HIV STUDY GUIDE

Case Study 5

What is PCP?

Pneumocystis pneumonia (PCP or pneumocystis) is the most common opportunistic infection in people with HIV. Without treatment, over 85% of people with HIV would eventually develop PCP. It has been the major killer of people with HIV. However, PCP is now almost entirely preventable and treatable.

What is the significance of the purplish spots on a client diagnosed with AIDS?

Kaposi's sarcoma is not curable, in the usual sense of the word, but it can often be effectively palliated for many years and this is the aim of treatment. In KS associated with immunodeficiency or immunosuppression, treating the cause of the immune system dysfunction can slow or stop the progression of KS. In 40% or more of patients with AIDS-associated Kaposi's sarcoma, the Kaposi lesions will shrink upon first starting highly active antiretroviral therapy (HAART). However, in a certain percentage of such patients, Kaposi's sarcoma may again grow after a number of years on HAART, especially if HIV is not completely suppressed. Patients with a few local lesions can often be treated with local measures such as radiation therapy or cryosurgery. Surgery is generally not recommended as Kaposi's sarcoma can appear in wound edges. More widespread disease, or disease affecting internal organs, is generally treated with systemic therapy with interferon alpha, liposomal anthracyclines (such as Doxil) or paclitaxel.

With the decrease in the death rate among AIDS patients receiving new treatments in the 1990s, the incidence and severity of epidemic KS also decreased. However, the number of patients living with AIDS is increasing substantially in the United States, and it is possible that the number of patients with AIDS-associated Kaposi's sarcoma will again rise as these patients live longer with HIV infection.

Blood tests to detect antibodies against KSHV have been developed and can be used to determine if a patient is at risk for transmitting infection to his or her sexual partner, or if an organ is infected prior to transplantation.

What precautions will you need to use when caring for a client diagnosed with HIV and AIDS?

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What will be the focus of your ongoing assessment? (List 3)

Differentiate between HIV-positive status and AIDS.

You have a client that has seropositive for several years, yet he has asymptomatic for AIDS. What factors may have influence development of PCP?

List at least five other opportunistic infections that HIV/AIDS patients are at risk for developing.

Case study 2Human Immunodeficiency Virus

What is and EIA test? Does a positive EIA mean that C.Q. definitely has HIV?

You explain to C.Q. that one of her tests needs to be repeated and you need to draw another blood sample. Why wouldn’t you tell C.Q. that her first rest result was positive and that another test is needed before the diagnosis can be confirmed?

The physician informs you that C.Q. Western’s blot results confirm that she is HIV positive; he requests that you be present when he talks to her. Before leaving C.Q.’s room, the physician requests that you obtain another blood sample for further testing, give C.Q. verbal and written information about local acquired immunodeficiency syndrome (AIDS) support groups, and help C.Q. call a friend to accompany her home this evening. She looks at you through her tears and states, “I can’t believe it. J is the only man I’ve had sex with since my divorce. He told me I had nothing to worry about. I cannot believe he would do this to me.

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C.Q. statement is based on three assumptions: that J. is HIV positive, that he intentionally withheld the information from her, and the he intentionally transmitted the HIV to her through unprotected sex. Based on your knowledge of HIV infection, how would you counsel C.Q?

In addition to offering alternatives explanations and exploring options, what is your most important role at this time?

Identify at least three issues related to R/T C.Q. care.

C.Q. has had a positive EIA test and is seropositive for HIV. Why doesn’t she have S/S of AIDS?

What are some of the acute signs and symptoms of an HIV infection that a patient may present with?

Why is it a good idea that someone C.Q. trusts escort her home this evening?

Has C.Q.’s right to privacy been violated? Explain why or why not.

C.Q. returns to the office 4 days later to discuss her diagnosis. What issues will you discuss with her at this time?

Does C.Q. have a legal responsibility to inform J. of her HIV status?

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