Jerry D. Durham, Ph.D, R.N., F.A.A.N., is professor and dean of the Barnes College of Nursing at the University of Missouri at St. Louis. Dr. Durham has earned six uni- versity degrees, including three in nursing and a doctorate in higher education admin- istration. In addition to his role as an educa- tor, he has held positions as a staff nurse, clinical manager, private practitioner in mental health nursing, and consultant in education and research. He was among the first researchers to investigate the nature of private practice in psychiatric nursing. He has received two fellowships in ethics from the National Endow- ment for the Humanities. In addition to The Person with HIV/AIDS: Nursing Perspectives, Dr. Durham has coedited Women, Children and HIV/AIDS (1993), as well as The Nurse Psychotherapist in Private Practice (1987). Together, these three books received five American Journal of Nursing Book-of-the-Year Awards. Dr. Durham also served as coedi- tor of Tuberculosis: A Sourcebook for Nursing Practice, which was selected as a "Best Book of 1995" by Nurse Practitioner. He serves as a reviewer for several nursing journals and is a member of the editorial board of the Journal of Psychosocial Nursing. Dr. Durham chaired the Education Committee of the Association of Nurses in AIDS Care. Felissa R. Lashley, Ph.D, R.N., A.C.R.N., F.A.A.N. (formerly Felissa L. Cohen), is professor and dean of the School of Nurs- ing, Southern Illinois University, Edwards- ville. She is also clinical professor of pediatrics at the School of Medicine, South- ern Illinois University, Springfield. Dr. Lashley previously served as professor and head of the Department of Medical-Surgi- cal Nursing at the University of Illinois at Chicago (UIC) College of Nursing, clinical chief for Medical-Surgical Nursing at the University of Illinois at Chicago Medical Center, and associate professor, Department of Genetics, School of Medicine, UIC. Dr. Lashley received her doctorate in human genetics with a minor in biochemistry from Illinois State University. She is certified as a Ph.D. medical geneticist by the American Board of Medical Genetics (the first nurse to be so certified) and is a founding fellow of the American College of Medical Genetics. Dr. Lashley began her practice of genetic evaluation and counseling in 1973. She has authored more than 200 publications including Clinical Genetics in Nursing Practice, which received a Book-of-the-Year Award from the American Journal of Nursing in its first edition, as have two of her other books. She was a coeditor of the Association of Nurses in AIDS Care's Core Curriculum for HIV/AIDS Nursing. Dr. Lashley is a distinguished lecturer for Sigma Theta Tau International and an associate editor of the journal IMAGE: The Journal of Nursing Scholar- ship, as well as a fellow of the American Academy of Nursing. She was the first nurse to serve on the AIDS Research Review Committee, National Institute of Allergy and Infectious Diseases (NIH), and was a member of the Priority Expert Panel B HIV Infection: Prevention and Care, National Center of Nursing Research. She was a member of the HIV Nursing Clinical Advisory Committee of the National AIDS Education and Training Centers, HRSA Bureau of Health Professions, and was a co-project director and co-investigator of the award for the Midwest AIDS Training and Education Center. She is an active member of the Association of Nurses in AIDS Care and has served as chair of the Nominating Committee. She is president- elect and a member of the board of directors of the HIV/AIDS Nursing Certifying Board. The Person with HIV/AIDS Third Edition Nursing Perspectives Jerry D. Durham PhD, RN, FAAN Felissa R. Lashley PhD, RN, ACRN, FAAN Editors Springer Publishing Company Copyright © 2000 by Springer Publishing Company, Inc. All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, Inc. Springer Publishing Company, Inc. 536 Broadway New York, NY 10012-3955 Acquisitions Editor: Ruth Chasek Production Editor: Helen Song Cover design by James Scotto-Lavino Library of Congress Cataloging-in-Publication Data The person with HIV/AIDS : nursing perspectives /Jerry D. Durham and Felissa R. Lashley, editors.