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THE HIV-POSITIVE PATIENT The individual identified as HIV-seropositive is one who is asymptomatic and does not meet the Centers for Disease Control and Prevention (CDC) definition for AIDS. Studies reveal that persons with HIV-positive status may remain asymptomatic for 10 or more years. During the period of asymptomatic infection, the individual has HIV in the blood and is contagious to others. Patients may live longer without symptoms if receiving highly active antiretroviral therapy (HAART) to reduce the viral load. After approximately a decade, especially in the undertreated individual, the immune system begins to decline and he or she develops symptoms of immune deficiency, a phase termed “symptomatic HIV infection.” The individual might then develop AIDS-defining diseases. With the inception of multiple drug regimens (using combinations of nucleoside reverse transcriptase inhibitors [NRTIs], protease inhibitors [PIs], or nonnucleoside reverse transcriptase inhibitors [NNRTIs]), the CD8+ CTL (cytotoxic T-lymphocyte) and the CD4 count can be maintained at higher levels longer and the viral load minimized.Controlling replication of HIV and lowering the viral load are the current focus of early intervention. Although imminent death is not a realistic concern, the patient needs to make major behavioral and lifestyle changes to prolong life expectancy and may have significant problems that require information and assistance. The person who is well supported medically may lead a productive life for an extended period. At present the rate of new infections is rapidly increasing among people of color, women in general (with the most common mode of transmission being heterosexual activity), and resurgence among young homosexual men who did not experience the losses of their predecessors and have a misconception regarding the efficacy of medications and therefore are engaging in unsafe sexual practices. CARE SETTING Community setting, although development of opportunistic infections may require occasional inpatient acute medical care. RELATED FACTORS AIDS Extended care Fluid and electrolyte imbalances Pneumonia: microbial Psychosocial aspects of care Sepsis/septicemia Patient Assessment Database Although patient may be asymptomatic, refer to CP: AIDS for potential signs/symptoms. Refer to section at end of plan for ongoing considerations. DIAGNOSTIC STUDIES Enzyme-linked immunosorbent assay ( ELISA ) : A positive test result may be indicative of exposure to HIV but is not diagnostic. Sensitivity varies, with the incidence of false-positive results being approximately 10%. (Seroconversion can occur between 4 wk to 6 mo after exposure.) Western blot test ( blood/urine ) : Confirms diagnosis of HIV-1 in individuals with positive ELISA screening.
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