HIV: Critical Review of Literature on Treatment, Transmission Modes, and Social Impact

This critical review of literature on HIV covers treatment, transmission modes, and social impact. It discusses the importance of healthcare professionals in prevention and care, and the use of antiretroviral therapies. The paper also highlights the sociological perspectives of HIV stigma and discrimination.

Running head: HIV
HIV
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Author note:

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HIV
HIV is one of the most dreadful disorders that have affected huge number of individuals
all over the world and it had resulted in huge number of deaths in the nation of Australia. In the
year 2017, it was estimated that about 27545 people are living with HIV in Australia. Of these
27545 number of people, about 89% of the individuals wee diagnosed with the disorders by the
end of 2017 (Coyle et al., 2016). Present day researches also show that about 95% of them are
accessing care. About 875 of the individuals who are accessing the care, about 875 are receiving
HIV treatments. It was also found that those people who are on the treatment, 95% of them had
an undetectable viral load. Therefore, it shows the importance of healthcare professionals to be
more aware about the disorder and take necessary interventions for prevention of the disorders
among the present day population (Mpango et al., 2018). They also have the duty to ensure
effective care to the people who are already affected with the disorder in proper ways so that
they can lead proper quality life. The assignment would be mainly based on the critical reviews
of the literature of the different aspects of the HIV infection. It would also show the different
interventions that the healthcare professionals need to undertake so that they can provide
evidence based care to the patients who are effected with the disease.
In order to find out articles that align with the different aspects of treatment for the
patients infected by HIV, authentic databases are needed to be researched. In this assignment,
articles will be collected from CINAHL, COCHRANE, MEDLINE as well as PUBMED. The
search terms which were utilized are “HIV and treatments”, “ HIV and its transmission modes”,
“HIV and social impact”, HIV and combination therapies, “HIV drugs”, “HIV and nursing
interventions” and many others. Boolean operators were used for combining the search terms and
these included “AND”, “NOR” and “OR”.

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McKinney & Marconi (2016) had discussed about the mode of infection of the HIV in
the human beings. HIV is a virus that attacks cells of the immune systems that are actually the
natural defenses against the different illness. The virus destroys a specific type of white blood
cells in the immune system called the helper T cells and makes copies of itself inside these cells.
T helper cells are also called the CD4 cells. As HIV is seen to destroy more than CD4 cells and
makes more copies of itself, it is seen to gradually weaken the immune system of the person.
This means that the person who is having HIV and is not taking any form of antiretroviral
treatment would find it harder to fight off any other infection and disorders. Raj et al. (2016) had
conducted a research on the progression rate of the HIV when left untreated in the individuals.
They have found that if HIV is left untreated, it might take for about 10 to 15 years for the
immune system to be so severely damaged that it can no longer defend itself at all. However, the
authors have been also quoted stating that the rate at which HIV might progress may vary among
different individuals depending on their general health, age as well as background.
It is important to understand the various ways by which HIV is spread from person to
person. Woods et al. (2016) had stated that the two most common ways by which HIV is
transmitted are through improper sexual behavior and incorrect use of needle and syringes. The
researchers have stated that only certain body fluids like that of the blood, semen (cum), pre-
seminal fluid (pre-cum), vaginal fluids, rectal fluids as well as breast milk from an already
infected HIV individual can result in transmission of the HIV. However, the researchers have
also mentioned of important conditions that ensure infection of the normal healthy human being
by the aforementioned fluid transmission (Vos et al., 2015). These fluids need to meet the
mucous membrane as well as the damaged tissues of need to be directly injected in the blood

