A school nurse is providing education to a group of adolescents about HIV.
Which of the following risk factors of HIV should the nurse include in the education? (Select all that apply.)

Choice A rationale

Unprotected sexual activity, particularly anal or vaginal intercourse, poses a high risk of HIV transmission because the virus is present in semen and vaginal fluid. Lack of a barrier method, such as a condom, allows the exchange of these fluids containing infected CD4 cells and virus particles across mucosal membranes, leading to infection.

Choice B rationale

Sharing needles, syringes, or other injection equipment when using intravenous drugs is a major risk factor. This practice directly transfers blood from an infected person into the bloodstream of an uninfected person, allowing the direct inoculation of the HIV virus, which has a high concentration in the blood.

Choice C rationale

Sexual assault significantly increases the risk of HIV transmission due to the potential for the exchange of blood or body fluids and the high likelihood of mucosal trauma (tears or abrasions) during the assault. This trauma provides an easier entry point for the virus into the recipient's bloodstream, facilitating infection.

Choice D rationale

Exposure to blood or certain body fluids (semen, vaginal and rectal secretions, breast milk, or other body fluid containing visible blood) from a person with HIV is the route of transmission. This includes percutaneous exposure (needlestick), mucous membrane contact, or non-intact skin contact with the fluid containing the virus, which then enters the recipient's system.

Choice E rationale

Smoking marijuana is not a direct route for the transmission of the HIV virus. HIV is transmitted through specific body fluids, primarily blood, semen, vaginal and rectal secretions, and breast milk, during activities like unprotected sex or sharing needles. Marijuana use does not involve these fluid exchanges.

Choice A rationale

The initial phase of HIV infection, known as acute retroviral syndrome (ARS), typically occurs 2 to 4 weeks after exposure. This syndrome is characterized by a high viral load and a significant drop in CD4+ T-lymphocyte count as the virus disseminates throughout the body. Manifestations closely mimic a severe viral infection, presenting as mononucleosis-like or flu-like symptoms, including fever, fatigue, swollen lymph nodes (lymphadenopathy), sore throat, and night sweats.

Choice B rationale

Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection that typically manifests in the late stages of HIV infection when the immune system is severely compromised, specifically when the CD4+ T-lymphocyte count falls below 200 cells/mm (Normal range is typically 500 to 1,500 cells/mm). It is a defining illness of AIDS, not an initial symptom of acute HIV infection.

Choice C rationale

Kaposi's sarcoma (KS) is a cancer caused by the Kaposi's sarcoma-associated herpesvirus (KSHV) and is also considered an AIDS-defining illness. Its appearance signals significant immunosuppression, typically occurring when the CD4+ T-lymphocyte count is very low. This manifestation involves the growth of abnormal blood vessels and is not characteristic of the initial, acute phase of HIV infection.

Choice D rationale

Increased susceptibility to various fungal and bacterial infections (e.g., severe thrush, recurrent bacterial pneumonia) is a direct consequence of the progressive damage to the immune system caused by the sustained high viral load and the gradual, chronic destruction of CD4+ T-lymphocytes. This vulnerability to opportunistic and recurrent infections is characteristic of the clinical latency period or, more commonly, the advanced stage of HIV disease (AIDS), not the initial presentation.