11 AIDS (HIV Positive) Nursing Care Plans

AIDS is what HIV does to an immune system left untreated: it strips out the CD4+ helper T cells until ordinary organisms turn lethal. Most of your work happens at the edges of that collapse. You are managing opportunistic infections, wasting, diarrhea, skin breakdown, neuro changes, and pain, while the patient carries a diagnosis that still draws stigma and isolation. Antiretroviral therapy is the spine of treatment, and adherence is the single factor that decides trajectory. Everything else supports the patient long enough for the drugs to work.

What is HIV and AIDS?

Acquired immunodeficiency syndrome (AIDS) is a severe secondary immunodeficiency caused by the retrovirus HIV. The virus progressively destroys cell-mediated (T-cell) immunity, and because CD4+ helper T cells are central to immune reactions, humoral (B-cell) immunity suffers too. The result is susceptibility to opportunistic infections, unusual cancers, and other abnormalities.

HIV comes in two forms, HIV-1 and HIV-2. Both share the same transmission routes and similar opportunistic infections, but HIV-2 progresses more slowly and presents with milder symptoms. Transmission occurs through contact with infected blood or body fluids and tracks with identifiable high-risk behaviors: men who have sex with men, injection drug users, recipients of infected blood or blood products, heterosexual partners of an infected person, and children born to an infected mother. Infection rates rise fastest among minority women.

There is no cure for HIV or AIDS, but antiretroviral therapy controls symptoms and delays progression, and a patient on effective treatment can live a near-normal lifespan.

Nursing Care Plans and Management

Care centers on slowing disease progression, managing symptoms, lowering the risk of infection and complications, holding the patient to the medication regimen, and supplying emotional and social support. Education for the patient and family covers transmission, prevention, and the stigma the patient is likely to face.

Nursing Problem Priorities

• Initiate and support antiretroviral therapy (ART).
• Monitor and manage opportunistic infections.
• Address coexisting conditions and promote preventive screenings.
• Support treatment adherence and retention in care.
• Provide psychosocial support and risk-reduction education.

Nursing Assessment

Assess for persistent or recurrent fever, profound unexplained fatigue, rapid weight loss with anorexia, chronic diarrhea, night sweats, and swollen lymph nodes in the armpits, groin, or neck. Watch for persistent cough, dyspnea, and recurrent infections (pneumonia, tuberculosis, fungal infections), along with skin rashes, sores, or lesions. Neurological signs include memory loss, confusion, and difficulty concentrating. Also note recurrent vaginal yeast infections, oral thrush, unexplained pain, and visual changes.

Nursing Diagnosis

After assessment, the nurse formulates diagnoses based on the patient's condition. Clinical judgment, not the diagnostic label, drives the care plan.

Nursing Goals

• The patient maintains weight or gains toward the desired goal, shows positive nitrogen balance, and reports improved energy.
• The patient performs ADLs with assistance as needed and participates in desired activities at the level of ability.
• The patient reports relief or control of pain.
• The patient shows improvement in wound or lesion healing and demonstrates techniques to prevent skin breakdown.
• The patient maintains intact oral mucous membranes, pink and moist, and demonstrates techniques to keep them that way.
• The patient maintains usual reality orientation and optimal cognitive function.
• The patient verbalizes awareness of feelings, shows a lessened fear and anxiety, and uses available resources.
• The patient verbalizes a sense of control over the situation and stays involved in self-care.
• The patient maintains hydration, evidenced by moist mucous membranes, good skin turgor, stable vital signs, and adequate urinary output, and shows no signs of bleeding.
• The patient stays afebrile and free of purulent drainage and other signs of infection.

Nursing Interventions and Actions

1. Promoting Adequate Nutrition and Hydration

HIV impairs nutrient absorption, and opportunistic infections, diarrhea, and GI disease push the patient toward malnutrition, weight loss, and fluid imbalance. Manage intake through diet, oral supplements, and IV fluids when oral intake fails.

