Download HIV Transmission Serbia

HIV Transmission,
Testing and
Diagnosis
Anele Waters, RN, BSc (Hons), MRes
HIV Research Nurse
North Middlesex Hospital, UK
HIV Transmission
HIV is NOT transmitted via
saliva, tears, sweat, faeces or urine
UNLESS
There is a visible presence of blood
HIV has been found at infectious levels in five
principal body fluids:
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blood
semen
cervicovaginal secretions
rectal secretions
breast milk.
HIV Transmission
4 conditions for HIV transmission
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Live virus in a contaminated body fluid or
body tissue.
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Sufficient quantity of virus
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Effective route of transmission
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Must reach susceptible cells to infect
Infection Control
Universal Precautions
• 1983 USA Center for Disease Control (CDC)
"Guidelines"Blood and Body Fluid Precautions.
• In 1987 CDC update (Universal Precautions)
– recommended that blood and body fluid
precautions be consistently used for all
patients regardless of their blood-borne
infection status.
Standard precautions
In 1996 CDC updated their infection control guidance
Potentially infected substances
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Blood
Peritoneal fluid
Cerebrospinal fluid
Pleural fluid
Pericardial fluid
Synovial fluid
Amniotic fluid
Faeces
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Semen
Vaginal secretions
Breast milk
Vomit
Urine
Sputum
Saliva
Any fluid with visible blood
Not Tears
NO exposure
Potential
exposure
High Risk
for
Exposure
Gown/Apron
possibly
Yes
Yes
Gloves
Not required
Yes
Yes
Wash hands before/after
Yes
Yes
Yes
Eye protection/mask
Not required
If appropriate
If appropriate
Dispose linen at bedside
Yes
Yes
Yes
Dispose soiled linen as
infected
Dispose soiled waste as
clinical waste
Not required
Yes if soiled
Yes if soiled
Not required
Yes if soiled
Yes if soiled
Decontaminate equipment Between patients
Sharps disposable at
bedside
Yes
Yes
Yes
Yes
Sharps & Waste Disposal
• Discard sharps bins when 3/4 full
• Do not pass sharps from hand to hand.
• Dispose of used sharps straight away
• Do not leave used sharps up.
• Sharps bin at the bedside.
• Never re-sheath used needles
Inoculation and
Needle stick injuries
Inoculation and needle stick injuries
• A penetrating injury
• A splash of blood to the mouth or eyes.
• A bite that breaks the skin or fluids into an open
wound.
How infectious is a needle stick
injury?
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1 in 3 when source is +ve for Hep B e antigen.
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1 in 30 when source is carrying Hepatitis C.
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1 in 300 when source is HIV positive.
What to do if you have a
needle stick injury
• Encourage the wound to
bleed – do not suck it!
• Wash well with soap under
LOTS of running water.
• Cover the wound with a
waterproof dressing.
• Report it!
Risks of Infection
• How likely does the donor carry the virus?
• How infectious is the donor?
• How deep, if at all, was the recipient’s skin or
mucous membranes penetrated?
• How much blood from the donor was on the
device?
HIV Testing and Diagnosis
Why do we want to test for HIV?
• Prevention of late diagnosis HIV and AIDs
• Early diagnosis and treatment can mean a
near normal lifespan
• Prevent onwards transmission of HIV
• A HIV +ve diagnosis test will change medical
management for patients
Late diagnosis in Europe
• In 2012 Half of these cases of HIV were reported as
late presenters (LP) (CD4 <350/mm3)
• 30% of LP had advanced HIV infection (CD4
<200/mm3)
• Highest in heterosexually acquired cases originating
from sub-Saharan Africa (62%) and among IVDU
(56%).
Lydia
• 35 year old sex worker requesting an HIV Test
• Recently found out her former partner a
former IVDU died of AIDS
• Has a 5 year old child with this partner
• They live with Lydia’s mother
• Sex work is the only income for family
Who should be tested?
• All with differential diagnosis of HIV
• All with sexually transmitted infections (STI)
• All sexual partners of those HIV+ve
• All MSM (and female partners of)
• All IVDU (and their partners)
• All those known to be from a country of high
HIV prevalence (and those they have sex with)
Pre HIV testing
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Brief discussion with Lydia
Has she had any prior HIV tests
Her risk factors
Sexual history
Who will give the results to her
The test
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Detects HIV antibodies and or p24 antigen
Antigens can be detected
Antibodies can be detected
Tests for HIV-1 and HIV-2
Different types, venous blood, oral fluid,
finger prick, urine
Post test: HIV positive
Post test: HIV positive
Lydia tests HIV positive
What might be her initial concerns?
1)About herself
2)About her daughter
3)About her mother
4)About her income
What’s next for Lydia?
• Disclosure
• Prevention of Transmission
• Blood tests
• Appointment with HIV doctor