Nursing Guide to HIV: Nursing Diagnosis, Interventions, & Care Plans

Human immunodeficiency virus (HIV) is a chronic viral infection that attacks the immune system. It specifically targets CD4+ T-cells, which are critical for immune function. Over time, HIV can weaken the immune system, making individuals more susceptible to certain infections and cancers.  

Without treatment, HIV can progress to acquired immunodeficiency syndrome (AIDS), the most severe stage of the infection. While there is no cure for HIV, advancements in antiretroviral therapy (ART) have made it a manageable chronic condition, allowing people with HIV to live long, healthy lives with proper treatment and care. 

Etiology and epidemiology 

HIV is primarily transmitted through exposure to infected bodily fluids, including blood, semen, vaginal fluids, rectal fluids, and breast milk. Common modes of transmission include unprotected sexual contact, sharing of needles, and from mother to child during childbirth or breastfeeding. HIV cannot be transmitted through casual contact, such as hugging, kissing, or sharing utensils. 

Risk factors: 

• Unprotected sexual activity: Particularly with multiple partners or with individuals who are HIV-positive or whose status is unknown.
• Injection drug use: Sharing needles increases the risk of bloodborne transmission.
• Blood transfusions and organ transplants: Though rare in developed countries due to rigorous screening, transfusions from infected donors can transmit HIV.
• Vertical transmission: From mother to child during pregnancy, childbirth, or breastfeeding if the mother is untreated. 

Epidemiology: 

Globally, there are approximately 38 million people living with HIV, with the highest prevalence in sub-Saharan Africa. The virus disproportionately affects certain populations, including men who have sex with men (MSM), transgender individuals, and people who inject drugs (PWID). In the U.S., around 1.2 million people are living with HIV, with new infections occurring predominantly in young people, MSM, and African Americans. Early detection and ART have significantly reduced the progression to AIDS and HIV-related deaths. 

ICD-10 code for HIV

The ICD-10 code for HIV infection is B20 – Human immunodeficiency virus [HIV] disease. 

Diagnosis 

Diagnosis of HIV involves screening tests followed by confirmatory tests. 

1. HIV antibody and antigen test (fourth-generation test): This is the most common screening test, which detects both HIV antibodies and the p24 antigen (a part of the virus) in blood. It can detect HIV infection within 2 to 6 weeks after exposure.
2. HIV RNA test: This test detects the virus’s genetic material and is useful in diagnosing early HIV infection or for monitoring viral load in individuals known to have HIV.
3. Western blot or immunofluorescence assay: These tests are used to confirm the diagnosis of HIV after a positive screening test.
4. CD4 count: Used to assess the status of the immune system. A CD4 count below 200 cells/mm³ is a criterion for diagnosing AIDS.
5. Viral load test: Measures the amount of HIV in the blood, which helps monitor treatment effectiveness and disease progression. 

HIV Management 

There is no cure for HIV, but antiretroviral therapy (ART) effectively controls the virus, allowing individuals to live healthy lives and preventing the transmission of HIV to others. 

Antiretroviral therapy (ART): 

• Goal of ART: Suppress the viral load to undetectable levels (<50 copies/mL), which prevents disease progression and reduces the risk of transmission (undetectable = untransmittable, U=U).
• Types of ART: ART consists of a combination of drugs from different classes to prevent resistance. Common drug classes include:
• Nucleoside reverse transcriptase inhibitors (NRTIs): e.g., tenofovir, emtricitabine.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): e.g., efavirenz, rilpivirine.
• Protease inhibitors (PIs): e.g., atazanavir, darunavir.
• Integrase strand transfer inhibitors (INSTIs): e.g., dolutegravir, bictegravir.
• Entry and fusion inhibitors: e.g., maraviroc, enfuvirtide.
• Adherence: Strict adherence to ART is crucial for viral suppression and to prevent resistance development. 

