Literature Review - Assignment Sample PDF

Running head: LITERATURE REVIEW
LITERATURE REVIEW
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LITERATURE REVIEW
Introduction:
HIV can be defined as the virus that has the capability of affecting the immune system of
the body. Researchers are of the opinion that this virus is seen to mainly attack specifically the
CD4 cells that are called the T cells. In course of time, the virus destroys huge number of these
cells that help the body in fighting with different infections and disorders (Schwartz et al., 2015).
Hence, when the individuals affected by HIV remain untreated, it results in reduction of huge
number of CD4 cells in the body. It affects the immune system of the body making it difficult for
the body to fight infections and other disorders (Krishnan et al., 2015). In such situations,
opportunistic infections and cancers are seen to take advantage of the weak immune system of
the affected individuals and this signals that the person has AIDS called the autoimmune
deficiency syndrome (Furgang, 2015). This assignment would conduct a literature review on
different important aspects of HIV and current information regarding each aspect would be
discussed.
Modes of transmission:
Baggaley et al. (2015) have put forward important information about the ways by which
HIV can be transmitted to healthy human beings. The researchers have identified a number of
activities that makes individuals vulnerable to HIV infection. The paper states that unprotected
sexual contact involving semen, pre-cum, vaginal fluids and blood is one mode of transmission.
Direct blood contact that mainly occurs through the sharing of injection drug needles is another
mode of transmission. Moreover, infections are also seen to spread through blood transfusions
that might happen through accidents in the healthcare settings or certain other blood products. It
might also spread from mother to babies; this might take place before and during birth and even

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through breastfeeding through breast milk (Fogel et al., 2016). This would be helping them to
develop health education sessions and would help them to focus on development of the
knowledge on actions among the individuals who are prone to adopt such risky habits
(Degenhardt et al., 2014). Schwartz et al. (2015) had supported the claims made by the above-
mentioned article. The first mode of transmission is the sexual intercourse. Unprotected anal
andvaginal intercourse is some of the high-risk activities. The virus might enter the penis, vagina
and anus through cuts and sores or might also be directly transmitted through mucus membranes.
Another way is the oral sex medium of transmission (Furgang, 2015). It is considered to be a
low risk practice but it cannot be completely risk free. Another mode of transmission is the
sharing of needles andother materials that are used for injecting. This is considered to be a high-
risk practice. Injection needles have the capability of passing blood from one person to another
person if they are shared. Mother to child is one another mode of transmission as the virus can
get transmitted from the mother to the fetus during the time of birth and during breast-milk
consumption.
Myths and misunderstandings:
Gunthardt et al. (2016) had conducted a study that had been very interesting to the
readers, as it had captured the myths and misunderstandings that many individuals have
regarding the transmission modes of HIV. The body fluids that are not infectious and cannot be a
medium for the transmission of AIDS are saliva and spit. Tears and sweat are also not the
mediums that can cause transmission of HIV. Feces and urine are also not the mediums that have
the capability of spreading HIV (Saag et al., 2018). Hence, this information can be used in the
health promotion programs and during education of the nurses in a community to prevent people
from developing misunderstanding and treating infected persons improperly.

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Mode of action:
Stanley eta l. (2017) had opined that HIV can affect different types of cells but mostly
they target the cells of the immune system. After infecting the cells, they can produce hundreds
of new copies if HIV. One interesting discovery made in the studies is that several kinds of
immune system cells have proteins on their surface that are called CD4 receptors. This virus is
seen to search for CD4 receptors as the CD4 proteins help the virus in binding to the cells.
Studies show that the main target for the virus is the white blood cell called the T4
lymphocyte or the T helper cells. This T4 cells is seen to be responsible
for warning the immune system that there are invaders who might affect
the body systems. Once the HIV is found to be inside the cell, it hides its
DNA inside the DNA of the cell (Masur et al., 2014). This is seen to turn
the cell into a type of factory where several copies of the HIV virus are
formed.
Stages of replication:
Wagh et al. (2016) had given a detailed description of the seven
important stages that the HIV undertakes to infect the cell completely.
The first step is called the binding stage. Proteins present on the outside
of the HIV are found to be strongly attracted to and thereby connect with
the CD4+ receptors that are present on the T4 cells. After this binding
occurs, the other proteins, which are present on the cell surface, also are

