How to Recognize and Treat Acute HIV Syndrome

The diagnosis of acute human immunodeficiency virus (HIV) syndrome requires a high index of suspicion and proper laboratory testing. Patients with the syndrome may have fever, fatigue, rash, pharyngitis or other symptoms. Primary HIV infection should be considered in any patient with possible HIV exposure who presents with fever of unknown cause. The diagnosis is based on a positive HIV-1 RNA level (more than 50,000 copies per mL) in the absence of a positive enzyme-linked immunosorbent antibody assay (ELISA) and confirmatory Western blot antibody test for HIV. Early diagnosis permits patient education as well as treatment that may delay disease progression. Triple-combination antiretroviral therapy should be started immediately and continued indefinitely. Compliance with medication regimens is essential to maximize benefit and discourage the development of viral resistance.

Care of HIV AIDS Patient

GENERAL CARE:

Sympathetic attitude, family and public support

Patient should be advised to take adequate rest and diet rich in proteins and vitamins

Patient should be advised not to donate blood or organs

Patient should be advised to use condom with any sexual partner

As far as possible patient should avoid eating outside food

Patient should be encouraged to give up all habits i.e. smoking, alcohol or chewing pan or tobacco

Patient should drink boiled water

Patient should be advised to do regular exercise or yoga

If patients follow above general care tips they can live 1-2 year longer.

SYMPTOMATIC TREATMENT:

Early treatment of common problems like fever, cough, diarrhea etc. from family doctor

Early detection and treatment of opportunistic infections like TB etc.

SPECIFIC ANTI-HIV TREATMENT:

Many new anti-HIV drugs which prevent the spread of the virus and can postphone various complications are now available at selected places in market.

Counselling
will be the biggest issue and will be of great benefit to the individual. It will also provide an excellent opportunity to give some health education, particularly in the "risky behaviour groups". Counselling must take place before and after blood testing, and at any time during the disease process. For those who test negative, it may go someway towards a behavioural change. It should involve not only the patient, but also his immediate family and sometimes his/her friends if that is the wish of the patient. It should take place in a private area where there will not be interruption. It is necessary for the counsellor and patient to build up a good rapport so that there is mutual trust and support. People will need to know the implications of the illness and try and understand what will happen to them. They may wish to discuss their own particular fears on death and dying. They must understand methods of preventing the spread of the disease to other members of society. Many of these people will be very young and as it can be a difficult role for the counsellors, it is important to look after yourselves and take plenty of time out for relaxing and getting support from your colleagues.

Social care
should be patient centred, helping people to care for themselves for as long as possible. Health care teams, whether they are in hospitals, clinics or in the community are in an ideal position to offer support and this help may well prevent a family crisis.

They can dispel myths and fears associated with the disease and make the world a better place to live in.

Spiritual and cultural
aspects depends very much upon the individual, but their personal needs should be considered and dealt with according to the wishes of the individual concerned.

Physical care
optimises then heath of the HIV/AIDS patients and promotes as far as possible his/her comfort in the face of complication as the disease progresses. Health maintenance includes sleep, exercise, stress management, the prevention of infections and sometimes the management of addiction.

Once the patient becomes symptomatic, the nursing care is specific to the disease manifestation they may have. If for example a patient has Tuberculosis, he/she should be nursed in exactly the same way as an antibody negative person with Tuberculosis. Similarly it is the same for any other disease or tumour. The patient who is dying of AIDS has the same fears and worries as any other person who is dying.

• Any patient we work with may be infected with a blood borne infectious agent

• Universal precautions should always be applied

• Good basic standards of hygiene and care will protect health care workers from being infected by the majority of infection agents we may encounter while caring for our patients

Fears, attitudes an beliefs

Fear is normal. It is the natural response to the unknown or danger. With education and knowledge of the disease and its route of transmission, we are able to protect ourselves from being infected with HIV, as long as we are vigilant with regards to the Universal Precautions.

Although we tend only to worry about being infected in our working environment, we must not forget the risk we may be taking in our personal lives. It is easy to take precautions while we are for known HIV/AIDS patients, but in our private lives we do not always know the HIV status of those we meet outside the work place. HIV is a blood born virus, which is transmitted by both man and women. From man to man, men to woman and woman to men. If at any time you are in doubt, remember the condom. Remember it is available and it is strong, sensitive, safe and simple.

Remember the three main transmission routes, sexual contact, blood and body fluid exposure and vertical. It is quite safe to hold hands and put reassuring arms around the patient. It is safe to use public showers, swimming pools, chopsticks and bowls and public phones and mosquito bits pose no hazard.

Attitudes and feelings

Because we are influenced by many different factors, these issues are far more difficult to address. Only when we have dealt with our own feelings and modify our attitudes, will we be able to care for our patients and the community. Many of these people will be drug users, prostitutes and their clients. Many will be innocent victims who through no fault of their own now suffer. However, traditionally people have turned to health care workers for help, for support and understanding when they are unwell or in distress. They need our expertise, skills and knowledge and we have a duty of care that does not allow us to select the patients that we would like to care for.

Often we are faced with difficulties in coming to terms with numerous situations, but invariably we are able to separate our personal feelings and maintain higher standards of care.

People with HIV/AIDS are ordinary people. No amount of debate about whether the disease is due to their own neglect or life style will alter the situation.

Because of the nature of the illness, that is a window period followed usually by an asymptomatic stage of maybe 10 or 11 years we may often care for infected individuals without being aware of it, often there is no reason to suspect that anything is wrong. HIV/AIDS is not a disease that is limited to just a few; it is an infectious agent that knows no racial, border, gender or age boundaries. If people fear they will not receive care they will not come forward and will conceal their disease which will lead to further spread of the virus.

We have to consider not only our own fears and attitudes but also those of the community in which we live.

It is unlikely that there are any differences, but our education gives us knowledge and knowledge give us power. If we can spread our knowledge it will give the community power and they will learn how to protect themselves.

Remember

Always pass on correct information.

Provide support

Encourage behaviour change when it is needed.

Give advice on healthy living.

Dispel fears and myths.

• Although there is no evidence that HIV is airborne masks, gowns and eye protection should be worn when procedures which may cause aerosol spray of body fluids, such as bronchoscopes /dentistry are carried out.

• Skin must be thoroughly washed with soap and water if contaminated with blood, body fluids, excretions or secretions from any patient.

• Dispose safely of waste contaminated with blood and body fluid.

• Careful handling of soiled linen.

• Spillage of blood and other body fluid should be treated with a chlorine-based compound and then cleaned up with disposable paper while wearing gloves and aprons.

• Cover broken skin sores or cuts with a waterproof dressing before contact with patients.

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