Statutory regulations made by the Secretary of State (22 March 1986) provide for AIDS being a notifiable disease for the purposes of Sections 35, 38, 43 and 44 of the Act. This Act allows for the provision of compulsory medical examination and for compulsory removal of a patient to hospital, where the interests of the sufferer, his or her family and the public appear to justify that such action should be taken. Section 38 of the Act allows for the compulsory detention in hospital of a patient already in hospital.
Obviously, the detention of any citizen in hospital against his or her will is a serious event, which, fortunately, is rarely required. However, there are circumstances when, either for the good of the patient or for the good of the community, compulsory admission may be appropriate. It may be necessary initially for the patient to be evaluated in a general hospital to rule out treatable neurologic infections such as opportunistic CNS infections. If the patient is suffering from intercurrent psychosis, such as a depressive or hypomanic phase of an existing manic–depressive illness, or if a patient with a chronic psychosis develops HIV disease and requires in-patient care, this care is best delivered in a psychiatric service.
Clearly, nurses have a profound duty to ensure that the legalities of compulsory admission have been properly enacted and to support the patient, family and friends during this frightening period.
Long-stay patients in psychiatric hospitals who are infected with HIV are, of course, able to sexually transmit this infection to other individuals. Sexual activity amongst psychiatric in-patients in long-stay units is probably quite common, perhaps compounded by the effect of chronic psychosis, which may diminish judgement and self-control.30Considerable vigilance is required from nursing staff to circumvent this risk. Additionally, the potential risk of violence is always real in individuals who are frightened, confused and have an altered mental state.
Summary
HIV-related neurologic and neuropsychiatric illnesses are common, especially in late symptomatic HIV disease. Both the central and peripheral nervous systems can be involved, causing a continuum of ill-health from progressive mental and physical disability to life-threatening infections and cancers. In this chapter, we have reviewed the impact of HIV infection on the nervous system, relating various neurologic and neuropsychiatric manifestations to specific patient problems. This information enables nurses to assess accurately individual patient needs and plan and implement appropriate nursing support and interventions.
REFERENCES
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Williams & Wilkins, 1999, 477–97.
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6. McArthur JC, Cohen BA, Farzedegan H et al. Cerebrospinal fluid abnormalities in homosexual men with and without neuropsychiatric findings. Annals of Neurology 1988; 23(Suppl.):S34–7.
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8. Grant I, Gold J, Rosemblum M et al. Toxoplasma gondii serology in HIV-infected patients: the development of central nervous system toxoplasmosis in AIDS. AIDS 1990; 4:519.
9. Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. New England Journal of Medicine 1992; 327:1643–8.
10. Jones JL, Hanson DL, Dworkin MS et al. Surveillance for AIDS-defining opportunistic illnesses, 1992–1997. Morbidity and Mortality Weekly Report (MMWR) 16 April 1999;
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11. Chaisson RE, Griffin DE. Progressive multifocal leukoencephalopathy in AIDS. Journal of the American Medical Association 1990; 264:79–82.
12. Sadler M. Colonizing tumours of the brain. In: Gazzard B (ed.), Chelsea & Westminster Hospital AIDS Care Handbook. London: Mediscript Ltd Medical Publishers, 1999, 161–82.
13. Moyle G. Cytomegalovirus infection. In: Gazzard B (ed.), Chelsea & Westminster Hospital AIDS Care Handbook. London: Mediscript Ltd Medical Publishers, 1999, 65–73.
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14. Karp JE. Overview of AIDS-related lymphomas: a paradigm of AIDS malignancies. In:
Merigan TC, Bartlett JG, Bolognesi D (eds), Textbook of AIDS Medicine, 2nd edn.
Baltimore: Williams & Wilkins, 1999, 437–50.
15. Bower M, Fife K. HIV-associated malignancy. In: Gazzard B (ed.), Chelsea &
Westminster Hospital AIDS Care Handbook. London: Mediscript Ltd Medical Publishers, 1999, 93–111.
16. Kaplan LD, Northfelt DW. Malignancies associated with AIDS. In: Sande MA, Volberding PA (eds), The Medical Management of AIDS, 6th edn. Philadelphia: W.B.
Saunders Company, 1999, 467–96.
17. Capaldini L. Psychosocial issues and psychiatric complications of HIV disease. In:
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Philadelphia: W.B. Saunders Company, 1999, 241–63.
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Clinical confirmation of the American Academy of Neurology algorithm for HIV-1 associated cognitive/motor disorder. Neurology 1996; 47:1247–53.
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21. Whitaker RE. Neuropsychiatry of HIV-associated dementia. Psychiatric Times March 2001; 17. Available online at: http://www.mhsource.com/pt/p010357.html
22. Whitaker RE. Psychopharmacological treatment issues in HIV disease. Psychiatric Times 1999; 16:24–30.
23. Whitaker RE. Significance of community psychiatry to HIV disease. Psychiatric Times 1999; 16:58–64.
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25. So YT, Olney RK. Acute lumbosacral polyradiculopathy in acquired immunodeficiency syndrome: experience with 23 patients. Annals of Neurology 1994; 35:53–8.
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FURTHER READING
Pemberton L. The unconscious patient. In: Alexander MF, Fawcett JN, Runciman PJ (eds), Nursing Practice – Hospital & Home, 2nd edn. Edinburgh: Churchill Livingstone, 2000, 851–71. (A succinct overview of the nursing care of patients with an altered level of consciousness.)
INTERNET RESOURCES
■ For a comprehensive review of HIV-related dementia, see Rupert Whitaker’s article
‘Neuropsychiatry of HIV-associated dementia’ in Psychiatric Times 2001; 17. Available online at:
http://www.mhsource.com
■ The current issue of the National AIDS Manual (NAM) HIV & AIDS Treatment Directory in the UK provides a valuable resource and is available from NAM, 16a Clapham Common Southside, London SW4 7AB (Tel. +44 (0)207627 3200). You can also contact NAM online at:
www.aidsmap.com
Internet resources 177
Viral hepatitis and HIV disease
Learning outcomes
After studying and reflecting on the material in this chapter, you will be able to:
■ describe the various hepatotropic viruses that may cause acute or chronic hepatitis in people living with HIV disease;
■ discuss the inter-relationship between viral hepatitis and HIV infection;
■ outline the clinical management of patients with viral hepatitis;
■ identify drug contraindications and increased risks of side effects in co-infected patients;
■ advise patients on effective strategies for primary and secondary prevention.
BACKGROUND
Acute viral hepatitis, the characteristic inflammation of the liver, can be caused by many infectious and non-infectious agents, but the most common causes are viruses. Several
Introduction
People who are vulnerable to infection with HIV are also at an increased risk of being infected with hepatitis (hepatotropic) viruses, as the ‘at-risk behaviours’ that lead to exposure for these enterically, parenterally and sexually transmitted viruses are similar. It is not surprising, therefore, that both acute and chronic viral hepatitis commonly occurs in people living with HIV disease, adding to their burden of ill-health and increasing the complexity of their treatment. An understanding of the issues associated with HIV and hepatotropic virus co-infection is important in developing sound nursing prevention and care strategies and in the early identification of complications associated with treatment or disease progression.