What are HIV and AIDS?
HIV (human immunodeficiency virus) is a chronic, retroviral infection that requires daily medication for life. HIV-1 is the retrovirus recognized as the etiologic agent of AIDS. HIV-2 is a related retrovirus identified in 1986 in AIDS patients in West Africa.
Classification
Staging rests on clinical history, exam, lab evidence of immune dysfunction, and the infections and malignancies present.
Primary (acute) infection runs from the moment of infection to the development of HIV-specific antibodies. Once the viral set point is reached, the patient enters the asymptomatic chronic stage (CDC Category A), in which the immune system cannot clear the virus. Category B covers symptomatic conditions not listed in Category C. AIDS (Category C) is diagnosed when CD4+ T-cell count drops below 200 cells/mm3 or a Category C condition appears.
Pathophysiology
HIV integrates itself directly into the immune system, which is why the infection is lifelong. GP120 and GP41 glycoproteins bind the host CD4+ receptor and a chemokine coreceptor (usually CCR5), fusing the virus to the CD4+ T-cell membrane and emptying the viral core into the cell. Reverse transcriptase converts viral RNA into double-stranded DNA, and integrase splices that viral DNA into the host genome, producing permanent infection. When the CD4+ T cell activates, the integrated DNA generates messenger RNA that builds new viral proteins and enzymes. HIV protease cleaves the polyprotein chain into individual proteins, the new virions migrate to the cell membrane, exit, and repeat the cycle.
Statistics and Epidemiology
In the fall of 1982, after the first 100 cases were reported, the CDC issued a case definition for AIDS. Globally, UNAIDS estimated about 40.8 million people were living with HIV in 2024, with roughly 1.3 million new infections that year, a 40 percent drop in new infections since 2010 (UNAIDS). Women and girls make up about 53 percent of people living with HIV, and sub-Saharan Africa still carries the heaviest burden. In the United States, the CDC estimates about 31,800 people acquired HIV in 2022, down from 36,200 in 2018, and more than 1.2 million people are living with HIV (CDC). Older counts of roughly 33 million people living with HIV and about 56,300 new US infections a year reflect the mid-2000s, before the scale-up of antiretroviral therapy and prevention.
Causes
HIV transmits through body fluids carrying free virions and infected CD4+ T cells: sharing contaminated needles or drug equipment, sexual contact with an infected partner, transfusion of infected blood or blood products (especially before screening), and perinatal transmission from an infected mother to her infant.
Clinical Manifestations
Manifestations track the four stages. Early infection produces an acute retroviral syndrome. Category B reflects the chronic symptomatic stage. Constitutional symptoms, fever above 38.5°C or diarrhea lasting more than 1 month, point to active HIV disease. Category C patients develop wasting syndrome with severe muscle loss.
Prevention
Until an effective vaccine exists, prevention is teaching. Other than abstinence, consistent and correct condom use is the only effective way to cut sexual transmission. In March 2007, based on three clinical trials, the WHO and UNAIDS recognized male circumcision as an effective strategy to reduce HIV acquisition in men. Patients should avoid sexual contact with multiple partners, known HIV-positive partners, or injection drug users, and HIV-positive or injection-drug-using patients must not donate blood or share drug equipment.
Complications
Watch for opportunistic infection, the defining danger in an immunosuppressed patient. Pneumocystis pneumonia (PCP) was once an extremely common AIDS-defining illness in untreated advanced HIV; it remains the most frequent serious opportunistic infection but is now far less common with antiretroviral therapy and prophylaxis. Impaired breathing can progress to respiratory and cardiac failure. Wasting syndrome, involuntary weight loss exceeding 10% of baseline body weight, is a common complication of HIV and AIDS.
