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HIV and AIDS S4S MARCH 2015 Some background on HIV DAPSICAMP Stigma- in HIV and other illnesses. HIV: what you need to know… In intermediates they can throw a question on HIV in, whether the biology of it (we had it) or in a social sense, so stigma. It’s a topic that is so important to know about for your future career too, you may never have any more teaching on HIV. Everyday nearly 7000 people contract HIV, that’s nearly 300 per hour. In 2013 there were 107,000 HIV-positive people in the UK, 26% were unaware of their status. 530 deaths in 2013 in UK 1990-2008: 14,000 HIV positive people in the UK have taken their own lives. 1981unexplained cases of enlarged lymph nodes in homosexual men in NYC. The condition is initially called Gay-Related Immune Deficiency (GRID). http://sichange.org/sic-uk/ 1984- The virus HIV is first isolated as the cause of AIDS. 1985- Ryan White, a 13year-old haemophiliac is barred from school. Definition What does HIV stand for? What does AIDS stand for? What is the difference? HIV= Human Immunodeficiency Virus HUMAN- Can only live in humans IMMUNODEFICIENCYCauses the immune system to weaken by destroying CD4 cells (T helper cells) VIRUS- Cannot replicate autonomously therefore hijack the replication equipment of the CD4 cells. AIDS- Acquired Immunodeficiency Syndrome ACQUIRED= This stage only occurs after HIV has been in the body for a long time. SYNDROME= Collection of symptoms. Characterised by either AIDS-defining illnesses or a CD4 count of under 200 cells/mm3 IMMUNODEFICIENCY= Prolonged attacking of the CD4 cells has led to very low immunocompetence. Aetiology and Pathophysiology T helper cells (CD4 cells) Amount Antibody Levels Virus Levels Time STAGE 1: PRIMARY INFECTION STAGE 2: QUIET PERIOD STAGE 3: EARLY HIV DISEASE STAGE 4: AIDS 1-12 WEEKS 5-7 YEARS VARIABLE MONTHS – 2 YEARS http://sichange.org/sic-uk/ The HIV virus HIV virus gp120 gp41 CD4 T helper cell http://sichange.org/sic-uk/ Dendritic cells transport HIV to lymph nodes. CD4 molecule recognised by GP120 CD4 cells produce HIV copies for 2 days and then die. The cycle continues making more HIV copies and attacking CD4 cells Loss of activated CD4 T-lymphocytes, decreased immunocompetence . How the virus works 1. 2. 3. 4. 5. 6. 7. Attachment - gp120 binds to CD4 receptor on body cell Uptake – gp41 changes shape, allowing fusion of viral and cell membranes Nucleic acid synthesis – reverse transcriptase Integration of HIV genome into host – viral DNA inserted into cell’s DNA Synthesis of new HIV proteins – cell produces new viral proteins Assembly of new viruses Release via budding – new viruses released AIDS-defining illnesses Toxoplasmosis HSV Oesophageal Candidiasis CMV Kaposi’s Sarcoma Pneumocystis pneumonia Tuberculosis http://sichange.org/sic-uk/ Symptoms Early infection: Seroconversion illness at start of infection- Non-specific flu-like symptoms for 3 weeks. Very high levels of HIV in blood and genital tract, very infectious. Others have no symptoms at all. P24 protein may be detectable on tests but not always. Late infection: Most have a 10 year gradual decline of CD4 between HIV (usually asymptomatic) and AIDS- very variable. Persistent tiredness Diarrhoea (gut mucosa is particularly affected by HIV) Weight loss Night sweats AIDS- defining illnesses Unprotected vaginal sex Blood to blood contact Transmission Mother to Baby Not transmitted by kissing, and low risk from oral sex. Unprotected Anal sex Investigations Take a sexual history with focus on HIV risk. Blood transfusions/medical procedure abroad? IV drug use? HIV Test: The most reliable is an antibody test. 3 Month window period though. Fourth generation tests screen antibodies and the p24 viral proteins on HIV. Used as first line testing. 11 day window. Home testing kits are available but not reliable and not recommended. Always repeat tests after 3 months regardless of initial result. Complications Complications of HIV: Drug-related; Side effects, resistance-need 95% adherence for medication. Psychological- Stigma Physical- Neurological (AIDS dementia complex), eye disease (CMV retinitis), GI (villous atrophydiarrhoea), Renal (nephrotic and nephrotoxic drugs), Cardiac (ARVs cause hyperlipidaemia). Almost every system is affected though! Complications of AIDS: Life threatening illnesses, but unlikely in UK today. Alternative Diagnosis I wouldn’t worry too much as unlikely to be asked this but… Seroconversion can also be EBV Cytomegalovirus Influenza Viral Hepatitis Secondary Syphilis Start when CD4 count is below 350 cells/mm3. Serious side effects. Management ANTIRETROVIRALS 4) Protease Inhibitors Stop viral proteins being assembled into a virion 1) Fusion/entry inhibitors Stop the virus getting into the cell. 2) Reverse transcriptase Inhibitors Stop viral RNA converting into viral DNA 3) Integrase Inhibitors Stop viral DNA integrating into human DNA USE THREE OF THESE- HAART 3 2 4 1 http://sichange.org/sic-uk/ Prognosis Almost normal life expectancy if ARVs work well. Focus is on psychological impact of living with HIV. Diagnosis causes Biographical disruption Narrative constructs change. Rethink biography and self-concept Body is physically disrupted Things for a doctor to consider Medication taking Disclosure Stigma and mental health Coping mechanisms Enacted stigma Stigmatisation Felt stigma Reverse stigmatisation Goffman’s stigmaVisibility of disability Obtrusiveness Knowledge of illness Perceived threat of illness Sympathy aroused? Perceived responsibility Any questions? Email: [email protected] Add HIVE Southampton on Facebook Follow @HIVESouthampton on Twitter If you interested in teaching come to a training session next term. Message HIVE Southampton on Facebook for details.