Nursing implications of late diagnosis – severe disease, treatment and prevention of opportunistic illnesses

Where people have been diagnosed late with HIV infection, skilled nursing is essential to the patient’s ability to follow through with treatments and remain engaged with the health system. The opportunistic illnesses (referred to as AIDS-defining illnesses or AIDS indicator diseases) with which those diagnosed late and with advanced disease may present are nowadays relatively rare. Nurses in low HIV prevalence settings such as Australia are therefore less likely to have first-hand experience and knowledge of such illnesses. Thus, it remains important for nurses to understand the natural history and management of HIV and opportunistic illnesses.

Nurses play a key role in supporting people who are diagnosed late, with the capacity to spend greater amounts of direct and indirect time with clients than other health professionals. Psychological and emotional reactions to a new HIV diagnosis can vary and can be serious (see Section 1 New diagnosis of HIV). The client may display signs of depression, appear withdrawn or become completely overwhelmed. Nurses can identify signs of difficulty with adjusting to and managing illness and can intervene and make appropriate referrals. They can support the client by listening, giving clients time to talk through their problems, providing empathy and care, and emphasising to the client that he or she is not alone. Utilising resources such as written information, audiovisual aids and peer support (meeting other HIV-positive people) can help ease the adjustment process. These interventions are all useful to promote engagement and retention in care.[17]

Nurses can educate clients, family members, and other disciplines alike about specific issues to be aware of during this period; for example, signs of anxiety and depression; barriers to care, signs of disengagement; signs and symptoms of new opportunistic illnesses; difficulty with adherence to medication and treatment toxicities or adverse reactions (see also Therapeutics and monitoring).

Primary health and community nursing services that are well integrated with peer support agencies and volunteer-based services can be fundamental to supporting the emotional and social adjustment of those diagnosed late and who have advanced disease.[18]