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activated. This allows the HIV to effectively fuse and thereby enter the
cell. The second stage is called the Reverse transcription phase. The
genetic material inside HIV is RNA while that inside the host cell is DNA. In
order to infect the cell, it become important for the virus to make DNA
copies of its own RNA and this process is done by reverse transcriptase
undergoing a procedure called reverse transcriptase (Van et al., 2017).
The new HIV DNA is called the pro-viral DNA. The third stage is called
integration. The new HIV DNA, which is formed, is then carried to the
nucleus of the cell where the DNA of the cell is present. Another enzyme
called the integrase hides the HIV DNA into the cells of the DNA. Then
when the cells try to make new proteins for itself, it accidentally makes
new HIV. The fourth stage is called the transcription stage. Once the HIV
DNA is found to be inside the cell, it directs the cell for the production of
the new HIV. Different types of enzymes create new genetic material
called the messenger RNA or mRNA. The other step is called the
Translation stage. Full strand of the mRNA undergoes processing in this
stage and thereby it transforms or translates into all the viral proteins
that are needed to make new virus. In this way, many new copies of virus
are produced affecting the human body system being released from the
body cell (Sales et al., 2016).
HIV stigmatization:

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Researchers like Sales et al. (2016) are of the opinion that HIV
stigmatization is one of the most negative aspects that remains
associated with HIV and makes it difficult for the affected individuals to
lead poor quality lives. Studies have found out that many people have
fears and prejudices and negative attitudes about stigma. Stigma have
high amount of negative impacts on the people who are living with HIV.
The HIV affected people feel insulted, rejected, and gossiped about and
they also feel excluded from the different social activities. Even in many
nations, instances of stigma get so high that it can result in stigma and
discrimination. This can result in isolation and felling of being
unsupported and these factors can lead to significant amount of impacts
on health and wellbeing (Collins et al., 2016). Stigma whether perceived
or real can often result in fuelling myths and misconceptions and choices
and this impact HIV education and awareness.
Effects of HIV stigmatization on the patients:
Stigma is found to be associated with things that people are afraid
of. Since the time of the first cases of AIDS in the period of 1980s, people
with HIV have been highly stigmatized. A number of reasons show that
stigmatization have negative impacts on the health. Researchers are of
the opinion that when individuals are unaware or do not understand about
how HIV is transmitted, they might be afraid of catching it through
different social contacts. Some of the people have strong sexual views

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about different sexual behaviors (Martens et al., 2014). They might think
that there are situations in which sex is found to be wrong or that certain
people should not have been involved in sexual behaviors making them
judgmental about infected persons. Researchers are of the opinion that
stigma and discrimination can lead to many human right violations even
in the healthcare settings (Wagman et al., 2015). This might occur when
affected people are barred from accessing healthcare services or enjoying
quality healthcare. Even researches have shown that families and peers
and other wider communities shun some of the affected people. Many of
the people face other poor treatment in the educational settings and
erosion of their rights and different physiological damage. These have
been mainly identified to limit the different access towards HIV testing
and treatments and other HIV services.
Policy implications:
Governments need to identify and develop various kinds of policies
that help in prevention of various kinds of stigmatization and better
quality life of the individuals. One of the most important domains that
need to be inculcated in the policies is effective protection. This would
need to cover three important aspects in the protective laws that need to

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be developed by the policy makers. These would include anti-
discrimination laws, decriminalization, challenging all kinds of violence,
and developing emergency lines and services for helping. The second
would include laws for empowerment. This would include two important
components that would include understanding of their own rights by the
affected individuals and thereby act on effective violations. They would be
also encouraged to overcome various barriers and depression and try to
empower themselves to lead better quality lives. The third policy
implication would mainly be effective inclusion. This would mainly
include introduction of laws and policies that would encourage reduction
of stigma and discrimination as important roles in the national strategies.
The fourth part would be including introduction of effective education
(Latkin, 2015). This would include addressing of the fears and changing
the attitudes of the societies through the effective methods of health
promotion and health educations among the different communities in the
nation. Moreover, the vulnerable populations like the homosexual
individuals, sex workers, youths of the nation and many others should be
included in the health education sessions as well.
Concept of drug resistance:

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LITERATURE REVIEW
Warkowski et al. (2015) had discussed in details about how the
mode of action of the HIV infection had resulted in creating resistance to
different medications all over the years. This had prevented healthcare
professionals from effectively treating HIV affected individuals
successfully. It has been seen that when HIV virus multiply, many of the
newly developed copies undergo multiplications. After these
multiplications, they have new mutations but they are slightly different
from the original virus. Even when the patients take up the anti-retroviral
therapies, the mutant virus are still undergo multiplications. When this
step undertakes, the virus develops resistance towards drug therapy. For
this reason, the antiretroviral therapies stop working. In such situations, if
only one or two drugs are seen to be used, it becomes easier for the virus
to develop resistance against the drugs. Therefore, for this reason, one or
two drugs are not used (Saag et al., 2018). Of more than three drugs are
used, it would become difficult for them to get around all the drugs at the
same time and therefore combination therapies are often seen to be
suggested. This takes the virus a longer time to develop resistance and
helps the patients to fight infections effectively.
Working mode of antiretroviral therapies:
HIV attack and destroy the different types of infection fighting CD4
of the immune system. Loss of the CD4 cells makes it very difficult for the
body of the human beings to fight different types of infections and even