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stream with the help of a needle of a syringe for the occurrence of transmission. The mucous
membranes are present inside the penis, vagina as well as the mouth and rectum,.
Authors like Fogarty et al. (2016) had discussed in details about the life cycle of the HIV
virus in details helping readers to understand the steps that the virus goes through before
showing reactions and outcomes on the health of the patients. After entering into the blood
stream, free virus are seen to circulate in the bloodstream. HIV is seen to attach to the cells of the
human beings and are seen to empty their contents in the cell. The reverse transcriptase enzyme
for building up of the HIV DNA mainly uses the genetic material of the HIV virus (which is
actually the RNA). This DNA is then inserted into the chromosome of the cell by the HIV
integrase enzyme. This helps in establishing the HIV infection in the cells. Researchers have
opined that this step mainly contribute to establishment of the HIV infection in the cells. When
the infected cell goes through reproduction, it helps in the activation of the HIV DNA cells. This
helps in making the raw materials for the new HIV viruses. This then is followed by formation of
the packets for the development of new virus. The immature viruses are then seen to push out of
the infected cells of the human being into the procedures that are named as budding. Then the
immature virus is seen to break free of the infected cells (Morin et al., 2016). The new virus then
goes through maturation stages where the raw materials are cut by the protease enzymes. These
get assembled into a functioning virus ready to affect new cells. This paper is found to be
important for the present day researchers as well as for the healthcare professionals.
Understanding the lifecycle of the virus will help them to develop knowledge about how the
virus gradually overcomes the barriers of the immune system and weakness the immune system.
This would also help researchers to develop various educations that would act in the vulnerable

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steps of the viral development to stop the virus from reproducing new individuals and their
succeeding maturation stages (Muhib et al., 2016).
Several papers have been published which had worked on the importance of the anti-
retroviral therapies. Winkelman et al. (2016) had stated that these therapies are actually
medications which help in the treatment of the HIV. These drugs do not skill or cure any form of
virus. However, when they are taken in combination with different form of drugs, they can
prevent the further growth of the different viruses. The effect of the HIV becomes less severe as
the virus is slowed down. Crawford et al. (2016) had stated that HIV medications help in
preventing HIV from multiplying and making copies of itself. This helps in reduction of the
amount of the HIV in the body. Researchers are of the opinion that when HIV becomes less in
the body, it gives immune systems the chances to recover gradually. Although the infections still
persists in the body, the immune systems become strong in fighting off infections as well as
different HIV related cancers.
Side effects from the medications can vary depending upon the medicines as well as the
persons taking the medications. Researchers like Orza et al. (2015) have seen through
randomized controlled trial that people taking the same medication might face different side
effects. Some of the side effects, which are not much serious, may include headaches and
occasional dizziness. Researchers have also noticed that harmful side effects like swelling of the
throat and tongue as well as other liver damage. This can include liver damage which can be life
threatening. Different HIV medications are also seen to interact with other HIV medications in
the HIV regimen. They are also seen to interact with other medications, vitamins, nutritional
supplements and even different herbal products. Drug interaction can result in the reduction as

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well as increase in the effects of the medicine of the body. Such interacts can also result in
causing different unwanted side effects (Gimmens et al., 2014).
An interesting aspect of the antiretroviral therapy is that it shows maximum outcome
when used in combination of three or more drugs from more than one class. This is called the
combination therapy (Palacio et al., 2016). This therapy helps in the prevention of the drug
resistances. It is important for the healthcare professionals providing care to the patients to
effectively understand the drug-resistance issues and the ways combination therapies can help in
the m overcome the drug resistances. When the HIV virus are seen to undergo multiplication,
many of the new copies also go through the procedures of mutations. They become slightly
different from the original mother copies.
Often there have been different debates as well as perspectives of different healthcare
professionals regarding the HIV medications that are included in the HIV regimens. The HIV
medications are mainly found to be grouped into seven drug classes according to how they fight
HIV. The initial HIV regimen mainly should include there HIV medications from at least two
HIV drug classes. Authors like Brennan et al. (2017) had stated that selection of HIV regimen
mainly depends on several important factors. These are seen to include different possible side
effects of the HIV medications as well as potential drug-drug interactions between the
medications. Researchers have noticed that many of the mutant viruses keep on undergoing
multiplications even when the affected individual is taking ARV drugs. During such occurrences,
the virus are seen to develop drug resistance to the drugs and the anti-retroviral therapy might
stop working on the affected individual. Researchers Kwan et al. (2016) are of the opinion that
when only one or two drugs are used, it becomes easier for the viruses to develop resistance
towards the medications. Therefore, the researchers are of the opinion that using one or two