Assess the patient's ability to chew, taste, and swallow. Lesions of the mouth, throat, and esophagus (candidiasis, herpes simplex, hairy leukoplakia, Kaposi's sarcoma) and medication-related taste changes cause dysphagia and reduce the desire to eat.

Auscultate bowel sounds. Hypermotility is common and pairs with vomiting and diarrhea. Lactose intolerance and malabsorption (with CMV, MAC, and cryptosporidiosis) worsen diarrhea and may force a change in diet or supplemental formula.

Weigh as indicated and compare against premorbid weight and serial measurements. Because immunosuppression skews many nutritional blood tests, weight is a primary indicator of intake adequacy.

Note drug side effects. ZDV causes altered taste, nausea, and vomiting; Bactrim causes anorexia, glucose intolerance, and glossitis; Pentam alters taste and smell; protease inhibitors raise lipids and blood sugar through insulin resistance.

Record ongoing caloric intake. Identifies the need for supplements or alternative feeding.

Plan the diet with the patient and SO. Offer small, frequent meals of nutritionally dense, non-acidic foods, and serve the largest meal when appetite is best. Including the patient gives a sense of control and improves intake; higher-fat foods may be encouraged as tolerated to boost taste and calories.

Limit foods that trigger nausea or are hard to tolerate with mouth sores or dysphagia. Avoid very hot foods and liquids. Serve foods that are easy to swallow, like eggs, ice cream, and cooked vegetables.

Schedule medications between meals and limit fluids with meals unless the fluid has nutritional value. Gastric fullness blunts appetite.

Provide frequent mouth care, observing secretion precautions, and avoid alcohol-containing mouthwashes. A clean mouth reduces nausea-related discomfort and improves appetite.

Provide a rest period before meals and avoid stressful procedures near mealtime. Conserves the energy needed for eating and reduces nausea.

Encourage the patient to sit up for meals. Eases swallowing and lowers aspiration risk.

Maintain NPO status or insert a nasogastric tube when indicated. An NG tube may reduce vomiting or deliver feedings, but use it cautiously: esophageal infection (Candida, herpes, KS) can seed secondary infection or trauma.

Administer vitamins, antiemetics, appetite stimulants, antidiarrheals, TNF-alpha inhibitors, and sucralfate suspension as ordered. See Pharmacologic Management.

Monitor vital signs, including CVP, and note hypotension or postural changes. Indicators of circulating fluid volume.

Note fever and its duration; give tepid sponge baths and keep linens dry. Fever affects roughly 97% of patients with HIV infection, and the resulting diaphoresis drives insensible fluid loss and dehydration.

Assess skin turgor, mucous membranes, and thirst. Indirect indicators of fluid status.

Measure urinary output and specific gravity, and estimate diarrheal and insensible losses. Rising specific gravity and falling output reflect reduced renal perfusion and volume.

Monitor oral intake and encourage fluids of at least 2500 mL/day. Maintains fluid balance and keeps mucous membranes moist.

Monitor serum and urine electrolytes, BUN/Cr, and stool specimens. Flags electrolyte disturbances and gauges renal function; bowel flora shifts with antibiotic therapy.

Make tolerable fluids easily accessible. Acidic juices may be too painful with mouth lesions; replace needed electrolytes.

Eliminate foods that potentiate diarrhea and use lactose-free products in lactose-intolerant patients. Reduces diarrhea.

Encourage live-culture yogurt or OTC Lactobacillus acidophilus (Lactaid). Restores bowel flora disrupted by antibiotics. Give 2 hr before or after the antibiotic so the live culture is not inactivated.

Maintain a hypothermia blanket if used, and give fluids and electrolytes by feeding tube or IV as needed. Necessary when other measures fail to control fever or when oral intake cannot keep up with losses.

2. Managing Fatigue and Weakness

Fatigue tracks with the disease itself, medication side effects, anemia, depression, anxiety, and poor sleep. Chronic inflammation and immune activation add to it.