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certain HIV related cancers. HIV medications help in prevention from the
HIV multiplication and this helps in the reduction of the amount of HIV in
the body. When patients have less number of viral infections in the
immune system, it becomes higher chance of the individuals to suffer less
from infections by other opportunist infections (Martens et al., 2014).
When these medications are less in the number of bodies of the human
beings, the immune system is stronger enough to fight off different
infections and other certain other HIV related cancers. By the reduction of
amount of HIV in the bodies, the medications help in reduction of the risk
of HIV transmission.
HIV-associated neurocognitive disorders (HAND):
HIV-associated neurocognitive disorders (HAND) is considered to be the hidden
epidemic in the present generation. The main risk factors for this disorder are Hepatitis C virus
co-infection; Low CD4+; Age > 50 years; Cardio-vascular disease; Diabetes or insulin
resistance; and Lower education level. Researchers have found out new strategy of treatment of
HAND which is based on the concept of the CNS penetration effectiveness (CPE) score of the
antiretroviral drugs (Penalva de Oliveira, 2015). This score is mainly seen to estimate the
effectiveness of the antiretroviral treatment in the CNS. CNS penetration effectiveness (CPE)
score was found to exhibit correlation of cognitive improvement and reduction of viral load of
HIV. This paper is therefore important to nursing professionals helping them to utilize the
evidences in their practices and ensure best up-to-date interventions for people suffering from
HAND.

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HIV and aging:
With the treatment and medications, HIV infected individuals are living longer and are reaching
old age as well. However, very few studies have showed how successfully they are ageing and
how well the quality of their lives is. Studies have found that HIV infected individuals while
aging are seen to be more prone to develop multi-morbidities like cardiovascular disorders,
cancers, renal disorders and other much faster than other aging individuals (Karpiak & Havlik,
2017). Hence, healthcare professionals are requested to provide more holistic approach of
treatment and find out ways for ensuring effective aging and quality lives of HIV infected aging
individuals.
Conclusion:
From the above discussion, it can be understood that HIV is one of
the most dreadful virus that contribute to the development of AIDS. This
disorder affects the immune system of the human bodies and this
weakens the immune system in ways by which it cannot protect the body
from the germs of other infection. The sufferers of this disorder are found
to be affected by stigma and discrimination often exhibited by the society
making them feel socially excluded. Moreover, it was also found that huge
number of people is not aware of the specific ways by which the virus are
transmitted and therefore become fearful of the disorders. Unprotected
sexual contact with multiple partners, using of same syringes by more
than one drug users and blood transfusion issues and even transmission
from mothers to babies are the main causes. Often using one or two HIV

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drugs are seen to develop resistance against the medications. Therefore,
it is important for the healthcare professionals to provide combination
therapy of the anti-retroviral drug. This mainly helps in the prevention of
the virus to develop drug resistance. As a result, the virus is successful
stopped from replicating its copies. Therefore, the number of viral
particles decreases considerably in the body of the individuals who had
been affected. This would help in development of health of the human
beings making them less prone to be affected by the disorders. Effective
policies need to be developed so that HIV stigmatization can be
prevented and better quality lives can be ensured.

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References:
Baggaley, R., Armstrong, A., Dodd, Z., Ngoksin, E., & Krug, A. (2015). Young key populations
and HIV: a special emphasis and consideration in the new WHO Consolidated Guidelines
on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Journal of the
International AIDS Society, 18, 19438.
Collins, L. M., Kugler, K. C., & Gwadz, M. V. (2016). Optimization of multicomponent
behavioral and biobehavioral interventions for the prevention and treatment of
HIV/AIDS. AIDS and Behavior, 20(1), 197-214.
Degenhardt, L., Mathers, B. M., Wirtz, A. L., Wolfe, D., Kamarulzaman, A., Carrieri, M. P., ...
& Beyrer, C. (2014). What has been achieved in HIV prevention, treatment and care for
people who inject drugs, 2010–2012? A review of the six highest burden
countries. International Journal of Drug Policy, 25(1), 53-60.

