Download HUMAN IMMUNODEFICIENCY VIRUS (HIV)

HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Case definition
CONFIRMED CASE
Adults, adolescents and children ≥18 months:
• detection of HIV antibody with confirmation (e.g. EIA screening with confirmation
by Western blot or other confirmatory test)
OR
• detection of HIV nucleic acid (e.g. DNA PCR or plasma RNA)
OR
• HIV p24 antigen with confirmation by neutralization assay
OR
• isolation of HIV in culture
Children < 18 months (on two separate samples collected at different times):
• detection of HIV nucleic acid (e.g. DNA polymerase chain reaction (PCR) or plasma
RNA)
OR
• HIV p24 antigen with confirmation by neutralization assay
OR
• isolation of HIV in culture
Causative agent
• Human immunodeficiency virus (HIV-1 and HIV-2), a retrovirus
• HIV-1 is the predominant strain in Canada and worldwide.
Source
Humans
Incubation
Antibodies can typically be detected in the blood 3 to 6 weeks after infection but in
some cases it can take up to 6 months before antibodies are detectable
Transmission
Possible routes of transmission include:
• sexual contact with an HIV-infected person
• percutaneous exposure to an HIV-contaminated implement (injection drug use
paraphernalia, needle stick puncture, razors, body modification, etc.)
Nova Scotia Communicable Diseases Manual
Section: Human Immunodeficiency Virus (HIV) (July 2007)
1
• perinatal transmission from an HIV-infected mother
• HIV-infected blood coming in contact with an open cut or mucous membrane
• transfusion, transplantation or ingestion of HIV-contaminated blood, blood
products, cells, organs, tissues or breast milk
Communicability
HIV infection is communicable from early infection onward, throughout the entire
course of infection, until death.
Symptoms
• 80-90% of HIV-infected people develop a flu-like illness within 4 to 8 weeks
after exposure to the virus. This non-specific illness may include recurring fever
or profuse night sweats, headaches, malaise, pharyngitis and lymphadenopathy.
These symptoms usually disappear within a week to a month and are often
mistaken for those of another viral infection. During this period HIV is present in
large quantities in genital fluids.
• Persons are then asymptomatic for months to years.
Diagnostic testing
• HIV screening tests are performed at regional laboratories in Nova Scotia. All
positive HIV screening tests are sent to the QEII Health Sciences Centre virology
laboratory for confirmatory testing.
• There are three options for HIV testing. These options are noted in the Reporting
Requirements of HIV Positive Persons Regulations.
ºº Nominal testing means that the client’s name is used on the form that is
sent to the laboratory with the blood sample. The name is also used on the
test result when the lab sends it back to the primary care provider (PCP).
If the result is positive, the lab and PCP report the test result and name to
the Medical Officer of Health (MOH) in the Public Health office covering the
jurisdiction where the testing originated.
ºº Non-nominal testing means that a code developed by the PCP is used on the
form that is sent to the laboratory with the blood sample. The code includes
6 numbers representing the full date of birth (day, month, and year), 1 letter
representing gender (either M or F), first 3 letters of the county of residence,
and 3 letters chosen by the individual. The code is also used on the test result
when the lab sends it back to the PCP. If the result is positive, the lab and
PCP report the test result and code to the MOH. The MOH has the authority
to request the name and other identifying information from the PCP in some
circumstances (e.g. positive individual has donated or received blood).
Nova Scotia Communicable Diseases Manual
Section: Human Immunodeficiency Virus (HIV) (July 2007)
2
ºº Anonymous testing means that the client’s name is not used on any forms.
The client contacts an anonymous testing clinic and makes an appointment
using their first name or pseudonym only. At no time is the client’s name
recorded.
Treatment
HIV infection is currently viewed as a chronic illness with ongoing advancements
in treatment modalities. HIV-infected individuals should be advised to consult their
PCP or local infectious disease clinic for treatment options.
PUBLIC HEALTH MANAGEMENT & RESPONSE
Case management
For the process to determine whether a case has been previously reported or a new
case refer to the Nova Scotia Surveillance Guidelines for Notifiable Diseases and
Conditions. novascotia.ca/dhw/populationhealth/surveillanceguidelines.asp
The public health nurse (PHN) assigned to the case calls the attending PCP to
determine the status of the case. As per the general guidelines, follow-up, partner
notification and education are usually managed by the PCP.