Preventive strategies: 

1. Pre-exposure prophylaxis (PrEP): A daily medication (e.g., tenofovir/emtricitabine) for individuals at high risk of HIV to prevent infection.
2. Post-exposure prophylaxis (PEP): A 28-day course of ART for individuals who may have been exposed to HIV, ideally started within 72 hours of exposure.
3. Prevention of mother-to-child transmission: Pregnant women living with HIV should receive ART to reduce the risk of transmitting the virus to their child. Infants born to HIV-positive mothers are also given ART prophylaxis. 

HIV nursing care plan 

Nursing considerations 

Nurses play a critical role in managing patients with HIV, from diagnosis through long-term care. Key areas of focus include medication adherence, managing comorbidities, and preventing opportunistic infections. 

Assessment 

• HIV status and ART adherence: Review the patient’s HIV status, current ART regimen, and adherence to medications. Assess for any barriers to adherence, such as side effects, mental health issues, or lack of access to healthcare.
• Nutritional status: Patients with HIV are at risk of malnutrition due to gastrointestinal side effects from medications or opportunistic infections.
• Psychosocial assessment: Screen for depression, anxiety, or stigma-related issues, as HIV can be associated with significant emotional distress.
• Risk for opportunistic infections: Monitor for symptoms of opportunistic infections such as tuberculosis, pneumocystis pneumonia (PCP), candidiasis, or cytomegalovirus (CMV), especially in individuals with low CD4 counts. 

Nursing diagnosis/risk for 

• Risk for infection related to immune suppression and opportunistic infections.
• Impaired nutrition related to side effects of ART or gastrointestinal opportunistic infections.
• Ineffective health management related to the complexity of ART regimens and social determinants of health.
• Social isolation related to stigma and fear of discrimination. 

Interventions 

• Medication management: Educate patients about the importance of strict adherence to ART to maintain viral suppression and prevent drug resistance. Monitor for side effects such as nausea, diarrhea, or fatigue, and address these with appropriate interventions.
• Infection prevention: Teach patients about the importance of routine screenings for tuberculosis, hepatitis, and other infections, as well as vaccinations against pneumococcal disease, influenza, and hepatitis B.
• Nutritional support: Provide dietary counseling to address any weight loss or nutritional deficiencies. Encourage a balanced diet high in protein and calories, especially for patients with wasting syndrome.
• Mental health support: Refer patients to counseling or support groups to help manage emotional stress, anxiety, or depression related to HIV diagnosis and treatment.
• Education on transmission prevention: Educate patients on safe sex practices, the importance of using condoms, and the role of PrEP for their partners if appropriate. 

Expected outcomes 

• The patient will achieve and maintain viral suppression with consistent adherence to ART.
• The patient will demonstrate an understanding of safe practices to prevent the transmission of HIV.
• The patient will maintain adequate nutritional status and avoid opportunistic infections.
• The patient will show improved mental health and coping skills regarding their HIV status. 

Individual/caregiver education 

• Medication adherence: Educate patients and caregivers about the importance of not missing ART doses. Explain that consistent adherence leads to undetectable viral loads, which means HIV cannot be transmitted to others (U=U).
• Preventing transmission: Teach patients about how to prevent HIV transmission, including the use of condoms, harm reduction strategies for injection drug use, and the role of PrEP for partners.
• Opportunistic infection prevention: Stress the importance of regular healthcare visits, adherence to prescribed prophylactic medications, and staying up to date on vaccinations.
• Psychosocial support: Encourage the use of support groups and mental health counseling to address feelings of isolation or stigma. Provide information on community resources that offer social and financial support for people living with HIV. 

References 

1. Centers for Disease Control and Prevention: HIV Basics
2. Mayo Clinic: HIV/AIDS Overview
3. World Health Organization: HIV/AIDS Fact Sheets
4. ICD-10 Data: B20 HIV disease 

Resources 

• Centers for Disease Control and Prevention (CDC): Offers information on HIV prevention, diagnosis, and management, as well as data on HIV/AIDS prevalence.
• AIDS.gov: A U.S. government website with resources on living with HIV, treatment options, and policy updates.
• World Health Organization (WHO): Provides global data on HIV/AIDS and guidelines for HIV care and treatment.
• The Body: A comprehensive online resource offering information on HIV management, research, and personal stories from people living with HIV.