Assess sleep patterns and note changes in thought processes and behavior. Sleep deprivation, emotional distress, drug and chemotherapy effects, and developing CNS disease all aggravate fatigue.

Monitor physiologic response to activity: changes in BP, respiratory rate, or heart rate. Tolerance varies with disease stage, nutrition, fluid balance, and the burden of opportunistic disease.

Schedule activities for high-energy periods and build in rest. Involve the patient and SO in planning. Activity during peak energy restores a sense of well-being and control.

Set realistic activity goals and encourage self-care, sitting up, and short walks. Conserves strength and builds stamina without undue fatigue.

Identify energy-conservation techniques: break ADLs into segments, keep walkways clear, and assist with ambulation as needed. Weakness can make ADLs nearly impossible and raises injury risk.

Encourage nutritional intake. HIV drives a hypermetabolic state, so adequate nutrients are needed to meet activity demands.

Provide supplemental O2 as indicated. Anemia or hypoxemia reduces oxygen for cellular uptake and worsens fatigue.

Refer to physical or occupational therapy and to community resources. Programmed exercise maintains strength and muscle tone; community services help as self-care becomes harder.

3. Promoting Skin Integrity

Immunodeficiency raises the risk of skin infection, slows healing, and invites fungal infections and rashes. Skincare and infection prevention protect integrity.

Assess skin daily, noting color, turgor, circulation, and sensation; measure lesions and photograph if needed. Establishes a comparative baseline for timely intervention.

Obtain cultures of open skin lesions. Identifies pathogens and guides treatment.

Maintain good skin hygiene: wash thoroughly, pat dry, and gently massage with lotion. Patting instead of rubbing protects fragile skin; massage improves circulation. Isolation precautions apply with extensive or open cutaneous lesions.

Reposition frequently, encourage weight shifts, and protect bony prominences with pillows, heel and elbow pads, and sheepskin. Reduces pressure-point stress and promotes healing.

Keep linens clean, dry, and wrinkle-free, preferably soft cotton. Friction from wet or wrinkled sheets irritates fragile skin and raises infection risk.

Encourage ambulation as tolerated. Decreases skin pressure from prolonged bed rest.

Cleanse the perianal area by removing stool with water and mineral oil, and apply zinc oxide or A&D ointment. Prevents maceration from diarrhea; avoid toilet paper over vesicles, which can abrade lesions.

File nails regularly. Long, rough nails increase dermal damage.

Cover open pressure ulcers with sterile dressings or a protective barrier (Tegaderm, DuoDerm). Reduces bacterial contamination and promotes healing.

Provide foam, flotation, or alternating-pressure mattresses. Reduces pressure on skin and lesions, decreasing tissue ischemia.

Apply prescribed topical medications and cover ulcerated KS lesions with wet-to-wet dressings or antibiotic ointment and nonstick dressing. Treats lesions and protects ulcerated areas; avoid cross-contamination with multidose ointments.

4. Managing Acute and Chronic Pain

Pain comes from the virus acting on the nervous system, from HIV-related infections and inflammation, and from antiretroviral side effects. Painful neuropathy and infection drive acute episodes.

Assess pain reports, noting location, intensity (0 to 10 scale), frequency, and onset, plus nonverbal cues like restlessness, tachycardia, and grimacing. Chronic pain produces no autonomic changes, but acute and chronic pain can coexist.

Encourage the patient to report pain early rather than waiting until it is severe. Timely intervention works better.

Encourage verbalization of feelings. Reduces anxiety and the perceived intensity of pain.

Provide diversional activities and palliative measures: repositioning, massage, and ROM of affected joints. Refocuses attention, promotes relaxation, and decreases muscle tension.

Teach visualization, guided imagery, progressive relaxation, deep breathing, meditation, and mindfulness. May reduce the need for CNS-depressant narcotics; less effective with dementia.

Provide oral care. Oral ulcers and lesions cause severe discomfort.