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Fogel, J. M., Hudelson, S. E., Ou, S. S., Hart, S., Wallis, C., Morgado, M. G., ... & Sabin, D.
(2016). HIV drug resistance in adults failing early antiretroviral treatment: results from
the HIV Prevention Trials Network 052 trial. Journal of acquired immune deficiency
syndromes (1999), 72(3), 304.
Furgang, Kathy. (2015). Hiv/aids, Rosen Publishing Group, ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/uwsau/detail.action?docID=5142800.
Günthard, H. F., Saag, M. S., Benson, C. A., Del Rio, C., Eron, J. J., Gallant, J. E., ... & Gandhi,
R. T. (2016). Antiretroviral drugs for treatment and prevention of HIV infection in adults:
2016 recommendations of the International Antiviral Society–USA panel. Jama, 316(2),
191-210.
Karpiak, S. E., & Havlik, R. (2017). Are HIV-Infected Older Adults Aging Differently?. In HIV
and Aging (Vol. 42, pp. 11-27). Karger Publishers.
Krishnan, A., Ferro, E. G., Weikum, D., Vagenas, P., Lama, J. R., Sanchez, J., & Altice, F. L.
(2015). Communication technology use and mHealth acceptance among HIV-infected
men who have sex with men in Peru: implications for HIV prevention and
treatment. AIDS care, 27(3), 273-282.
Latkin, C. A. (2015). The phenomenological, social network, social norms, and economic
context of substance use and HIV prevention and treatment: a poverty of
meanings. Substance use & misuse, 50(8-9), 1165-1168.
Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection: epidemiology, pathogenesis,
treatment, and prevention. The Lancet, 384(9939), 258-271.

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Masur, H., Brooks, J. T., Benson, C. A., Holmes, K. K., Pau, A. K., & Kaplan, J. E. (2014).
Prevention and treatment of opportunistic infections in HIV-infected adults and
adolescents: Updated Guidelines from the Centers for Disease Control and Prevention,
National Institutes of Health, and HIV Medicine Association of the Infectious Diseases
Society of America. Clinical Infectious Diseases, 58(9), 1308-1311.
Penalva de Oliveira, A. (2015) HIV. Journal of the Neurological Sciences , Volume 357 , e463
Saag, M. S., Benson, C. A., Gandhi, R. T., Hoy, J. F., Landovitz, R. J., Mugavero, M. J., ... &
Del Rio, C. (2018). Antiretroviral drugs for treatment and prevention of HIV infection in
adults: 2018 recommendations of the International Antiviral Society–USA
Panel. JAMA, 320(4), 379-396.
Sales, J. M., Swartzendruber, A., & Phillips, A. L. (2016). Trauma-informed HIV prevention and
treatment. Current HIV/AIDS Reports, 13(6), 374-382.
Schwartz, S. R., Nowak, R. G., Orazulike, I., Keshinro, B., Ake, J., Kennedy, S., ... & TRUST
Study Group. (2015). The immediate effect of the Same-Sex Marriage Prohibition Act on
stigma, discrimination, and engagement on HIV prevention and treatment services in men
who have sex with men in Nigeria: analysis of prospective data from the TRUST
cohort. The Lancet HIV, 2(7), e299-e306.
Stanley, K., Lora, M., Merjavy, S., Chang, J., Arora, S., Menchine, M., & Jacobson, K. R.
(2017). HIV prevention and treatment: the evolving role of the emergency
department. Annals of emergency medicine, 70(4), 562-572.

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Van Griensven, F., Guadamuz, T. E., Van Wijngaarden, J. W. D. L., Phanuphak, N., Solomon, S.
S., & Lo, Y. R. (2017). Challenges and emerging opportunities for the HIV prevention,
treatment and care cascade in men who have sex with men in Asia Pacific. Sex Transm
Infect, 93(5), 356-362.
Wagh, K., Bhattacharya, T., Williamson, C., Robles, A., Bayne, M., Garrity, J., ... & Gao, H.
(2016). Optimal combinations of broadly neutralizing antibodies for prevention and
treatment of HIV-1 clade C infection. PLoS pathogens, 12(3), e1005520.
Wagman, J. A., Gray, R. H., Campbell, J. C., Thoma, M., Ndyanabo, A., Ssekasanvu, J., ... &
Brahmbhatt, H. (2015). Effectiveness of an integrated intimate partner violence and HIV
prevention intervention in Rakai, Uganda: analysis of an intervention in an existing
cluster randomised cohort. The Lancet Global Health, 3(1), e23-e33.
Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines,
2015. MMWR. Recommendations and reports: Morbidity and mortality weekly report.
Recommendations and reports, 64(RR-03), 1.