CHAPTER 20

The Patient/Client With HIV/AIDS

LEARNING OUTCOMES

Upon completion of this chapter, the nurse will:

PATHOPHYSIOLOGY REVIEW OF HIV/AIDS

HIV is a retrovirus that is transmitted through blood and body fluids. It was first diagnosed in 1984 after the discovery of a specific antigen–antibody complex. A constellation of body changes occurs when the HIV enters the body:

Manifestations of HIV can range from no symptoms to severe immune system collapse. When first infected, the person may experience:

These manifestations are similar to many other infections and disease processes, which makes it difficult to diagnose at first. And, it takes weeks to months for the body to develop antibodies to the virus. Even so, the person is extremely contagious during this time.

A person learns of having HIV through voluntary testing. A person might believe an exposure to body fluid or blood occurred through intimacy and asks for testing to be done. Or, a health care professional might have accidentally received a needle stick and testing is part of the postexposure care. Another way HIV testing maybe completed is if a person is planning to store blood for autotransfusion for an upcoming surgery or is participating as a blood donor.

Once considered an immediate death sentence, people with HIV can live many healthy years if medication treatment is initiated and continued without interruption. Should there be a change in the person’s health status or medication treatment ceases to be effective, AIDS can develop. The diagnosis of AIDS is dire because the T lymphocyte levels are dangerously low and the person can develop an array of opportunistic infections.

CHALLENGES

Disease management programs created for HIV/AIDS started in the mid to late 1990s and were sponsored by state and federal programs through Medicaid. Several states have published the results and successes of these programs; however, there is still much to be accomplished.

One of the major issues when working with this population is confidentiality. The results of an HIV/AIDS test are confidential, and there needs to be controls built in so that patient/client confidentiality is not breached.

States with HIV/AIDS Medicaid programs enroll individuals with the illness into their disease management program. The individual receives written communication about being enrolled and has an opportunity to accept enrollment or decline. There is no penalty for choosing to decline; however, the major benefit for participating is an improvement in the person’s health. The states with these programs have to guarantee that all communication complies with the Health Insurance Portability and Accountability Act (HIPAA) privacy standards.

BENEFITS

Besides enhancing the number of healthy years living with HIV and preventing the development of AIDS, specific advantages of using telephonic disease management for this client population includes reducing the number of:

PRIMARY CARE FOCUS

The focus when providing telephonic care to a person with HIV is not to discuss the way in which the infection was obtained. Care calls should focus on:

Current Health Status

Ideally, the person with HIV would not be aware of having an illness. Others with the disorder may experience one or more swollen lymph nodes.

Changes in Symptoms

Any changes in symptoms need to be further investigated and substantiated with a T lymphocyte cell count (CD4 T-cell count). These changes can include:

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