People living with HIV/AIDS face many challenges daily. These challenges are concerned not only with health problems but also with negative attitudes, stigma, and other unpleasant reactions. While all HIV patients have some common issues and health complications, every case is different, and every population group has some specific problems. Women living with AIDS may have difficulties connected with mental and reproductive health, as well as various depressive disorders.
The paper consists of three major parts: introduction incorporating literature research based on scholarly articles from peer-reviewed journals, a case study, and a conclusion. A case study has been performed for six months and includes the previous data on the patient who was diagnosed with HIV four years ago. The conclusion section shall discuss the progression of the patient’s disease, identify the possible etiologies, and predict the outcomes of the disease in the patient.
Defining HIV/AIDS and HIV Life Cycle
HIV (human immunodeficiency virus) is a virus that attacks a person’s immune system and progressively destroys it by harming and killing CD4 cells (“The HIV life cycle,” 2016). These cells perform a crucial function in protecting the organism; therefore, the reduction of CD4 cells is very dangerous. HIV multiplies the CD4 cells and distributes them throughout the person’s organism. This process is comprised of seven stages and is called the HIV life cycle. The following stages compose the HIV: (1) binding, (2) fusion, (3) reverse transcription, (4) integration, (5) replication, (6) assembly, and (7) budding (“The HIV life cycle,” 2016). At the initial stage, the virus bunds itself to the CD4 cell molecules: CD4 receptors and coreceptors CXCR4 or CCR5. During the second stage, the CD4 cell membrane fuses with the HIV envelope. In the third stage, HIV enzymes are formed and used to combine with the CD4 cell nuclei. The fourth stage is characterized by HIV protruding the viral DNA into the DNA of CD4 cells. At the fifth stage, HIV forms long chains of HIV proteins. During the sixth stage, new HIV proteins drift to the cell surface and gather into noninfectious HIV. The last stage in the HIV life cycle causes the damage of long protein chains and is characterized by HIV proteins’ activity aimed at forming infectious HIV (“The HIV life cycle,” 2016).
The final phase of HIV is AIDS (acquired immunodeficiency syndrome). HIV-infected people are diagnosed with AIDS when their CD4 count becomes less than 200 cells/mm3. If such patients do not receive proper treatment, their average life expectancy is nearly three years (“The HIV life cycle,” 2016).
HIV/AIDS: Epidemiology, Pathogenesis, and Treatment
HIV in the core reason of the world burden of disease (Maartens, Celum, & Lewin, 2014). In 2010, it was the major agent of the global disability-adjusted years in people between 30 and 44 years old. Moreover, HIV is the fifth major agent for people of all ages. Death rates have decreased in the last ten years (from 2,3 million in 2005 to 1,6 million in 2012) (Maartens et al., 2014). However, the rates are still very high, and they are not connected with the countries’ income rates. Nearly fifty percent of death cases in patients on antiretroviral therapy in developed countries were not caused by AIDS. The crucial agents of death in people on retroviral therapy are liver disease, cardiovascular disease, and non-AIDS-defining cancers (Maartens et al., 2014). The risk of myocardial infarctions is fifty percent higher in HIV-infected people than in people without HIV. What concerns low-income countries, the core reason of mortality there is tuberculosis, which often remains undiagnosed (Maartens et al., 2014).
HIV-1, the most damaging infection, may be imposed by various host and viral components (Naif, 2013). HIV pathogenesis is most severely impacted by cellular tropism which outlines the receptor-coreceptors and viral phenotype. These factors, in their turn, establish viral entry into different types of cells (Naif, 2013). Thus, this is the most usual pattern for disease development.
The most dangerous impact of HIV is the depletion of CD4 T cells, which are responsible for the organism’s immune function. The number of these cells considerably falls when a person is impacted by direct infection. Thus, the first treatment suggested is antiretroviral therapy (Maartens et al., 2014). Other treatment methods include drug prescription for inflammation reduction. There are also prospects of the discovery of new approaches such as functional and sterilizing cure (Maartens et al., 2014). These methods will allow to control or eliminate the HIV-infected cells in the patients. They will also make it possible to reduce costs spent on current therapeutic methods (Deeks, Lewin, & Havlir, 2013).
Possible Complications and Risks Presented by HIV/AIDS
Not only is HIV a dangerous disease but it also may present dramatic complications to the people suffering from it. Risk factors that may lead to the colonization and infection of Methicillin-resistant Staphylococcus aureus (MRSA) involve antibiotic therapy, invasive medical operations, and cases of previous hospitalization (Ferreira et al., 2011). Additionally, MRSA may be caused by specific behaviors such as homelessness, imprisonment, substance abuse, and risky sexual relations.
