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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 1 7/22/2015 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 2 7/22/2015 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 3 7/22/2015 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 4 7/22/2015 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 5 7/22/2015 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 6 7/22/2015 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) 7 7/22/2015 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 8