Assessment and Diagnostic Findings
AIDS is not officially diagnosed until CD4+ T-cell count falls below 200 cells/mcl or an associated clinical condition appears. CBC shows anemia (in up to 85% of AIDS patients, sometimes profound) and idiopathic thrombocytopenia; leukopenia may be present, with a left shift suggesting an infectious process such as PCP. PPD determines TB exposure or active disease; 100% of AIDS patients exposed to active Mycobacterium tuberculosis will develop the disease. ELISA screens serum antibody; a positive result indicates exposure but is not diagnostic because of false positives. Western blot confirms HIV in blood and urine.
Viral load testing drives therapy decisions. RT-PCR detects viral RNA as low as 50 copies/mL of plasma up to an upper limit of 75,000 copies/mL; the bDNA 3.0 assay covers a wider range of 50 to 500,000 copies/mL and is the leading indicator of treatment effectiveness. Total T-lymphocyte count is reduced. CD4+ count below 200 indicates severe immune deficiency and a diagnosis of AIDS. A reversed T8+ to T4+ ratio (2:1 or higher) indicates immune suppression. PCR for HIV-DNA is most helpful in newborns of HIV-infected mothers, who carry maternal antibodies and test positive by ELISA and Western blot even when uninfected.
STD screening (hepatitis B envelope and core antibodies, syphilis, and other common STDs) may be positive. Cultures of urine, blood, stool, spinal fluid, lesions, sputum, and secretions identify opportunistic organisms: protozoal and helminthic (PCP, cryptosporidiosis, toxoplasmosis); fungal (Candida albicans, Cryptococcus neoformans, Histoplasma capsulatum); bacterial (Mycobacterium avium-intracellulare and CMV both occur with CD4 counts less than 50, plus miliary mycobacterial TB, Shigella, Salmonella); and viral (CMV, herpes simplex, herpes zoster). Neurologic studies (EEG, MRI, CT of the brain, EMG/nerve conduction) evaluate altered mentation, fever of undetermined origin, or sensory and motor changes. Chest x-ray may be normal early or show progressive interstitial infiltrates from advancing PCP or TB. Pulmonary function tests detect early interstitial pneumonia, and a gallium scan shows diffuse pulmonary uptake in PCP. Biopsy differentiates Kaposi's sarcoma and other neoplastic lesions. Bronchoscopy with tracheobronchial washings and biopsy confirms PCP or lung malignancy. Barium swallow, endoscopy, and colonoscopy identify GI opportunistic infection or stage Kaposi's sarcoma.
Medical Management
Management targets opportunistic infections. For Pneumocystis pneumonia, TMP-SMZ is the treatment of choice; for Mycobacterium avium complex, azithromycin or clarithromycin are the preferred prophylactic agents; for cryptococcal meningitis, IV amphotericin B is the primary treatment. TMP-SMZ also serves as prophylaxis. Octreotide acetate (Sandostatin), a synthetic somatostatin analog, controls severe chronic diarrhea. Depression is treated with psychotherapy plus imipramine, desipramine, or fluoxetine. For unexplained weight loss, obtain calorie counts and add appetite stimulants and oral supplements.
Nursing Management
Any organ system can become the target of infection or cancer, which makes this nursing challenging.
Nursing Assessment
Identify risk factors including risky sexual practices and injection drug use. Assess nutritional status with a diet history and the factors limiting oral intake. Inspect skin and mucous membranes daily for breakdown, ulceration, or infection. Monitor respiratory status for cough, sputum, dyspnea, orthopnea, tachypnea, and chest pain. Check neurologic status (level of consciousness; orientation to person, place, and time; memory). Assess fluid and electrolyte balance through skin and mucous membrane turgor and dryness, and gauge the patient's knowledge of the disease and its transmission.
Diagnosis
Common diagnoses include impaired skin integrity related to cutaneous HIV manifestations, excoriation, and diarrhea; diarrhea related to enteric pathogens; risk for infection related to immunodeficiency; activity intolerance related to weakness, fatigue, malnutrition, impaired fluid and electrolyte balance, and hypoxia; disturbed thought processes related to HIV encephalopathy; ineffective airway clearance related to PCP, increased secretions, and weak cough; pain related to perianal breakdown, Kaposi's sarcoma, and peripheral neuropathy; and imbalanced nutrition, less than body requirements, related to decreased oral intake.