HIV is known to affect the pulmonary system severely. The disease has a strong impact on the lungs (Benito, Moreno, Miro, & Torres, 2011). Many HIV patients have pulmonary complications in the course of their HIV history. The introduction of highly active antiretroviral therapy (HAART) and treatment with Pneumocystis jirovecii prophylaxis has caused the core modification in pulmonary infections connected with HIV. The most frequent among such infections are bacterial pneumonia, Pneumocystis pneumonia, and tuberculosis (Benito et al., 2011). Since pulmonary infections are the major reasons for mortality and morbidity among HIV-patients, it is vital to find ways of etiological diagnosis for them. The primary suggestions for diagnosing pulmonary infections include a thorough physical examination and a sufficient clinical history (Benito et al., 2011). Information obtained from the patient’s history allows one to eliminate the probable symptoms and choose an optimal treatment method.
Another danger connected with HIV is the risk of acute myocardial infarction (Freiberg et al., 2013). Having performed a prospective longitudinal cohort study, Freiberg et al. (2013) assessed the probability of acute myocardial infarction (AMI) among HIV patients. As a result of the study, the scholars concluded that HIV infection causes a fifty-percent higher risk of AMI in comparison with the patients not infected with HIV (Freiberg et al., 2013).
Peculiarities of HIV in Female Patients
According to the statistics, HIV diagnoses among females have reduced explicitly in the last decade. Annual reduction of HIV diagnoses was 20 percent from 2010 to 2014 (“HIV among women,” 2017). However, even with that reduction, the number of women infected is still high – in 2015, 7,000 females were diagnosed with HIV (“HIV among women,” 2017). The spread of the disease is disproportionate among women of divergent ethnicities. In 2014, out of all diagnosed women, 19 percent were white, 15 percent were Latin Americans and Hispanics, and 61 percent were African Americans (“HIV among women,” 2017).
Women diagnosed with HIV/AIDS may have issues, not about men. Among such issues, the acutest one is the maternity options. The Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive was implemented in 2011 (Matheson et al., 2015). This project was aimed at increasing the efforts to stop the vertical spread of HIV. The strategy employed to stop HIV transmission was called Option B+ (Matheson et al., 2015). It suggested that pregnant and breastfeeding HIV-infected females should receive a lifelong retroviral treatment. However, the suggestion did not include any variations depending on the amount of CD4 cells. Thus, Matheson et al. (2015) argue that female HIV patients should be treated by human rights and community-based support.
Middle-aged women very rarely experience the problems concerned with maternity, but they meet with other serious challenges to their health. The factors raising the possibility of an HIV infection in middle-aged women are related to climacteric symptoms, the partner’s refusal to use preservative methods during sex, sexual and global self-esteem, and altered sexual conduct of a partner (Valadares, Pinto-Neto, Abdo, & Melo, 2010). To deal with these factors, Valarades et al. (2010) propose the following interventions:
- creating a possibility for middle-aged HIV-positive women to communicate about their relationship problems and sexual function;
- encouraging these women to share their sexual behavior patterns to understand the ways of the spread of sexually transmitted diseases and prevent them;
- organizing support clubs for climacteric females where they would be encouraged to discuss their sexual health and learn to be accountable for their conduct decisions;
- arranging the combined educational programs for doctors dealing with climacteric women and those treating HIV patients (Valarades et al., 2010).
The abovementioned measures can eliminate physical risks for women and their partners. However, there is also the mental side of the problem. Women with HIV frequently experience mental disorders and depression because of their disease. Rao et al. (2012) investigated that stigma connected with HIV hurts the patients. Depressive symptoms are closely related to the quality of treatment and the level of stigma the patients’ experience (Rao et al., 2012). Depression often leads to serious mental disorders due to being overloaded with stress and not receiving sufficient support (Orza et al., 2015). Therefore, the mental health of HIV-diagnosed women is seriously damaged by the attitude of their family and friends and by treatment approaches.
The patient (S. A.) chosen for the case study is a fifty-three-year-old female who was diagnosed with HIV four years ago. S. A. was followed for six months for the present study.
The etiology of the patient’s disease was connected with having sexual intercourse with an HIV-positive partner. S. A.’s boyfriend was in denial and refused to take his medications. Unfortunately, he died six months ago. S. A. also denies any drug or alcohol use.
Pathogenesis of the patient’s disease can be best described via the history of her hospitalizations which incorporates three cases. When she was hospitalized for the first time, S. A. had general body weakness, fatigue, fever, weight loss, and loss of appetite. During the second hospitalization, the patient presented flu-like symptoms such as cough, fever, thick yellow sputum, and had difficulty breathing. S. A. was given respiratory treatment, and she was placed on complete bed rest. During the third hospitalization, the patient indicated gross pounding headaches. She developed Cryptococcus Meningitis and had surgery to implant a lumbar peritoneal shunt. The surgery was done to offset the developing hydrocephalus which caused her head to be bigger in size and her eyes to bulge outwards. S. A. was given Amphotericin B IV for seven days which removed the infection from her brain but left her with scarred tissue of the brain. The shunt was placed to drain the excess fluids through the lumbar region. Since that surgery, S. A. denies complaints of any headache.
