Clinical Manifestations HIV infections generally progress through 4 stages. Acute HIV infection Asymptomatic stage Symptomatic stage Progression from HIV to AIDS

	HIV Stage 1: Acute HIV Infection Pathophysiology: Once HIV enters the body, it infects CD4+ cells and uses the cell to starts replicating itself. The viral load (the amount of HIV in the blood) spikes to a high level. CD4+ cells may decrease because it is being killed by HIV Antibodies to HIV have not yet developed. Tests for HIV antibodies at this stage will be negative even if the patient is infected Patients must wait for antibodies to develop (a process known as seroconversion) before HIV antibody tests will be accurate. This is known as the window period. Most people develop HIV antibodies within 6-12 weeks of infection. Research has shown that 95% of people who are infected with HIV develop antibodies within 34 days of the date of infection.13 Very rarely, it can take up to 6 months. The clinical manifestations of this stage resemble flu-like symptoms. Due to the non-specific nature of the signs and symptoms during this stage of HIV, diagnosis is often missed. Nurses play a role in helping to identify individuals at risk of contracting HIV and initiating HIV testing. Initial HIV infection resembles the flu: Fever/fatigue; Sore throat; Swollen lymph nodes; Headaches; Rash; Cough/congestion; Question: A patient is presenting with signs of the flu. During the history, the patient discloses engaging in recent unprotected sex with multiple partners. As his nurse, you recognize the increased risk of HIV from the engagement in risky behaviors and flu-like symptoms. An HIV antibody test is recommended and accepted by the patient. However, the results come back negative for HIV antibodies. What is your top priority for patient teaching? (Click one of the options below.) Educate the patient on the risks involved with engaging in unprotected sex. Educate the patient on the risk of HIV transmission even with a negative HIV antibody test and recommend retesting 3 months later. Inform the patient, s/he is HIV negative and provide education on the risks of HIV transmission and unprotected sex. [Back to top]
	HIV Stage 2: Asymptomatic stage Pathophysiology: The CD4+ cell count will remain stable as the body begins the long war against HIV. With treatment, this stage lasts an average of 10 years.15 The viral load decreases from its initial spike and remains stable. However, the patient remains infectious since HIV has integrated with the host's genetic material. Risk of transmission increases with increased viral load. HIV antibodies have developed, but have been shown not to be effective against HIV.16 Clinical symptoms This stage is generally free from major symptoms. Although research has shown that HIV is very active in the lymph nodes, rather than being dormant17. Thus, there may be swollen lymph nodes. Treatment usually begins when the CD4+ cell count is less than 200 cells/mm3 (1 mm3 = the size of a pinhead). The purpose of treatment is to help prevent further damage to the immune system by inhibiting HIV replication. Patients on treatment usually remain asymptomatic. [Back to top]
	HIV Stage 3: Symptomatic stage Pathophysiology: Over time, damage occurs to the immune system and causes the body to have difficulty fighting opportunistic infections that it would have been able to fight previously. CD4+ cell count decreases. The drop in CD4+ cell count is associated with a rise in viral load. HIV infection becomes symptomatic due to infections that can occur in almost all body systems. Clinically: Treatment at this stage will focus on targeting HIV as well as the specific infections and illnesses. It is important to monitor drug interactions at this stage to minimize drug interactions. Co-trimoxazole has been used as a prophylaxis to prevent several HIV-related opportunistic infections (including TB, bacterial pneumonia, malaria, septicemia). Research has shown it to be effective in reducing deaths among individuals with HIV who are beginning treatment.14 [Back to top]
	HIV Stage 4: Progression of HIV to AIDS Pathophysiology: As the immune system becomes more and more damaged, the individual may develop increasingly severe opportunistic infections and cancers, leading eventually to an AIDS diagnosis. In adults and children older than 5, the preogression to AIDS is diagnosed when the CD4 count is less than 200 cells/mm3 and the individual becomes highly susceptible to life-threatening infections (bacterial, viral, fungal) as well as cancers (especially Kaposi sarcoma and non-Hodgkin lymphoma). Some common life threatening conditions associated with AIDS: PCP A lung infection that causes pneumonia. Toxoplasmosis An infection that affects the brain, causing headaches and vomiting. CMV A viral infection of the eye that can cause blindness. MAC An infection of the GI system. Other common opportunistic infections Tuberculosis An infection of the lungs that progresses rapidly in individuals with HIV Kaposi sarcoma A cancer that causes blue lesions on the skin. Back to top Next Page: Etiology Back to main page Good job! #2 is correct. HIV antibody tests may be negative because the body has not yet undergone seroconversion (antibody development), although the virus is present in the body if infection has already occured. The risk of transmission is the highest at this time because of the spike in the viral load (amount of virus in the blood). Back to question. Sorry, wrong answer. Try again. :) Next Page: Etiology Back to Main Page