HIV & AIDS: A Foundation for Nursing and Healthcare Practice, 5th edition

481 Pages·2003·2.49 MB·English

by  Robert J. Pratt

HIV & AIDS:
A foundation for nursing and
healthcare practice
5TH EDITION
Robert J. Pratt
CBE FRCN RN BA MSc RNT DN (Lond) PGDARM
Professor of Nursing,Director,Richard Wells Research Centre,
Faculty of Health & Human Sciences,Thames Valley University,London,UK
PARTOFHACHETTELIVREUK
First published in Great Britain in 1986
Second edition 1988
Third edition 1991
Fourth edition 1995
This fifth edition published in 2003 by Hodder Arnold,
a part of Hachette Livre UK,
338 Euston Road, London NW1 3BH
www.hoddereducation.com
© 2003 Robert Pratt
All rights reserved. No part of this publication may be reproduced or
transmitted in any form or by any means, electronically or mechanically,
including photocopying, recording or any information storage or retrieval
system, without either prior permission in writing from the publisher or a
licence permitting restricted copying. In the United Kingdom such licences
are issued by the Copyright Licensing Agency: Saffron House, 6–10 Kirby Street,
London EC1N 8TS.
Whilst the advice and information in this book are believed to be true and
accurate at the date of going to press, neither the authors nor the publisher
can accept any legal responsibility or liability for any errors or omissions
that may be made. In particular (but without limiting the generality of the
preceding disclaimer) every effort has been made to check drug dosages;
however, it is still possible that errors have been missed. Furthermore,
dosage schedules are constantly being revised and new side-effects
recognized. For these reasons the reader is strongly urged to consult the
drug companies’ printed instructions before administering any of the drugs
recommended in this book.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN 978 0340 70639 8
Commissioning Editor: Georgina Bentliff
Development Editor: Heather Smith
Project Editor: Wendy Rooke
Production Controller: Lindsay Smith
Cover Design: Amina Dudhia
Typeset in Berling Roman by Phoenix Photosetting, Chatham, Kent
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Contents
Contributors v
Foreword to the fifth edition vii
Acknowledgements ix
Introduction xi
1 The evolution of a pandemic 1
2 Understanding the cause of AIDS – the biology of viruses 15
3 Retroviruses – the cause of AIDS 21
4 HIV transmission 32
5 Understanding immunology 43
6 Cellular pathogenesis and the journey towards AIDS 68
7 The clinical spectrum of HIV disease 80
8 Tuberculosis and HIV disease – a dangerous liaison 123
9 HIV disease and the nervous system 157
10 Viral hepatitis and HIV disease 178
11 The impact of HIV infection on women 194
12 Preventing mother-to-child HIV transmission 210
13 Children and HIV disease 226
14 A strategy for infection control in nursing practice 242
15 Preventing and managing occupational exposure to blood-borne
pathogens 252
16 The individualized care of patients with HIV disease 264
Robert Pratt and Tim Stephens with Karen Gibson
17 Nutrition and HIV disease 319
18 Discharge planning and community care 337
19 The nurse as a health educator 352
20 Understanding antiretroviral therapy 362
21 Adherence to antiretroviral therapy 380
Heather Loveday
22 Complementary and alternative approaches to care 394
Nicola Robinson and Robert Pratt
23 HIV disease in the industrially developing world 417
Carol Pellowe
Glossary 430
Index 449
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Contributors
Karen Gibson RN, BSc, MSc, PGDipEd
Senior Lecturer (Sexual Health),Thames Valley University,London,UK
Heather Loveday MA, RN, RNT, PGCARM
Principal Lecturer (Research),Richard Wells Research Centre,Thames Valley
University,London,UK
Carol Pellowe MA (Ed), BA (Hons), RN, RNT, PGDARM
Deputy Director,Richard Wells Research Centre,Thames Valley University,
London,UK
Nicola Robinson PhD, BSc (Hons) Lic Ac, Hon MFPHM
Head of Centre for Complementary Health Care & Integrated Medicine,
Faculty of Health & Human Sciences,Thames Valley University,London,UK
Tim Stephens BA (Hons) Nursing, RN
Staff Nurse,Intensive Care Unit,Royal London Hospital,London,UK
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Foreword to the fifth edition
In the UK, London has always been the epicentre of our national epidemic of human
immunodeficiency virus (HIV) infection and disease.Here,we now have almost a quarter of
a century of collective experience in caring for and supporting large numbers of people who
are living with HIV/AIDS. Our knowledge of the underlying science and pathology that
underpin this disease continues to increase dramatically in leaps and bounds.Today’s great
success story of this epidemic,at least here in Europe and in North America,Australasia and
other resource-rich nations, has been the development of sophisticated and effective
antiretroviral treatment strategies that delay end-stage disease and significantly improve the
quality of life for those living with HIV.However,no biomedical ‘cure’ for this disease has
yet emerged and, although several candidate vaccines are now in clinical trials, it may be
years before an effective vaccine to prevent HIV disease is available.The need for nurses to
‘care’ is as urgent now as it was when this disease first surfaced.
Since its first edition in 1986,this book has established itself as the premier reference text
in Europe on the nursing care of people with HIV disease.Now completely rewritten and
updated,the fifth edition includes important new chapters reflecting the changing face of
HIV/AIDS.
Using the latest available research evidence,Robert Pratt outlines a new understanding of
the science behind the disease and the factors driving the epidemic.Complex subjects are
