Joel Paparello, Irene Zeller, Alison While Joel Paparello, HIV Specialist Nurse, St Thomas’ Hospital, London; Irene Zeller, Lecturer, Adult Nursing, Florence Nightingale Faculty of Nursing & Midwifery, King’s College London; Alison While, Emeritus Professor of Community Nursing, Florence Nightingale Faculty of Nursing & Midwifery, King’s College London Email: paparello@me.com Meeting the complex needs of individuals living with HIV: a case study approach ABSTRACT This article critically discusses the nursing care and management of a person living with the human immunodeficiency virus (HIV) infection as a long-term condition, requiring highly complex HIV care. Complex HIV care is managed in the secondary care setting. However, recent legislation has motivated shifts in HIV care to the community care setting. This article aims to enhance health professionals’ understanding in order to equip practice and district nurses to deliver HIV care provision. Antiretroviral adherence is a prerequisite for disease survival as well as an essential component of complete HIV self-care management. It is therefore imperative that nurses tailor adherence strategies according to each patient’s requirements. Case management strategies such as the use of cognitive behavioural therapy to alleviate depressive symptoms will be considered. Furthermore, the use of motivational interviewing for antiretroviral adherence is highlighted as a potential intervention to help patients overcome the physical, psychological and physiological challenges of living with HIV-associated comorbidities. The delivery of integrated HIV care is pivotal for the management of the person living with HIV, as is the facilitation of a self-caring behaviour. KEY WORDS w HIV w Long-term conditions w HIV-associated depression w Disease management w Self-management T he human immunodeficiency virus (HIV) is defined as a blood-borne pathogen that has a direct transmission through blood or body fluids (Weston, 2008). This blood-borne virus creates exhaustion within the immune system by the depletion of T-helper lymphocyte cells known as CD4+ (Bennett and Greenfield, 2013). The reduction of this CD4+ function in the immune system provokes a suitable microbiological envi- ronment for the development or restricted prevention of opportunistic infections; for example, pneumocystis carinii pneumonia (PCP). The HIV pathogen instigates the immune hyper-activa- tion, leading to a rapid increase of viral duplication (Février et al, 2011). This hyper-activation increases the amount of HIV viraemia in the person living with HIV, making them more infectious, increasing the risk of HIV transmission during sexual intercourse—which then becomes a public health concern. Another risk of an increase in viraemia occurs when individuals do not adhere to their HIV medication, which can affect the ability of the antiretrovi- ral therapy (ART) to control viral replication, which may allow ART resistance to develop. Furthermore, depression is linked with HIV disease progression, decreased physical immunity, increased plasma viraemia and poor prognosis in ART adherence regimen (Su et al, 2013). Importance of ART adherence ART adherence is a prerequisite for survival for people with HIV. It is therefore imperative that nurses recognise and support patients such as Mr Blake (see Box 1) who are at risk of ART non-adherence. This can be achieved by redesigning adherence-boosting strategies according to each patient’s requirements so that a potentially terminal disease can become a self-care-managed condition. Resistance to anti-HIV medications is the major factor that could limit the successful treatment of HIV infection in Mr Blake’s condition. Resistance results in the anti-HIV medication no longer being as effective, leading to an LONG-TERM CONDITIONS 526 British Journal of Community Nursing November 2014 Vol 19, No 11 © 2014 MA Healthcare Ltd Box 1. Case study discussed in the article ‘Mr Blake’ will be used as a pseudonym in order to protect the person’s pri- vacy and dignity (Nursing and Midwifery Council, 2008). Mr Blake is a 45-year- old man of a black ethnic background who has sex with men. He was diag- nosed with a late HIV infection 10 years ago following a hospital admission for pneumocystis carinii pneumonia, which is an HIV-associated opportunistic infection. Mr Blake was unable to cope after his diagnosis and this triggered further anxiety, and he developed HIV-associated depression. This depression led to poor antiretroviral therapy (ART) adherence, The patient then developed ART resistance and HIV progression, which directly affected his HIV progno- sis. Mr Blake’s inability to deal with these stressors led to further disengage- ment with his HIV care. This disengagement allowed the HIV to progress, resulting in an increase of serum HIV viraemia and a reduction of immune functionality, at which point Mr Blake required a further admission to hospital. h Journal of Community Nursing.Downloaded from magonlinelibrary.com by 081.108.161.174 on December 29, 2014. For personal use only. No other uses without permission. . All rights res