Web.