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drugs should not be the standards practice of the healthcare professionals. They have found that
when more than two or three drugs are utilized, a successful mutant would have to get around all
of the drugs at the same time. Using of the combination therapies would ensure that the viral
infection takes much longer for the resistance to develop. Therefore, using of the combination
therapy had become one of the most recommended standards of the practices for treating
individuals who are affected with the disorder.
Another author like Ching et al. (2017) had classified the transmission modes into three
distinct categories which make it much easier for the readers to understand the modes of
transmission. The first one is the sexual transmission that occurs when there initiates a contact
with the infected sexual fluids like rectal, genital as well as the oral mucous membranes. This
can take place when an individual get involved in sex without a condom that might include
vaginal, oral as well as anal sex. The second form of transmission is the perinatal transmission,
where a mother can transmit HIV to her child during the times of childbirth as well as during
pregnancy and even during breastfeeding sessions. The third mode is called the blood
transmission that involves the risk for transmitting HIV through the procedures of blood
transfusion (Ralph et al., 2015). One important area where the authors have also focused on is
the risky behavior of the drug users who use and reuse syringes to inject drugs along with
sharing of the syringes with similar individuals. This enhances the risk for those individuals to be
affected with the disorder. One of the most interesting features of this paper is that the author had
used very simple terms and had written the paper in a simple language that makes it easier for the
readers to develop a vivid picture of the transmission modes than fidgeting about the issues
throughout the paper. Hence, this becomes one of the best feature and selection criteria for
reviewing the paper.

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One important paper had been found out through the searches of the databases that had
handled on one of the most concerning aspect of HIV infection in most of the nations of the
world. Kaufman et al. (2014) had discussed in details about the concept of HIV stigma. The
paper is unique in the sense that the author had put more focus on the sociological perspectives
associated with HIV when most authors of the generation had set their goals on the biological
attributes of HIV. Therefore, in a way, the author had been able to put forward to the readers the
conditions of the people who had been already living with the viral infection and the quality of
the lives they lead. HIV related stigma mainly refers to the negative beliefs as well as feelings
and attitudes towards people living with HIV, their families and even the people who are seen to
work with them like the HIV service providers. The authors have also talked about an important
concept called the HIV discrimination (Kahn et al., 2016). This approach taken by the authors
have been praise-worthy as it would help a large number of healthcare professionals to provide
person-centered care to the affected individuals. It had helped the professional to understand that
only caring for the biological symptoms would not ensure them better quality living until the
attributes of social exclusion, discrimination and prejudices are handled from the core. HIV
discrimination mainly refers to the unfair as well as unjust treatment of someone that remains
solely based on the real as well as perceived HIV status. HIV discrimination can be also fueled
by the different myths of casual transmissions of the HIV as well as the different pre-existing
biases against certain groups, certain social behaviors, drug use and fear arising from illness and
even deaths. Therefore, healthcare professionals can be benefitted from this paper and advocate
for institutionalization for discrimination through laws, practices and policies.
Another important paper had been derived from the searches where researchers have
talked about the metabolic capacities of the HIV infected persons and the diets that should be