Some other organs and tissues were affected by the disease. The patient had blisters on her vagina and top lip. Also, there were white spots in her mouth which made swallowing difficult. Additionally, S. A. had callouses on her hands which caused them to be hard and dry. Finally, the patient experienced hair loss and loss of muscle mass which made her very thin. These losses were caused by the medication Atripla which she received daily in the amount of 600 mg.
The patient met hostile reactions from some of her relatives upon admitting her state. Several people expressed scorn and resentment, and two of them are not on speaking terms with S. A. This social factor caused some depression, but the patient was able to manage it as other family members provided her with the necessary support. S. A. can function normally in society as only a few of her friends know about her disease, and she does not feel stigmatized or threatened.
S. A.’s current condition is quite satisfactory. She is physically fit and can work an eight-hour shift as a pharmacy assistant. She is also pursuing a career to become a respiratory therapist. The patient also is in good psychological form. She harbors no ill feelings or thoughts towards her boyfriend. S. A. does not have any suicidal ideation. She takes her medication as prescribed, exercises regularly, and keeps a well-balanced diet. On the last visit to her doctor, S. A. mentioned that she would like her medication plan to be changed because she wanted to gain some weight.
However, there is a danger to the patient’s health as her CD4 T cell count was 8 cells/mm3 when she last visited a hospital. Such a low count of CD4 cells means that S. A. has the final stage of HIV – AIDS. This diagnosis is rather dangerous, but in the case of S. A., she receives appropriate treatment and visits her doctor regularly. Thus, her life expectancy is quite high on the condition that she maintains taking the prescribed medicines and keeps a healthy lifestyle and diet. Since AIDS makes people vulnerable to outside infections, the patient was instructed to stay away from people with infections or colds. Also, S. A. was told about the importance of frequent hand washing and covering her nose when being outside.
The patient’s prognosis is quite positive. With the current lifestyle and attitude, she will be able to lead a normal lifestyle. If she maintains the prescribed treatment, the adverse symptoms of HIV will not bother her to a great extent. S. A. is determined to get better, stay healthy, and appreciate her life.
Having performed a literature search and a case study, we are now able to combine the results of these two parts of the project to evaluate the progression of the disease in our patients.
What concerns the pathophysiology of HIV, S. A.’s disease is a typical infectious case. It has one etiology which is connected with the patient’s partner. As it was mentioned in the study of Valarades et al. (2010), one of the primary causes of HIV development in climacteric women is the partner’s refusal to use preservatives during intercourse. This was exactly the case with S. A. The patient has reached the final stage of HIV – AIDS. AIDS is diagnosed when the CD cell count is below 200, and the patient’s count is 8cells/mm3.
Treatment of the patient’s symptoms is performed by the suggested cure methods (Maartens et al., 2014). Even though the patient experiences some side effects such as weight loss and hair loss, the medicines she is receiving help stabilize her condition.
The most adverse impact of HIV on S. A. is a very low amount of CD4 T cells, which makes her rather vulnerable to many outer factors and requires extra cautiousness in communication with other people (Maartens et al., 2014).
The patient was impacted by one of the most widespread complications presented by the HIV – pulmonary system (Benito et al., 2011). However, after receiving proper treatment, S. A. got rid of her respiratory problems.
A serious difficulty in S. A.’s situation is presented by stigma on the part of some of the relatives which may lead to depression issues (Rao et al., 2012; Orza et al., 2015). However, this danger is eliminated since S. A.’s friends and most of the family are supportive and caring. Thus, the possibility of developing a mental disorder in this patient is minimal.
The prospective outcomes of S. A.’s disease are rather hopeful. The woman has an optimistic attitude and endeavors to continue living an active life and wishes to improve her health condition. To ensure the best results for S. A., frequent visits to the physician are recommended. The patient should have regular check-ups, and her treatment methods should be adjusted in the case of any considerable changes. S. A. should continue her healthy diet habits and lead an active lifestyle. Additionally, she could enroll in some support could at a hospital for middle-aged women diagnosed with HIV. Being able to share her experience and discuss her problems with people like her would enable the patient to feel more relaxed among the people who treat her in a resentful and hostile way.
If S. A. takes care of her disease and keeps a positive attitude, she will be able to cope with the complications and avoid the most dangerous outcomes of HIV/AIDS. The rationale for antiretroviral therapy is to help S. A. reduce the spread of HIV in her organism and diminish the possibility of complications.
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Deeks, S. D., Lewin, S. R., & Havlir, D. V. (2013). The end of AIDS: HIV infection as a chronic disease. The Lancet, 982(9903), 1525-1533.
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Freiberg, M. S., Chang, C.-C. H., Kuller, L. H., Sanderson, M., Lowy, E., Kraemer, K. L.,… Justice, A. C. (2013). HIV Infection and the risk of acute myocardial infarction. JAMA, 173(8), 614-622.