Download Seminar in PDF format

7/22/2015
HIV/AIDS for Allied Health
Professionals
A.U. Bankaitis, PhD, FAAA
Vice President
Oaktree Products
St. Louis, MO
Oaktree Products, Inc.
St. Louis, MO
GENERAL OBJECTIVES
• Overview
• Immune System & HIV
• Infection Control
• Testing, Consent & Confidentiality
• Summary
HIV AIDS
• acquired
• human
immunodeficiency immunodeficiency
syndrome
virus
severely
compromised
opportunistic
infection
Person with HIV
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Basic Statistics
• Worldwide
– ~40 million living with HIV
– ~2.3 million newly infected/yr
• United States
– ~1 million living with HIV
– ~50,000 newly infected/year
with 16% unaware of status
Joint United Nations Programme on HIV/AIDS (UNAIDS), 2013
CDC, 2014
HIV Transmission
• Mainly spread by
blood
– Unprotected sex
– Sharing needles, syringes
vaginal
breast fluids
milk blood
• Less commonly by
–
–
–
–
–
–
semen
Birth
mucous
Breast Feeding
membranes
Stream
Blood transfusions
damaged
Contaminated needle
tissue
Bite
Contact between broken skin or mucous membranes
with HIV-infected blood or bodily fluids
Who is at Risk for HIV?
0.5% 0.5%
1%
2%
Whites
African American
31%
21%
Hispanic/Latino
Asians
44%
American
Indian/Alaskan
Native
Hawaiin/Other
Multiple Races
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ADAPTIVE
IMMUNE
SYSTEM
•
•
•
•
Bone Marrow
Thymus
Lymph Nodes
Spleen, tonsils,
adenoids, appendix,
peyer’s patches
Image from: http://uhaweb.hartford.edu/BUGL/immune.htm#fluids
How immune system works
IMMUNE
LYMPHATIC
BLOOD
CELL
ASSEMBLY
STREAM
SYSTEM
•Network of vessels
•Channels lymph fluid to
lymph nodes
•Directs lymph fluid toward chest
•Empties into
bloodstream
•Reabsorbed by body
tissues
Image from: http://uhaweb.hartford.edu/BUGL/immune.htm#fluids
B-Cell
How immune system works
Lymphocytes
• Maturation process
occurs within bone
marrow
• Identify antigen ANTIGEN
• Triggered to produce
antigen-specific
antibody proteins
Image from: http://uhaweb.hartford.edu/BUGL/immune.htm#fluids
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Humoral Immunity
Activation Signal
B-Cell
antibody
antibody
Antigen
antibody
antibody
Bodily fluid = HUMOR
CD-4
T-Cell
T-Cell
Lymphocytes
• Maturation process
initiated within bone
marrow
• Completed in thymus
• Several categories
ANTIGEN
• Detects antigen
• Destroys antigen
Image from: http://uhaweb.hartford.edu/BUGL/immune.htm#fluids
Classification System-HIV/AIDS
Adolescents & Adults
CD4 CELL
COUNTS
CATEGORY
1
>500/(mm³)
2
200-499/(mm³)
3
<200/(mm³)
CLINICAL
CLINICAL
CLINICAL
CATEGORY A
CATEGORY B
CATEGORY C
(asymptomatic)
(not A or B category)
(AIDS indicator condition)
A1
A1
B1
1
C1
1
A
A2
B2
C2
A
A3
B3
C3
CDC, 1993
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Classification System-HIV/AIDS
Children
N
1
2
3
A
B
C
N1 A1 B1 C1
2 A2 B2 C2
N3 A3 B3 C3
CDC, 1994
DIRECT
Developmental/Cognitive
CHILDREN
• ENCEPHALOPATHY
• Microencephaly
• Developmental Issues
ADULTS
• ENCEPHALOPATHY
• Microencephaly
• Developmental Issu
– Mental retardation
– Cerebral palsy
– ADHD
– Mental retardation
– Cerebral palsy
– ADHD
• Other cognitive,
behavior and motor
deficits
• Other cognitive,
behavior and motor
deficits
DIRECT
ORAL MANIFESTATIONS
• Candidiasis*
• Salivary gland disease*
• Herpes Simplex
• Oral hairy leukoplakia
• Kaposi’s sarcoma
• Advanced periodontal
disease
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DIRECT
OTOLOGIC/AUDIOLOGIC
MANIFESTATIONS
• Otitis media*
• Otitis Externa
• Osteomyelitis
DIRECT
FEEDING/SWALLOWING
• Dysphagia*
– Oral
– Pharyngeal
– Esophageal
Antiretroviral Drugs for
treatment of HIV & AIDS
PREVENTS REPLICATION
• Reverse Transcriptase
Inhibitors
• Protease Inhibitors
• Integrase Inhibitors
PREVENTS ENTRY
• Entry Inhibitors
• Fusion Inhibitors
MULTI-CLASS COMBO
• Combo of HIV drug classes
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Practical Lessons Learned
•HIV = infection control
•Indeed, allied health
professionals serve HIV/AIDS
populations
•Various immuno-compromised
populations served
Standard Precautions
Appropriate personal barriers (gloves, masks,
eye protection, gowns) must be worn when
performing procedures that may expose to
infectious agents
 Hands must be washed before and after every
patient contact and after glove removal
 “Touch” and “splash” surfaces must be precleaned and disinfected
 Critical instruments must be sterilized
 Infectious waste must be disposed of
appropriately

HIV Testing – Legal Issues
• For patients in all health-care settings
– Routine voluntary HIV screening after patient
notified testing will be performed unless patient
declines (opt-out screening)
– Separate written consent not required
– Persons at high risk screened at least annually
– Prevention counseling should not be required with
HIV diagnostic testing or as part of screening
CDC (2006)
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HIV Tests
TYPES:
• Antibody test
• Antigen/Antibody
• Nucleic Acid (RNA)
What HIV Results Mean
• Negative Test Result
– Retest in 6 weeks, 3 months, 6 months
– Precautions to prevent secondary
transmission
– Postexposure Prophylaxis (PEP)
Regimen
• Retrovir (AZT) + Epivir (aka Combivir)
• Positive Test Result
– Confirmatory test (Western Blot test)
A.U. Bankaitis, PhD, FAAA
Oaktree Products
[email protected]
800.347.1960
www.oaktreeproducts.com
www.aubankaitis.com
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