Apply warm, moist packs to pentamidine injection and IV sites for 20 min after administration. These injections cause pain and sterile abscesses.

Administer analgesics, antipyretics, and narcotic analgesics; use PCA or around-the-clock dosing with PRN rescue. Stable blood levels prevent cyclic under- and overmedication. Ativan may potentiate analgesic effects.

5. Maintaining Oral Mucous Membrane Integrity

Immune suppression invites oral thrush (Candida), ulcers, and viral lesions like herpes simplex. Oral hygiene, antifungal or antiviral treatment, and dental care preserve oral health.

Assess mucous membranes and document all oral lesions, noting pain, swelling, and trouble chewing or swallowing. Edema, open lesions, and crusting cause pain and feeding difficulty.

Obtain culture specimens of lesions. Reveals causative agents and guides therapy.

Provide oral care daily and after meals with a soft toothbrush, non-abrasive toothpaste, non-alcohol mouthwash, floss, and lip moisturizer. Eases discomfort and prevents acid formation from retained food.

Rinse oral lesions with saline and dilute hydrogen peroxide or baking soda solution. Reduces spread of lesions and encrustations and promotes comfort.

Suggest sugarless gum or candy. Stimulates saliva to neutralize acids and protect mucous membranes.

Avoid salty, spicy, abrasive, and acidic foods; check temperature tolerance and offer cool, smooth foods. Abrasive or extreme-temperature foods reopen and aggravate healing lesions.

Encourage oral intake of at least 2500 mL/day. Maintains hydration and prevents drying of the oral cavity.

Encourage the patient to stop smoking. Smoke dries and irritates mucous membranes.

Administer nystatin (Mycostatin), ketoconazole (Nizoral), and a TNF-alpha inhibitor such as thalidomide as ordered, and refer for dental consultation. Targets oral infection and prevents dental loss.

6. Improving Mental Status and Thought Process

CNS involvement and the psychological weight of the diagnosis produce cognitive impairment, memory difficulty, depression, and anxiety. Mental health support runs alongside physical care.

Assess mental and neurological status with appropriate tools. Sets a functional baseline at admission.

Consider emotional distress: anxiety, grief, and anger. These reduce alertness and can present as confusion, withdrawal, and hypoactivity.

Monitor the medication regimen. Prolonged drug half-life and altered excretion cause cumulative effects and toxic reactions. Haloperidol (Haldol) can seriously impair motor function in AIDS dementia complex.

Investigate changes in personality, orientation, and level of consciousness, and new headache, nuchal rigidity, vomiting, fever, or seizures. May signal opportunistic disease or CNS infection; early treatment limits permanent cognitive impairment.

Maintain a pleasant environment and provide reorientation cues: clocks, calendars, radio, an outside view, the patient's name, and consistent staff. Frequent reorientation helps during fever or acute CNS involvement, and continuity reduces anxiety.

Suggest datebooks and lists to track activities, and encourage family to reorient with current news and family events. Helps manage forgetfulness; familiar contacts support reality orientation, especially with hallucinations.

Encourage the patient to dress, groom, and see friends. Maintains mental ability longer.

Support the SO and encourage discussion of concerns and fears. Bizarre behavior or deterioration frightens the SO and impairs coping; stress, burnout, and anticipatory grieving compound it.

Provide ongoing information and answer questions simply and honestly, repeating as needed. Reduces fear of the unknown and improves cooperation.

Reduce noxious stimuli and maintain a quiet, safe environment: keep the call bell within reach, bed low with rails up, smoking monitored, seizure precautions, and soft restraints if indicated. Limits agitation and provides security in a confusing situation. Decreasing night noise promotes sleep and reduces cognitive symptoms.

Discuss prognosis and treatment if dementia is diagnosed, using concrete terms. ZDV has been shown to improve cognition, which can give the patient hope and a sense of control.