Planning & Goals
Goals include intact skin, a usual bowel pattern, absence of infection and complications, improved activity tolerance and thought processes, clear airway, comfort, improved nutrition, increased socialization, prevention of new infections, maintained homeostasis, psychosocial support, and patient understanding of the disease and treatment.
Nursing Interventions
Protect skin integrity: discourage scratching, use nonabrasive, nondrying soaps and nonperfumed moisturizers, give regular oral care, and clean the perianal area after each bowel movement. Monitor stool frequency and consistency and any abdominal pain. Watch for signs of infection and abnormal labs. Plan daily routines that balance activity and rest. Have the family speak in simple, clear language and allow time to respond. For airway clearance, provide coughing, deep breathing, postural drainage, percussion, and vibration as often as every 2 hours to prevent stasis of secretions. Relieve pain with soft cushions, foam pads, and prescribed NSAIDs and opioids. Encourage foods that are easy to swallow and avoid rough, spicy, and sticky items.
Evaluation
Expected outcomes: maintained skin integrity, usual bowel pattern, absence of infection and complications, improved activity tolerance and thought processes, clear airway, increased comfort, improved nutrition, and increased socialization.
Discharge and Home Care Guidelines
Teach the patient and family to prevent transmission, including handwashing and safe handling and disposal of items soiled with body fluids. Advise avoiding exposure to others who are sick or recently vaccinated. Teach caregivers to administer medications, including IV preparations. Assess adherence to the regimen and suggest strategies to support it. Confirm that infection is prevented or resolved, complications minimized, pain controlled, the patient is coping realistically, the diagnosis and regimen are understood, and a plan is in place for needs after discharge.
Documentation Guidelines
Document lesion or condition characteristics; the impact on self-image and lifestyle; assessment findings including elimination pattern; risk factors including current antibiotic therapy; signs of infection; breath sounds, secretions, and use of accessory muscles; caloric intake; cultural or religious restrictions and preferences; the plan and teaching plan; response to interventions; progress toward outcomes; modifications to the plan; and long-term needs.
Frequently Asked Questions
What is the difference between HIV and AIDS? HIV is the virus that attacks CD4+ T cells. AIDS is the most advanced stage, diagnosed when the CD4+ count drops below 200 cells/mm3 or an AIDS-defining (Category C) opportunistic illness appears. Not everyone with HIV develops AIDS, especially on consistent treatment.
What does the CD4 count tell you? It measures immune function. A normal count is well above 500; below 200 signals severe immunosuppression and an AIDS diagnosis. The CD4 count guides when to start prophylaxis against opportunistic infections, while viral load tracks how well treatment is working.
How does HIV spread? Through specific body fluids carrying the virus: unprotected sexual contact, sharing needles or injection equipment, transfusion of infected blood (rare now with screening), and from mother to infant during pregnancy, birth, or breastfeeding. It does not spread through casual contact.
Can HIV be prevented? Yes. Consistent and correct condom use, sterile injection equipment, and not sharing drug equipment reduce risk. Pre-exposure prophylaxis (PrEP) and treatment that suppresses viral load to undetectable levels (which means it is untransmittable sexually) are now central prevention tools (CDC).
Why are people with HIV at risk for opportunistic infections? HIV destroys CD4+ T cells, so the immune system loses the ability to control organisms it normally would. As the CD4 count falls, the risk of infections like Pneumocystis pneumonia, candidiasis, and cytomegalovirus rises, which is why prophylaxis is started at specific count thresholds.
Is HIV still common? Globally about 40.8 million people were living with HIV in 2024, with roughly 1.3 million new infections that year (UNAIDS). In the US about 31,800 people acquired HIV in 2022 (CDC). Antiretroviral therapy has turned HIV into a manageable chronic condition for people who can access and stay on treatment.