The PHN contacts the PCP and documents required case management information
including risk factors and receipt or donation of blood products, cells, tissues or
organs. If blood transfusion or donation has been identified, specific information
with respect to the dates of transfusion/donation, institution and the case’s address
at the time of transfusion/donation are collected with as much detail as possible.
If the PCP requests assistance or the PHN deems that it is necessary, the PHN
proceeds with case management, contact notification, and follow-up.
Nova Scotia Communicable Diseases Manual
Section: Human Immunodeficiency Virus (HIV) (July 2007)
3
HIV Initial Case and Contact Management
HIV Lab Report Received
by Public Health Services
Contacts reported to PHS
(separate from lab report eg.
known HIV positive case)
Review lab report
Ensure source is
appropriate health
care provider
Not on file
Previously reported and
followed up
Call physician
PREVIOUSLY
REPORTED CASE
In Nova Scotia
NEW CASE
Outside Nova Scotia
Call physician and document:
1. Risk factors
2. Receipt or donation of
blood products/CTO*
3. Partners/contacts
Contact HPP to verify if
already recorded
Follow up completed
in other DHA
Not on file
Risk factors
Send lab report &
memo to CMOH
Treat as new case
Receipt or
donation of blood
products/CTO*
Partners/contacts
Physician Assistance
to follow requested from
PHS or deemed
necessary
File with previous report &
update database as required
Ensure education
and follow-up is
appropriate
Updated April 2007
Nova Scotia Communicable Diseases Manual
Section: Human Immunodeficiency Virus (HIV) (July 2007)
Traceback / Lookback
protocol as per CDC
Manual
Consider contact and
follow up as per CDC
Manual
CTO*
Cells, Tissues, Organs
4
Contact tracing
Reporting Requirements for HIV Positive Persons Regulations have been
made under Sections 74 and 106 of the Health Protection Act. Section 13 of the
Regulations details the responsibility of the HIV-positive person to notify partners
that may have been exposed to the HIV virus.
Definition of contacts
An individual who has had contact with blood, body fluids, cells, organs and tissues
from an HIV-infected individual.
Susceptibility
Susceptibility is universal.
Exclusion
No exclusion is required, however sexual contacts should be counseled to practice
safer sex by using latex condoms with oral, vaginal and anal sex at least until the
results of HIV testing have been determined and preferably on an on-going basis.
Surveillance forms
novascotia.ca/dhw/populationhealth/surveillanceguidelines/NS_Notifiable_
Disease_Surveillance_Case_Report_Form.pdf
novascotia.ca/dhw/populationhealth/surveillanceguidelines/HIVAIDS%20
National%20%20Case%20Report%20Form.pdf
novascotia.ca/dhw/populationhealth/surveillanceguidelines/HIV_Strain_and_
Drug_Resistance_Surveillance_Form.pdf
General Information Sheet
REFERENCES:
Public Health Agency of Canada. (2009). Case Definitions for Communicable Diseases under National Surveillance.
CCDR 2009; 3552, 1-123. Retrieved from phac-aspc.gc.ca/publicat/ccdr-rmtc/09pdf/35s2-eng.pdf
Control of Communicable Diseases Manual, 17th edition. 2000. James Chin, editor. American Public Health Association.
Laboratory Definitions and Case Definitions for Infectious Diseases under National Surveillance, Laboratory
Standardization Subcommittee, May 15, 2006.
Reporting Requirements for HIV Positive Persons Regulations made under Sections 74 and 106 of the Health
Protection Act, S.N.S 2004, c.4, O.I.C. 2005-457 (October 14, 2005, effective November 1, 2005), N.S. Reg. 197/2005.
phac-aspc.gc.ca/aids-sida/hiv_aids/index.html
phac-aspc.gc.ca/publicat/epiu-aepi/index.html
canadian-health network.ca/servlet/ContentServer?cid=1048003175132&pagename=CHN- RCS%2FPage%2FGT
PageTemplate&c=Page&lang=En
cdc.gov/hiv
Nova Scotia Communicable Diseases Manual
Section: Human Immunodeficiency Virus (HIV) (July 2007)
5