Human Immunodeficiency Virus (HIV): Causes, Effects and Treatments

Abstract

Human immunodeficiency virus (HIV) is a retrovirus that may lead to the progression of acquired immunodeficiency disease (AIDS) if untreated. The virus attacks the body’s immune system, which eventually leads to the individual being very susceptible to acquiring opportunistic infections. There is currently no cure for AIDS, and although there are treatments for it, your body can never fully get rid of the virus. Thus, infected individuals should take antiviral therapy medications to help prevent transmission to others via bodily fluids. The disease often causes extensive emotional, physical, and financial hardships on those affected by it, but there are ways health care providers can help ease these burdens.

Keywords: HIV, AIDS, virus

Human immunodeficiency virus (HIV) is a retrovirus that infects and diminishes part of one’s immune system. The virus is found in bodily fluids, so it can be transmitted via sexual activity, IV drug use, mother to child transmission during birth, etc. (McCance & Huether, 2019, p.312). Once an individual contracts the virus, they will have it for the rest of their lives as the human body can’t fully get rid of it (“HIV Basics,” 2019). Moreover, these immunocompromised individuals are extremely vulnerable to other infections and diseases. Once they become infected with these opportunistic diseases, it is indicated that they are in the final stage of the infection, AIDs (“HIV Basics,” 2019).

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One of the largest risk factors for HIV is sexual activity. “The CDC estimates that 91% of new HIV infections in the United States result from sexual activity with those who are undiagnosed or diagnosed but not treated for HIV infection” (McCance & Huether, 2019, p.312). Specifically, homosexual men are the most at-risk population for contracting HIV, especially when protection is not properly used. In fact, “in 2017, gay and bisexual men accounted for 66% of all HIV diagnoses and 82% of diagnoses among males (“HIV Basics,” 2019). Another major risk factor is intravenous drug use and the sharing of needles (McCance & Huether, 2019, p.312). Since HIV is transmitted through bodily fluids, most of the risk factors are related to risky behaviors that can lead to the sharing of these fluids. Additionally, African Americans and Hispanics account for more cases of HIV. According to the CDC, African Americans account for 43% of those diagnosed with HIV and Hispanics account for 26% (“HIV Basics,” 2019).

HIV is a retrovirus, which means it transports genetic information in the form of two duplicate RNA copies (McCance & Huether, 2019, p.311). There are seven stages of the HIV life cycle: binding, fusion, reverse transcription, integration, replication, assembly, and budding (“The HIV Life Cycle,” 2019). The virus must first gain entry into its target cell, which is predominantly C4+ T-helper cells. Nonetheless, macrophages and dendritic cells may also become infected with the virus. The lymph nodes are the predominant sites of infection in the beginning stages (McCance & Huether, 2019, p.312). Once the virus is attached to the CD4 cell, it fuses with the cell to gain entry. Next, it releases an enzyme called reverse transcriptase. This enzyme converts HIV RNA into HIV DNA, which allows it to invade the CD4 nucleus. Another HIV enzyme is then released in order to integrate the HIV DNS into the cell’s DNA. The virus uses the CD4 cell to begin replicating itself. The new HIV then expels itself from the host cell and releases protease, another HIV enzyme. The protease engages the immature virus to become an infectious virus (“The HIV Life Cycle,” 2019). Most of the symptomatic changes occur once AIDs has developed and the individual’s immunity is significantly weakened. The organ and systemic changes often occur due to the opportunistic infections that they contract due to this weakened immune system.

Those that are infected with HIV often don’t show any signs or symptoms in the beginning, but they may experience symptoms of an acute viral infection. These symptoms may include fever, fatigue, headache, inflamed lymph nodes, muscle and/or joint pain, and a rash on their skin (McCance & Huether, 2019, p.313). These symptoms occur during stage 0, which is the first 180 days after they become infected. The CD4 cell counts are closely monitored during stages 1 through 3 to follow the progression of the disease (McCance & Huether, 2019, p.313). These initial symptoms will resolve and the individual will become asymptomatic, even though the virus is still causing cell damage. After about three months, antibodies specific to HIV may be detected. The disease usually progresses very slowly, and it may take years for symptoms to develop (Naif, 2013). Once the primary infection develops, the virus is constantly replicating itself in the bloodstream and lymph nodes. However, the infected individual will still look and feel healthy during this time. Although they don’t feel ill yet, the immune system is progressively getting more damaged. Once symptoms begin arising, the person has entered the late stage of HIV, or AIDS. This is the point in time where they are the most vulnerable to opportunistic infections (Naif, 2013).