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advised to them by the healthcare professionals. Gustafson et al. (2016) have found that people
who are suffering from the HIV might ace various issues that can affect their scale of the
nutrition. These include modifications in the metabolism of the body as well as medicines that
can upset the stomach. Even instances of the opportunistic infections causing issues with
swallowing and eating like the different oral candidiasis and Kaposi sarcoma have been also
observed in many individuals. Even many foods like raw meats and fish can affect the
antiretroviral therapy. Therefore, these foods need to be avoided. These different problems have
the capability of affecting the ability of the body to absorb different nutrients that are highly
necessary for staying in the good health (Conway et al., 2015). Therefore, in the
recommendations the authors have provided detailed information about the healthy eating of the
affected individuals so that they can absorb the nutrients necessary for the staying in good health.
Four important criteria need to e maintained while developing the diet chart for affected HIV
individuals. Foods need to be chosen that provides nutrients and energy that the body requires for
fighting HIV as well as other infections. The foods should also ensure maintaining a healthy
weight of the individuals. The foods should also manage HIV symptoms and medications
effectively. The foods should also improve the absorption of the different types of medicines that
can help in managing the side effects. This paper is therefore found to be extremely helpful for
the dieticians as well as the nursing professionals who are providing palliative acre to the
affected patients or those individuals who are present in the long-term care. They can follow the
suggestions of the authors of this paper and thereby set up food items for the affected individuals
so that the four criteria of the choosing of correct foods are maintained. This would help in
healthy living of the affected individuals.

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Authors of paper Dockrell (2017) had also been similar in approach to that of the
previous paper where they have mentioned the importance of exercises on the health of the
affected HIV individuals. Exercise offers benefits that can help in maintenance of the good
physical and the mental health. Exercises can also cause increase in the strength, endurance as
well as the fitness and thereby this helps in the immune systems in working better to the fight
various infections. People with HIV can the similar types of exercises as people who are not
affected by HIV. Therefore, nursing professionals can follow this paper, educate the affected
patents as well as family members, and encourage them to undertake exercise regimens that
develop the quality of the health.
One important paper has been found which had discussed the effects of smoking to a
person who had been affected by HIV. Legoupil et al. (2017) had discussed how smoking
increases the risk of developing lung cancer as well as other cancers, heart disorders and even
chronic obstructive pulmonary disorders, asthma and even other disorders. It also reduces the
lifespan of the individuals affected by HIV by further by few years. Smoking has several
negative health impacts on the people who are suffering from the HIV infection. A number of
observations are made in the paper by the authors. They have stated that in case of HIV,
percentage of the affected individuals who smoke are higher in number than the proportion of the
general population who smokes. Such affected individuals who smoke remain at a greater
vulnerability for developing lung cancer as well as head and neck cancer, cervical as well as anal
cancers and many other forms of cancer. They are also seen to develop bacterial pneumonia,
COPD as well as heart disorders and even Pneumocystis jiroveci pneumonia. They are also seen
to remain at a higher chances of developing conditions that affect the mouth like that of the oral
candidiasis like thrush and even others like the oral hairy leucoplakia. They are also seen to have

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poorer response to the antiretroviral therapies. Therefore, this paper can be extremely helpful for
the healthcare professionals who provide care to the HIV affected individuals. They can
understand the ill impacts of smoking on the health of the HIV affected individuals. Therefore,
they can arrange either health promotion programs or health education session for the affected
individuals and their families. These would help in ensuring better health quality lives of the
affected individuals.
From the above discussion, it can be seen that HIV is a communicable disorders that can
be transmitted through sexual activities as well as from mothers to babies and even through
blood transfusions. Present day treatment that is seen to provide effective results are anti-
retroviral treatments that are provided in form of combination therapies. This approach prevents
the virus from developing drug resistance. However, different drug interactions and side effects
are also present and therefore the nursing professionals need to be careful about them and take
necessary precautions. However, nurses also need to know that the patients suffer from
stigmatization and discrimination that have negative mental impacts on their health. Therefore,
nurses need to educate people and make people develop knowledge on the disorder so that they
do not harbor prejudices. They also should make them careful about unsafe practices that make
them vulnerable. The nurses also need to be aware about the food, exercises and smoking
behaviors of the patients that reduce their lifespan when already affected by the viral infection.
One of the gaps found is that very few researchers have tried to identify the social determinists
for the disorder and had fewer researches on the sociological concerns faced by the affected
patients. More researches are needed so that nurses can also provide effective care that would
also involve caring for the social determinists of health so that patients can develop better quality
lives.

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