Administer antiretroviral, anti-anxiety, and antipsychotic medications as ordered, and refer to counseling. See Pharmacologic Management. Counseling helps the patient regain control with thought disturbances or psychotic symptoms.

7. Managing Anxiety and Providing Emotional Support

Stigma, fear of discrimination, and the burden of chronic illness drive anxiety and isolation. Education, counseling, and community engagement counter both.

Watch for withdrawal, anger, or inappropriate remarks, and assess suicidal ideation on a scale of 1 to 10. Denial, guilt, and spiritual distress can make the patient see suicide as a viable alternative. Even a patient too sick to act on ideation must be taken seriously, and intervention initiated.

Assure confidentiality within the limits of the situation. Provides reassurance and a chance to problem-solve.

Maintain frequent contact; talk with and touch the patient, and limit isolation clothing and masks. Conveys acceptance and fosters trust.

Provide accurate, consistent information about prognosis without arguing about the patient's perceptions. Reduces anxiety and supports realistic decisions.

Provide an open environment where the patient feels safe to discuss feelings or stay silent, and allow expressions of anger, fear, and despair without confrontation. Acceptance lets the patient begin to deal with the situation.

Recognize the stage of grieving for patient and family. Dictates the choice of interventions.

Explain procedures with opportunities for questions, and arrange for someone to stay during anxiety-producing procedures. Accurate information reduces fear of the known.

Identify and encourage interaction with support systems, including family and SO. Reduces isolation; outside sources may be needed when family support is absent.

Discuss advance directives and end-of-life wishes, explaining options clearly. Helps the patient and SO plan realistically; many do not understand medical terminology or options.

Refer to psychiatric counseling and spiritual or hospice support as indicated. Provides further help with diagnosis, prognosis, and suicidal thoughts, and addresses spiritual and end-of-life concerns.

Ascertain the patient's perception of the situation and watch for verbal and nonverbal cues of despair and aloneness. Acknowledging these cues usually opens the patient to talking about suicide, isolation, and hopelessness.

Spend time with the patient during and between care, treating them with dignity. Counters the physical isolation of medical status and the social isolation tied to the diagnosis.

Limit masks, gowns, and gloves when possible, and explain isolation precautions to patient and SO. Barriers are required only for contact with secretions or excretions; misuse deepens emotional and physical isolation.

Encourage open visitation, telephone contact, and social activity within tolerance. Participation fosters belonging and lessens the likelihood of suicide attempts.

Develop an action plan with the patient: review resources, support healthy behaviors, and problem-solve around imposed isolation. A plan gives a sense of control and something to work toward.

Identify contributors to powerlessness: a terminal diagnosis, lack of support, and lack of knowledge. Powerlessness is most prevalent in newly diagnosed patients and in those dying of AIDS. Fear of AIDS, in the public and the family, is the most profound cause of the patient's isolation.

Assess feelings of helplessness: flat affect, lack of communication, expressions of no control. Determines when depressed feelings have immobilized the patient.

Encourage an active role in planning and set realistic daily goals, identifying what the patient can and cannot control. Builds feelings of control and self-worth.

Encourage a living will and durable medical power of attorney with precise instructions on acceptable and unacceptable measures. Protects the patient's wishes when others may otherwise make decisions for them.

Discuss and assist with funeral planning as appropriate. Involvement gives a sense of completion and lets the patient include what matters to them.

8. Promoting Safety and Preventing Injury

Thrombocytopenia and clotting disturbances make spontaneous bleeding a real threat. Safety measures protect the patient from bleeding and injury.

Report epistaxis, hemoptysis, hematuria, non-menstrual vaginal bleeding, or oozing from lesions, orifices, or IV sites. Spontaneous bleeding may signal DIC or immune thrombocytopenia.

Monitor vital signs and skin color: BP, pulse, respirations, pallor, and discoloration. Bleeding and hemorrhage can progress to circulatory failure and shock.

Evaluate changes in level of consciousness. May reflect cerebral bleeding.

