Download HIV/AIDS 101 - CHOICES - Memphis Center For Reproductive Health

HIV 101 for
Providers
Jennifer Marshall
Assistant Director
[email protected]
901-791-9384
Why Parallel Paths?
• Individuals have sexual and reproductive health
needs related to HIV testing and prevention.
• Routine HIV Testing
• Prevention Counseling
• Linkages to HIV Care if Infected
• Persons Living with HIV have sexual and
reproductive health needs.
• Pregnancy Prevention
• Pregnancy Planning
• Basic GYN Care
• STI Testing and Treatment
• Abortion
• Prenatal Care
HIV 101
HIV
is the Human
Immunodeficiency
Virus
HIV is the virus that
causes AIDS
AIDS is the Acquired
Immune Deficiency
Syndrome
3/1/2010 AM
HIV 101
 HIV
belongs to a family of viruses called
retroviruses
 Retroviruses mutate so quickly a person’s
immune system does not have any
defenses against the new version of the
virus
 HIV is also a lentivirus – a virus with a long
delay between initial infection and the
time the infected person starts to show
symptoms
HIV 101
HIV
•
•
needs 2 (two) things to live:
An Air-tight container (the human body)
Protein
HIV




only lives in four body fluids
Blood ( including menses)
Semen ( including pre-ejaculate)
Vaginal Fluids
Breast milk
HIV 101
Shelby
 As
County:
of 12/2009:
 6,304
PLWHA
 394 new HIV infections
HIV 101
Having
unprotected sex with
an infected individual
•
•
•

Anal
Vaginal
Oral
Acts listed in descending order from the
greatest to least risk
HIV 101
Blood-to-blood
contact with
an infected
person, which
includes
sharing needles
for any reason
HIV 101
Mother
to Child ( perinatal
transmission) can occur during
pregnancy, labor, delivery, or
breastfeeding
 If
NO treatment is received during pregnancy
the risk of mother-to-child transmission is around
25%
 If HAART IS received during pregnancy, delivery
and after birth the risk drops to as low as 0.5% to
2%
HIV 101
HIV is NOT
 Saliva
 Urine
 Sweat
 Tears
HIV
transmitted via…
is not transmitted through casual
contact!
The Stages of HIV Disease
Primary Infection:
 The
first stage of HIV disease
 2 to 4 weeks after infection, 87% of HIV+ persons
suffer flu-like symptoms (acute HIV syndrome)
 After infection, the body begins to produce
antibodies to the virus, or to seroconvert
 It takes between 3-12 weeks for the body to
produce enough antibodies to be detected on
a test (rare cases 6 months)
 If antibody test is done too early in this process it
may not be accurate
HIV in the Body
Acute HIV Infection
 2-8
weeks after infection, most people
experience flu-like symptoms
 Viral
load spikes dramatically after initial
infection and then stabilizes.
 High
levels of HIV in sexual fluids during this
period.
 More
HIV=More Infectious
Window Period for
HIV Antibody Detection
0 weeks
3 weeks
6 weeks
3 months
Majority of HIV
infections can
be identified
here
Infected
with HIV
Earliest
detection
85%
of
infections
detected
Over 99%
of
infections
detected
Note: In very rare situations, detection of antibodies may take up to 6 months or longer.
The Stages of HIV Disease
Chronic HIV Infection:
 Asymptomatic
Period
• Also called clinical latency – person has no
signs or symptoms of HIV disease
• Although individual shows no symptoms, the
virus is actively multiplying and infecting and
killing immune system cells
 Immune System Decline
• The more HIV a person has (the plasma viral
load) the lower the number of CD4+ cells;
ultimately results in the rapid decline of the
immune system
The Stages of HIV Disease
Asymptomatic HIV Infection
 Can
last up to 10 years
 No symptoms
 Virus is actively multiplying and
impacting the immune system
 Even though a person may look and feel
healthy, they can spread HIV to other
people.
 At this stage, person should show as
positive on a HIV Antibody test.
HIV in the Body
Symptomatic HIV Infection

