Nugt1524 Lu 10 Hiv New

Mrs. A.
Welman (September 2023)
NUGT1524 LU 10
HIV & PMTCT
www.ufs.ac.za
With credit to Mrs. M. Prinsloo

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Outcomes
 Interpret the surveillance data on the HIV status of children and adults in South Africa and the world.
 Explain the pathophysiology of HIV in the body, and its effect on the immune system.
 Identify transmission risk factors for HIV in adults and children.
 Discuss methods to prevent the spread of HIV.
 Assess the HIV status of an infant and/or child according to national guidelines.
 Distinguish between the types of HIV tests used at PHC level.
 Classify/diagnose and manage a patient with exposure to HIV or HIV-associated symptoms and diseases according to
national guidelines.
 Assess, classify and manage an infant or a child with a confirmed HIV infection according to national guidelines.
 Compare breastfeeding, formula feeding, and mixed feeding as feeding methods for infants with HIV reactive mothers.
 Plan a person-centred health dialogue for a HIV reactive pregnant woman including adherence to medications,
transmission to the child, and feeding practices after birth, while still adhering to national guidelines.
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Sources
Brown, D., Edwards, H., Buckley, T. & Aitken, R. L. 2017, Lewis’s Medical-Surgical Nursing:
Assessment and Management of Clinical Problems. 5 th Edition. Elsevier: Chatswood.
South Africa (DoH). 2020. Standard Treatment Guidelines and Essential Medicines List for South
Africa. Government Printers: Pretoria.
South Africa (DoH). 2022. Integrated Management of Childhood Illness 2022. Government
Printers: Pretoria.
South Africa (DoH). 2019/2020. Adult Primary Care Guide. Government Printers: Pretoria.
Soweto Trust. 2023.

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EPIDEMIOLOGY: HIV INFECTION
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Contributing factors 4 the  Gender
spread of HIV (Van Dyk, – Women 7x more likely to become
2017) infected
– Biological, cultural and social reasons
 Age
– Women acquire HIV 5-10 years earlier
than men
– Inter-generational sex … “sugar daddy”
 Other sexually transmitted infections (NB
when symptomatic)
– Genital inflammation – increased
immune cells with CD4+T receptors
– Ulcers or sores!
 Socio-economic and cultural conditions
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 Socio-economic and cultural conditions
Socio-economic factors • Unemployment rates – migration to cities – new
sexual network
4 the spread of HIV • Tradition – women low status – cannot negotiate safe
sex
• Extreme poverty – sex work
• Dire conditions & no access to health care
• Disempowered people – low health seeking
behaviour
• Low socio economic conditions – high STI rates – low
contraceptive use
• Widespread illiteracy and poor education
• Lack of info & support services
• Alcohol abuse high – lowers inhibition & decision
making power
• Famine, war, conflict, crime and corruption
• Traditions of morals are crumbling
• Fear of violence – especially if men are physical &
sexual dominant
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THE HI VIRUS AND THE HUMAN IMMUNE
SYSTEM
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• Seroconversion - After this period has
Concepts – [Van Dyk et occurred, the disease can be detected
al, 2017:87] in blood tests for the antibody.
• Window period - The period is the time
between potential exposure to HIV
infection and the point when the test will
give an accurate result
• Acute retroviral syndrome - two to four
weeks after someone is infected with
HIV and where the patient might
experience acute flu like symptoms
• Primary infection - It is the stage of
infection where the patient is
asymptomatic and lasts until the body
has created antibodies against HIV
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What is the window period? [Van Dyk et al, 2017:132]
It takes about 3 weeks

During the window
(22days) after infection,
(16 days with fourth period, a person will test
for the antibodies to be
generation test) negative…but is really
detectable with a third
‘positive’
generation test
You must be clear on

A person can pass the
this – a first negative
virus during the window
test may not be
period !
accurate
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Immune system reaction
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Steps of infection of a CD4+T cell by an HIV virus – [Van
Dyk et al, 2017:37-45]
1 2 3 4 5 6 7
Step 1 – Step 2 – Step 3 – Step 4 – Step 5 – Step 6 – Step 7 –

Attachment Fusion Injection Reverse Integration Replication Production of
(RNA plus transcription of genetic of genetic new viruses
reverse (Viral RNA material material (Protease
transcriptase, changed into (Integrase (Virus uses enzyme helps
integrase and proviral DNA enzyme helps the machinery to make more
protease the proviral of the host HI viruses and
DNA to join cell to they break
the cell’s DNA replicate the free from the
in core of the genetic cell, killing it
cell) material and infecting
(RNA) to more cells
manufacture
new viruses
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The immune reaction and viral load
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SIGNS AND SYMPTOMS
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HIV: TRANSMISSION AND
PREVENTION
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Methods of transmission
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Prevention strategies
Behaviour Biomedical interventions Structural interventions
• A: Abstinence from sex • HIV testing • Social, political and
• B: Be faithful to one • MMC (Medical male economic structures
partner circumcision)
• C: Correct and Consistent • ART (Antiretroviral
use of Condoms treatment, including PEP
• D: Delay or postpone and PrEP, PMTCT etc)
onset of sexual
intercourse
• E: Exchange
programmes for
injectable drug users
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PMTCT
Provider initiated Screening for TB, Decrease the
Early onset of Counselling and STIs, OIs, Viral load asap.
antenatal care Testing @ Chronic Look after the
intervals conditions, CrAg women’s health
Health dialogue, Promote

HCT and ART for Care and
women-centered exclusive
infant compassion!
care breastfeeding
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TESTING
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HIV TESTING
Different HIV tests work by looking for three different things.
Proteins on the surface of the virus (antigens/Ag) like protein 24

(called p24).
An immune response to the virus (antibodies/Ab).
Genetic material from the virus (HIV RNA or DNA).
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Thank you.
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Mrs. A.

Welman (September 2023)

With credit to Mrs. M. Prinsloo

Soweto Trust. 2023.

It takes about 3 weeks

You must be clear on

Step 1 – Step 2 – Step 3 – Step 4 – Step 5 – Step 6 – Step 7 –

Health dialogue, Promote

Proteins on the surface of the virus (antigens/Ag) like protein 24

An immune response to the virus (antibodies/Ab).

Genetic material from the virus (HIV RNA or DNA).

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