Hematest urine, stool, and vomitus for occult blood. Prompt detection may prevent critical hemorrhage.

Review PT, aPTT, clotting time, platelets, and Hb/Hct. Detects clotting alterations. Up to 80% of patients have a platelet count below 50,000 and may be asymptomatic, so monitor regularly.

Avoid injections, rectal temperatures, and rectal tubes, and give rectal suppositories with caution. Thermometers and rectal tubes can tear mucosa and cause bleeding.

Keep necessary objects and the call bell within reach and the bed in a low position. Reduces accidental injury that could cause bleeding.

Maintain bed or chair rest when platelets fall below 10,000. Reduces injury risk while preserving needed activity; a patient can have a surprisingly low platelet count without bleeding.

Avoid aspirin products and NSAIDs, especially with gastric lesions. They impair platelet aggregation, prolong coagulation, and worsen gastric irritation.

Administer blood products as indicated. Transfusion may be needed with persistent or massive bleeding.

9. Preventing Infection

A compromised immune system cannot fight opportunistic infection, and chemotherapy or immunosuppressants raise the risk further. Close monitoring, prophylaxis, and management of co-infections reduce it.

Assess the patient's knowledge and ability to maintain the opportunistic-infection prophylactic regimen. Long, complex regimens are hard to sustain; self-adjustment based on side effects leads to inadequate prophylaxis, active disease, and resistance.

Assess respiratory rate and depth; note dry spasmodic cough, sputum changes, wheezes, or rhonchi, and start respiratory isolation when the cause of a productive cough is unknown. Congestion may signal developing PCP, but TB is rising and other infections can compromise the lungs. CMV and PCP can coexist.

Investigate headache, stiff neck, altered vision, and changes in mentation, and monitor for nuchal rigidity and seizures. Neurological abnormalities are common and may be HIV-related or from secondary CNS infection (encephalitis most often).

Examine skin and oral mucous membranes for white patches or lesions. Oral candidiasis, KS, herpes, CMV, and cryptococcosis commonly affect the cutaneous membranes.

Monitor vital signs, including temperature. New or frequent fever signals a new infectious process or that medications are not controlling existing infection.

Monitor for heartburn, dysphagia, retrosternal pain on swallowing, abdominal cramping, and profuse diarrhea. Esophagitis may follow oral candidiasis, CMV, or herpes. Cryptosporidiosis causes watery diarrhea, often more than 15L/day.

Inspect wounds and invasive-device sites for local inflammation and infection. Early treatment of secondary infection may prevent sepsis.

Wash hands before and after all care contacts and teach the patient and SO to do the same. Reduces cross-contamination.

Provide a clean, well-ventilated environment, screen visitors and staff for infection, and maintain isolation precautions. Reduces the pathogen load and nosocomial infection risk.

Clean the patient's nails frequently; file rather than cut, and avoid trimming cuticles. Breaks in the skin transmit pathogens, and fungal nail infections are common.

Wear gloves and gowns for direct contact with secretions and excretions or breaks in the caregiver's skin, and add a mask and eye protection when splattering may occur. Required for contact with sputum, blood and blood products, semen, and vaginal secretions.

Dispose of needles and sharps in rigid, puncture-resistant containers. Prevents accidental inoculation. Do not recap needles; report needlesticks immediately, with followup evaluation per protocol.

Label and bag blood, body-fluid containers, soiled dressings, and linens per isolation protocol. Prevents cross-contamination and triggers hazardous-materials handling.

Clean spills of blood or body fluids with a 1:10 bleach solution, and add bleach to laundry. Kills HIV and controls surface microorganisms.

10. Initiating Patient Education and Health Teachings

Gaps in knowledge about transmission, treatment, and resources drive poor adherence, infection, and worse outcomes.

Review the disease process and future expectations. Gives the patient a base for informed choices.

Determine the level of independence, physical condition, and available family or caregiver support. Plans the amount of care and additional resources needed.

Review transmission routes, especially if newly diagnosed. Corrects myths and promotes safety for the patient and others.

