# HIV AIDS Nursing Management > HIV AIDS nursing management: ART adherence under NACO, universal precautions, post-exposure prophylaxis within 72 hours, ICTC counselling and confidentiality. - Canonical URL: https://prepelephant.com/topics/allied/nursing/hiv-aids-nursing-management - Exam / course: Allied Health · Subject: Nursing - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "HIV AIDS Nursing Management", PrepElephant, https://prepelephant.com/topics/allied/nursing/hiv-aids-nursing-management ## Direct answer Universal precautions plus unconditional respect define HIV nursing: the virus travels by sexual contact, blood and blood products, contaminated needles and from mother to child — never by meals, touch or insect bites — and every patient is handled as potentially infectious, making stigma scientifically as well as morally wrong. Infection is staged by CD4 count and opportunistic infections; AIDS is defined by CD4 below 200 cells per microlitre or an AIDS-defining illness, with tuberculosis the commonest opportunistic infection in India. Antiretroviral therapy — first-line under NACO being a tenofovir-lamivudine-dolutegravir (TLD) combination taken lifelong — converts HIV into a manageable chronic disease, provided adherence stays near-perfect. After a needlestick, post-exposure prophylaxis starts within 72 hours and runs 28 days. ## What you must remember - **Routes and non-routes:** sexual transmission, blood and blood products, sharing of needles, and vertical transmission in pregnancy, delivery and breastfeeding; HIV is not spread by casual contact, mosquitoes, shared food, toilets or saliva. - **Natural history:** acute seroconversion illness (fever, rash, lymphadenopathy, often mistaken for viral fever) → years of clinical latency with falling CD4 counts → AIDS with CD4 under 200 cells/microlitre or opportunistic infection. - **Opportunistic infections by threshold:** oral candidiasis and pulmonary TB at higher counts, Pneumocystis pneumonia risk below about 200 (co-trimoxazole prophylaxis starts here), toxoplasmosis and cryptococcal meningitis below 100, cytomegalovirus retinitis below about 50. - **ART basics:** lifelong triple therapy, first-line TLD (tenofovir + lamivudine + dolutegravir) free at NACO ART centres; adherence of at least 95 per cent prevents resistance; treatment is now offered to all regardless of CD4 count. - **Post-exposure prophylaxis:** after a significant exposure — wash immediately, report at once, baseline testing of source and exposed person, and start PEP within 2 hours ideally and never beyond 72, continuing 28 days with follow-up serology at 6 weeks, 3 months and 6 months. - **PPTCT:** lifelong ART in pregnancy plus prophylaxis to the newborn and safe infant feeding counselling, driven by the four-pronged prevention-of-parent-to-child-transmission strategy. - **Testing ethics:** HIV testing at ICTCs requires informed consent, is accompanied by pre-test information and post-test counselling, and results remain confidential — testing without consent is unlawful. - **Nursing duties that never change:** universal precautions for every patient, no discrimination in any ward procedure, nutrition and positive-living counselling, and recognition that the patient's own family is often the first barrier to overcome. ## A needlestick on a Tuesday morning A nurse recapping a used needle after drawing blood from a known HIV-positive patient sustains a deep prick. The sequence is rehearsed: wash under running water (do not squeeze), report at once, and have the exposure assessed for depth, volume and source status. Baseline HIV, hepatitis B and C testing of both source and nurse is done, and PEP started ideally within two hours — never beyond 72 — for 28 days. The nurse receives counselling on adherence, avoids blood donation and pregnancy until cleared, and repeats serology at 6 weeks, 3 months and 6 months. The incident report closes the loop by fixing the system failure — the recapping that caused it — because PEP is the rescue, but the engineering and habits that prevented the prick were the real protection. ## The Indian context NACO's network of ART centres, ICTCs, community care and early-infant diagnosis services is one of the largest public HIV programmes anywhere, and the nurse sits at most of its junctions: counselling at the ICTC, adherence follow-up at the ART centre, and inpatient care where the late-diagnosed arrive with tuberculosis, chronic diarrhoea or weight loss. The HIV/AIDS Act 2017 makes discrimination in treatment, employment and insurance unlawful and protects the privacy of status — a nurse who reveals a patient's serostatus to relatives without consent breaks the law as well as the code of ethics. Adherence counselling is the highest-yield intervention: a patient on TLD who understands lifelong therapy, reports missed doses honestly and attends viral-load follow-up will likely die of something other than HIV. The exam favourites are stable: routes, the CD4 threshold, PEP timing, and the first-line regimen. ## Frequently asked questions ### Within what time must post-exposure prophylaxis start? Ideally within two hours of exposure and no later than 72 hours, continued for 28 days, with follow-up HIV testing at 6 weeks, 3 months and 6 months. ### At what CD4 count is AIDS defined? Below 200 cells per microlitre, or the occurrence of an AIDS-defining opportunistic infection regardless of the count. ### Which opportunistic infection is commonest in Indian AIDS patients? Tuberculosis — pulmonary and extrapulmonary — remains the leading opportunistic infection and a frequent presenting illness in newly diagnosed cases. ### What is the first-line ART combination under NACO? A single-tablet TLD regimen — tenofovir, lamivudine and dolutegravir — taken daily and lifelong, with adherence near-perfect to prevent resistance. ### Can HIV be transmitted by sharing food or mosquito bites? No — HIV survives poorly outside blood and body fluids, is not transmitted by casual contact, shared utensils or insects; transmission requires sexual, blood-to-blood or mother-to-child contact.