—3rd ed. p. cm. Rev. ed. of: The person with AIDS. 2nd ed. c1991. Includes bibliographical references and index. ISBN 0-8261-1293-5 (hardcover) 1. AIDS (Disease)—Nursing. I. Durham, Jerry D. II. Lashley, Felissa R., 1941- . III. Person with AIDS. [DNLM: 1. Acquired Immunodeficiency Syndrome— nursing. 2. HIV Infections—nursing. WY 153.5 P467 1999] RC607.A26P47 2000 610.73'699—dc21 DNLM/DLC for Library of Congress 99-16258 CIP Printed in the United States of America To Kathy, whose kindness, love, and understanding have sustained our lives together. Jerry D. Durham To my wonderful and growing family—Pete, Julie, and Benjamin; Neal and Anne; Heather; my mother, Ruth Lashley; and my friend Tony Oliver. Benjamin, may you grow up in a world where HIV disease no longer exists. Felissa R. Lashley This page intentionally left blank Contents List of Tables ix List of Figures xi Con tribu tors xi Preface xv 1. The Etiology, Epidemiology, Transmission, and Natural History of HIV Infection and AIDS 1 Felissa R. Lashley, R.N., Ph.D., A.C.R.N, F.A.A.N. 2. The Pathogenesis of HIV Infection 75 Janice M. Zeller, R.N., Ph.D., F.A.A.N. Barbara Swanson, R.N., D.N.Sc., A.C.R.N. 3. Preventing HIV Infection 97 Barbara Burger, R.N., Ph.D., A.C.R.N. Vida M. Vizgirda, R.N., M.S. 4. Promoting Wellness in Persons with HIV Infection 139 Susan L. Keller, R.N., M.S. 5. The Clinical Spectrum of HIV Infection and Its Treatment 167 Felissa R. Lashley, R.N., Ph.,D., A.C.R.N., F.A.A.N. 6. Symptom Management in HIV/AIDS 271 AnthonyJ. Admolfi, R.N., M.S.N., A.N.P., A.C.R.N. 7. The Medical Treatment of HIV Disease 311 Susan L. Wightman, R.N., B.S.N., A.C.R.N. Michael K. Klebert, R.N., M.S.N., AMP. 8. Principles of Infection Control 351 Barbara Russell, R.N., M.P.H., C.I.C., A.C.R.N. vii viii CONTENTS 9. Testing and Counseling 369 Richard S. Ferri, R.N., Ph.D., A.N.P., A.C.R.N., F.A.A.N. 10. Principles of HIV/AIDS Case Management 387 Demetrius Porche, R.N., D.N.S., C.S., C.C.R.N. 11. HIV Infection in Women 401 Mary Jo Hoyt, R.N., M.S.N., F.N.P. Susan Holman, R.N., M.S., A.N.P. 12. HIV Disease in Children 429 Wendy M. Nehring, R.N., Ph.D. 13. Minorities Living with HIV Infection/AIDS: Stories and Practical Strategies 511 Barbara Aranda-Naranjo, R.N., Ph.D. 14. Ethical and Legal Dimensions 523 Jerry D. Durham, R.N., Ph.D., F.A.A.N. Appendix I: Considerations in Caring for Persons after Potential Nonoccupational Exposure to HIV When Data Are Inadequate 551 Appendix II: Prophylaxis for First Episode of Opportunistic Disease in HIV-Infected Adults and Adolescents 55 7 Appendix III: Prophylaxis for Recurrence of Opportunistic Disease (After Chemotherapy for Acute Disease) in HIV-Infected Adults and Adolescents 563 Appendix TV: Advising Patients Concerning Prevention of Exposure to Oportunistic Pathogens 567 Appendix V: Selected Sources of Information on the World Wide Web 57 Index 585 List of Tables 1.1 1992 Revised classification system for HIV infection and expanded AIDS surveillance case definition for adolescents and adults 4 1.2 Clinical categories 5 1.3 Conditions included in the 1993 AIDS surveillance case definition 6 1.4 Selected common epidemiological definitions 7 1.5 U.S. AIDS cases by age at diagnosis reported to CDC through December, 198 3 1.6 Reported AIDS cases worldwide as of June 20, 1998 39 1.7 Adults and children living with HIV/AIDS worldwide, December, 198 39 1.8 United States adult/adolescent AIDS cases by exposure category as reported to CDC through December, 198 45 1.9 Pediatric AIDS cases in the United States as reported to CDC through December, 198 46 3.1 Proper use of condoms to prevent sexual transmission of HIV 105 4.1 Living with HIV disease: A summary of research on health promotion 150 5.1 Selected opportunistic infections and conditions fre- quently associated with CD4+ cell count categories 170 5.2 Selected HlV-related central nervous system disorders 229 5.3 Early symptoms of AIDS dementia complex/HIV- asociated dementia 229 5.4 Clinical staging of the AIDS dementia complex 231 5.5 Selected HIV-related gastrointestinal disorders 239 5.6 Major oral disorders manifested in HIV infection 242 5.7 Selected cutaneous manifestations seen in HIV infection 245 ix