Identify signs requiring medical evaluation: persistent fever and night sweats, swollen glands, continued weight loss, diarrhea, skin lesions, headache, chest pain, and dyspnea. Early recognition prevents progression to life-threatening complications.

Teach infection control: handwashing for everyone, gloves for bedpans, dressings, and soiled linens, a mask if the patient has a productive cough, soiled linens bagged and washed separately in hot water, surfaces cleaned with a 1:10 bleach and water solution, the toilet and bedpan disinfected with full-strength bleach, food prepared in a clean area, and dishes washed in hot soapy water. Reduces transmission while immune control of flora is reduced.

Stress daily skin care: inspect skin folds, pressure points, and perineum, and apply protective ointments and padding. Healthy skin is a barrier to infection.

Confirm the patient or SO can perform oral and dental care, and encourage regular dental visits. Oral mucosa can deteriorate quickly; 65% of AIDS patients have some oral symptoms, so prevention is critical.

Review dietary needs (high-protein, high-calorie) and ways to improve intake despite anorexia, diarrhea, weakness, and depression. Supports healing and the immune system.

Discuss the medication regimen, interactions, and side effects. Increases the probability of success with therapy.

Provide symptom-management tips, such as taking diphenoxylate (Lomotil) before a social event for intermittent diarrhea. Gives the patient control and reduces the risk of embarrassment.

Stress adequate rest and activity at a tolerated level. Rest manages fatigue; activity stimulates endorphin release and a sense of well-being.

Stress continued healthcare and followup, and recommend smoking cessation. Followup allows the regimen to track changing needs; smoking raises respiratory infection risk and further impairs immunity.

Identify community resources: hospice and residential care, visiting nurses, home care, Meals on Wheels, and peer support. Eases the transfer from acute care to recovery, independence, or end-of-life care.

11. Administering Medications and Pharmacologic Support

Beyond antiretroviral therapy, patients with AIDS need medications for specific symptoms and complications: prophylactic antibiotics, antifungals, antivirals for co-infections, and drugs for vomiting, anemia, pain, or mental health disorders.

Antiemetics: prochlorperazine (Compazine), promethazine (Phenergan), trimethobenzamide (Tigan). Reduce nausea and vomiting and improve oral intake.

Sucralfate (Carafate) suspension; a mixture of Maalox, diphenhydramine (Benadryl), and lidocaine (Xylocaine). Given with meals (swish and hold) to relieve mouth pain; may be swallowed for pharyngeal or esophageal lesions.

Vitamin supplements. Correct deficiencies from poor intake or malabsorption. Avoid megadoses; the suggested supplemental level is 2 times the recommended daily allowance (RDA).

Appetite stimulants: dronabinol (Marinol), megestrol (Megace), oxandrolone (Oxandrin). Marinol (an antiemetic) and Megace (an antineoplastic) stimulate appetite in AIDS; Oxandrin is under study to boost appetite, muscle mass, and strength.

TNF-alpha inhibitors: thalidomide. Reduces elevated tumor necrosis factor that drives wasting and cachexia. Studies show a mean weight gain of 10% over 28 wk of therapy, and it treats oral lesions from recurrent stomatitis.

Antidiarrheals: diphenoxylate (Lomotil), loperamide (Imodium), octreotide (Sandostatin). Slow GI motility. Imodium and Sandostatin treat secretory diarrhea effectively.

Antifungal and antibiotic therapy: ketoconazole (Nizoral), fluconazole (Diflucan), nystatin (Mycostatin). Treat and prevent GI and other infections; drug choice depends on the infecting organism, such as Candida.

ZDV (Retrovir) and other antiretrovirals, alone or in combination. Improve neurological and mental functioning for a period of time.

Antipsychotics: haloperidol (Haldol); antianxiety agents: lorazepam (Ativan). Cautious use helps with sleeplessness, emotional lability, hallucinations, suspiciousness, and agitation.