made understandable as he describes more comprehensively the biology of HIV,the natural
history of HIV infection and disease and our evolving perception of the immunological
responses to infection. Key clinical issues are extensively described, such as HIV-related
tuberculosis,viral hepatitis and nervous system pathology.
Important new chapters on the management of occupational exposure to blood-borne
pathogens,preventing mother-to-child HIV transmission and the complexities of antiretro-
viral therapy are included in this new edition.Of particular value has been the opportunity
for nurse clinicians,educationalists and researchers to input into this extensively used text.
Tim Stephens and Karen Gibson have co-authored with Robert Pratt the core chapter on
the individualized nursing care of patients with HIV disease.As in previous editions, the
focus of this chapter is firmly on the unique role of the nurse in caring for individuals with
HIV disease.The authors develop a behavioural and needs-based model of nursing to set the
scene for an in-depth exploration of the actual and potential care requirements of people
requiring in-patient care.
In response to the changing needs and expectations of patients,Dr Nicola Robinson has
co-authored with Robert Pratt a new chapter on complementary and alternative approaches
to care,describing the best available evidence of efficacy for each therapy.
Heather Loveday provides a thoughtful and immensely helpful chapter on the central
importance of supporting adherence to therapy.Recognizing the international distribution of
this text and the global reach of AIDS,a new chapter by Carol Pellowe focuses on important
nursing care issues in the resource-poor regions of the industrially developing world.
Each chapter begins with a description of the intended learning outcomes and is
complemented by extensive references, recommended further reading and, importantly,
comprehensive and relevant internet resources and associated website addresses.
viii Foreword to the fifth edition
Robert Pratt has been associated with the issues surrounding the nursing care of patients
with HIV disease since the very beginning of the pandemic and he has made a major
contribution in facilitating the nursing profession’s effective response to the challenges of
HIV disease, both in the UK and internationally. As a Consultant to the World Health
Organization and the British Council,he has for many years directed HIV-related nursing
and medical education and action research projects in Africa,Asia, the Arabian Gulf and
Eastern Europe. He is an adviser to a variety of government and non-governmental
organizations,including the Chief Medical Officer’s Expert Advisory Group on AIDS at the
Department of Health (England).He is also the President of the Infection Control Nurses
Association of the British Isles and Patron of the UK National HIV Nurses Association.In
1998, he was conferred with the Fellowship of the Royal College of Nursing for his
international contribution to promoting sexual health. In recognition of his unique
contribution to nursing education,in 2003 he was appointed a Commander of the Order of
the British Empire by Her Majesty,Queen Elizabeth II.
Drawing on his experience of working in London at the very heart of the UK epidemic,
he offers a clear,easy to understand,yet comprehensive reference text for nurses and other
healthcare professionals who need ready access to current nursing and scientific information.
Having been published in five different languages, including a special Arabic edition
published by the World Health Organization,the continuing popularity of this book reflects
how effectively it meets the needs of nurses and other healthcare professionals around the
world.
Effective nursing care is based on research,knowledge,skill,compassion and integrity,
and all of these elements are consistently reflected throughout this text.I commend this new
edition to you as the definitive reference guide for professional nurses and other healthcare
practitioners striving to deliver confident,competent and compassionate support within the
arena of HIV patient care.
Professor Christine Beasley CBE
Partnership Development Director
NHS Modernisation Agency
July 2003,London
Acknowledgements
I am grateful to many colleagues for their help in developing this new edition,including my
new chapter co-authors,Carol Pellowe,Heather Loveday,Dr Nicky Robinson,Tim Stephens
and Karen Gibson,all at Thames Valley University,London.Professor Clive Loveday and
Professor John M.Grangein London and Dr Roger Woodruffin Melbourne,Australia,were
invaluable in providing scientific and medical advice. Ian O’Reilly and Simon Jones at
Thames Valley University and Anne Wadmore in London vastly improved the material in
this edition by their skilful artwork.I am also grateful to the staff at Hodder Arnold and the
freelances who have worked on this book, especially Georgina Bentliff (commissioning
editor), Laurence Errington (indexer), Wendy Rooke (project editor), Heather Smith
(development editor), Jane Smith (copy-editor) and Harriet Stewart-Jones (proofreader).
Finally,I am especially thankful to my colleague and good friend Carol Pellowefor reviewing
chapter drafts and advising on style.
This text is dedicated to all my friends,colleagues,students and patients whose lives have
been affected by AIDS, principally remembering Werner, David, John and Michael.They
were my friends,my first patients and,ultimately,my teachers.Finally,remembering always
the outstanding contribution made to our profession by the late Richard Wells FRCN,at the
Royal College of Nursing,I especially dedicate this text to his memory,and to the memory
ofMaurice Jeffery.