There are a few diagnostic tests than can be performed to diagnose HIV. Antibody tests may be done to identify antibodies that the person is making against the virus. A more specific test, an antigen/antibody test, is a common diagnostic test that is used to detect for both HIV antibodies and antigens in the body. If the individual positive for HIV, an antigen called p24 will be noted via this test (“HIV Basics,” 2019). A more expensive test that can be conducted is a nucleic acid test, or NATs. This can detect the actual virus in the bloodstream (“HIV Basics,” 2019). One major lab value to monitor closely is the number of CD4+ Th cells. The number of these cells declines dramatically once the disease has progressed to AIDS (McCance & Huether, 2019, p.313).  The number of CD4 cells depends on the age of the infected individual, so the provider must keep this in mind when determining the severity of the disease.

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There is currently no cure for AIDS. However, there are preventative therapies that can help prevent or slow the progression from HIV to AIDS. The standard treatment is highly active antiretroviral therapy (HAART). These drugs work together to attack distinctive parts of viral replication. Currently, there are more than 25 drugs that are FDA approved to treat this disease (McCance & Huether, 2019, p.313). The therapeutic regimen may be individualized for the infected individual. The overall goal of these therapies is to lessen the amount of the virus and decrease morbidity associated with the disease. Additionally, these drugs are aimed to extend survival and prevent further transmission of the virus (McCance & Huether, 2019, p.314).

Being diagnosed with HIV or AIDS not only affect a person’s mental and physical well-being but also their financial well being. One study found that a high proportion of people with AIDS lost their jobs due to illness. This in turn decreased the amount of family income. Furthermore, paying for constant medical check-ups, lab work, and medications put a significant financial burden on these individuals (Haldar et al., 2011). Antiviral drugs and continuous monitoring can be extremely expensive. Although insurance helps cover some of the costs, not everyone has insurance to do so. One study found that some people receiving antiviral therapy could pay up to almost $400,000 in total over approximately 25 years (Hutchinson et al., 2006). “75% of the total costs were mortality-related productivity losses (Hutchinson et al., 2006).

Nurse practitioners and other health care providers need to use evidence-based practice to better the care of these patients. Once the disease progresses to AIDS, many of these individuals need palliative care measures to ease their suffering. Clinicians should constantly be assessing these patients for pain and treating them with pharmacologic and non-pharmacologic therapies to lessen the pain. Many of these patients become depressed once being diagnosed. Therefore, health care providers need to consider their mental health status. This disease is very physically exhausting, but it also wears on people’s mental status, emotions, and quality of life. Enhancing their quality of life as much as possible is crucial for these patients.

Human immunodeficiency virus is a preventable disease, but almost 40,000 people were still diagnosed in the United States in 2017 (“HIV Basics,” 2019). Education is crucial in preventing this disease, including regular screenings if high risk, protection during sex, avoiding IV drug use, etc. It takes years for signs and symptoms to occur, but once they do, the disease has progressed to the final stage, AIDS. Although there is no cure, there are treatments available to help these patients and improve their quality of life.

References

• McCance, K. L., & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children(8th ed.). St. Louis, MO: Elsevier Mosby.
• Haldar, D., Taraphdar, P., Dasgupta, A., Mallik, S., Chatterjee, A., Saha, B., & Rray, T. (2011).              Socioeconomic consequences of HIV/AIDS in the family system. Nigerian Medical Journal, 52(4), 250–253. doi: 10.4103/0300-1652.93798
• HIV Basics. (2019, August 6). Retrieved from https://www.cdc.gov/hiv/basics/index.html
• The HIV Life Cycle. (2019, July 1).  Retrieved from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/73/the-hiv-life-cycle
• Hutchinson, A. B., Farnham, P. G., Dean, H. D., Ekwueme, D. U., Rio, C. D., Kamimoto, L., &               Kellerman, S. E. (2006). The Economic Burden of HIV in the United States in the Era of               Highly Active Antiretroviral Therapy. JAIDS Journal of Acquired Immune Deficiency              Syndromes, 43(4), 451–457. doi: 10.1097/01.qai.0000243090.32866.4e
• Naif, H. M. (2013). Pathogenesis of HIV Infection. Infectious Disease Reports. Doi: 10.4081/idr.2013.s1.e6