Over time the immune
system becomes severely
damaged. The body fails to
keep up with replacing the
CD4+cells that are lost.
3/1/2010 AM
Immune System Decline
Non-specific Symptoms:
 When
the immune system is damaged, people
begin to experience mild symptoms
• Swollen lymph nodes
• Fatigue
• Weight loss
• Frequent fevers and sweats
• Frequent or persistent yeast infections
• Persistent skin rashes
• Shingles
Advanced HIV Disease
(AIDS)
The CDC has two different sets of criteria for
diagnosing AIDS:
Set 1—An HIV infection, confirmed by testing,
plus a CD4+ T-cell count
of less than 200 per cubic millimeter of blood
Set 2—An HIV infection, confirmed by testing, plus one
of 26 clinical conditions, primarily opportunistic
Infections that do not normally affect healthy people
Opportunistic Infections
•
Examples
•
•
•
•
•
•
•
Pneumocystis Carinii Pneumonia (PCP)
Kaposi's Sarcoma (KS)
HIV wasting syndrome (extreme weight loss)
Non-Hodgkin's lymphoma
HIV encephalopathy (AIDS Dementia)
Candidiasis (Yeast Infection) of the trachea,
bronchi, or lungs
Candidiasis (Yeast Infection) of the esophagus
3/1/2010 AM
HIV Testing Recommendations
Everyone
ages 13-64 in all
healthcare settings
Everyone beginning treatment for TB
Everyone seeking treatment for STDs
All pregnant women
HIV Testing
Antibody
test
 Blood
 Oral
Fluid
Confidential
Minors
age 13
and up
Rapid Testing
HIV Testing
FREE and CONFIDENTIAL HIV Testing
 CHOICES:
Health

Memphis Center for Reproductive
1726 Poplar Avenue (901) 274-3550
 Friends
for Life
 43 N. Cleveland (901) 272-0855
 Planned Parenthood Greater Memphis Region
 2430 Poplar Ave. Suite 100 (901) 725-1717
 Memphis and Shelby County Health Dept.
 814 Jefferson Ave. (901)544-7552
 Primary Care Physician
HIV Testing
 ELISA
(Enzyme-Linked Immunosorbent
Assay): determines if HIV antibodies are
present in blood or oral fluids
 Western Blot: A highly specific test that is
used for confirming the ELISA test
 Rapid HIV tests: Screening tests using oral
mucose transudate, urine or blood. At
home HIV antibody testing kits fall into this
category
 HIV RNA tests: Diagnose HIV infection very
early, before antibodies are even formed
HIV Testing
What if a person is
NEGATIVE?
HIV is preventable
 Individuals
who are
sexually active and/or use
needles should continue to
be tested on a regular,
usually every 6 months
basis
 The CDC recommends
that everyone be tested
for HIV at least one a year
regardless of perceived
risk.
HIV Testing
What if a person is
POSITIVE?
 Treatment


is available
Ryan White Services
www.hivmemphis.org
 Early
treatment and
intervention are key to
maintaining the quality
of life
HIV/STI Prevention
100%
Safe 
 Abstinence
 Masturbation
98%
Male Condoms
95% Female Condoms
Dental Dams
Finger Cots
HIV/ STI Prevention
The Male Condom
 Can
be made of Latex or Polyurethane
 Only Water-based and Silicone lubricants
can be used
 Comes in a variety of sizes, styles, colors, and
flavors
 Can be used during anal, oral, and vaginal
sex.
 Cannot be used in conjunction with the
female condom or with another male
condom (1 @ a time!)
 Must use a new condom with each sex act
HIV/STI Prevention
The Female Condom
 Made
of Polyurethane-transmits heat better than
latex (more natural feeling)
 Can be used with non- water based lubricants
 Can be used during vaginal sex
 Can be inserted up to 8 hours before sex
 Offers more skin to skin protection than the male
condom
 Comes in one size fits most women
 Can only be used one time
 Cannot be used in conjunction with the male
condom.
HIV/STI Prevention

Dental Dams are latex
barriers used for
oral/anal and
oral/vaginal sex

If Dental Dam is not
available nonmicrowavable plastic
wrap or a latex
condom cut open to
lay flat, may be used.

Used for anal or
vaginal digital sex
(fingering)

Helps prevent
bacterial infections

Reduces risk for STI
associated with
fingering
Pre-Exposure Prophylaxis (PrEP)
HIV
negative people who are at high
risk, take antiretroviral medication
daily to try to lower their chances of
becoming infected with HIV
Shown to be effective in men who
have sex with men (MSM) and
heterosexual men and women
Pre-Exposure Prophylaxis (PrEP)
November 2010, NIH iPrEx clinical trial
 daily oral use of Truvada provided an average
of 44% additional protection to men who have
sex with men (MSM)
July 2011, CDC TDF2 study
 once-daily Truvada reduced the risk of
acquiring HIV infection by roughly 63 percent in
the study population of uninfected
heterosexual men and women.
More info, including study results:
http://www.cdc.gov/hiv/prep/
Post-Exposure Prophylaxis (PEP)
 Usually
consists of a month long course of
two or three different types of the
antiretroviral drugs
 needs to be taken as soon as possible,
and definitely within 72 hours of exposure
to HIV.
 Longer
and it is thought that the
effectiveness of the treatment is severely
diminished.
 Occupational
Exposures
 Sexual Assault Victims