Download HIV & AIDS

HIV & AIDS
RCS 6080
10/24/06
Some Terms
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Virus: Any large group of submicroscopic
agents capable of infecting plants, animals
and bacteria. They are characterized by a
total dependence on living cells for
reproduction and by a lack of independent
metabolism.
HIV: Human Immunodeficiency Virus.
AIDS: Acquired Immune Deficiency
Syndrome
More Terms
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Antibody: A protein (immunoglobulin) that is
secreted and produced by B lymphocytes
when it finds an antigen. Antibodies can
bind to and, in turn, destroy certain antigens.
When you test positive for HIV, they are
actually testing for antibodies.
Antigen: A substance that is recognized as
foreign by the immune system. Antigens are
either whole microorganisms, or they can be
a portion of an organism or virus.
See the handout for a more complete
glossary of AID related terms
History
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AIDS was first recognized a new disease in
1981.
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First report in the medical literature was
concerning 5 young, homosexual men living in
the Los Angeles area that had Pneumocystis
carinii pneumonia and Kaposi's sarcoma.
A few weeks later there was a report from San
Francisco and New York about 26 young
homosexual men with the same conditions.
This was followed by reports of individuals who
had injected drugs with similar conditions.
All of these individuals had profound
immunodeficiency suggesting a depletion of
CD4-positive, or T-helper, lymphocytes.
History continued
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With the prominence of homosexual men
and intravenous drug users in the early
cases it was originally speculated that these
individuals became immunosuppresed
because of a history of drug use or because
of multiple sexually transmitted diseases.
HIV was 1st identified in a lab in France.
Strong evidence did not show up until 1984
when 4 papers were published in one issue
of Science.
Several variants of the HIV were discovered
during this time.
Transmission
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HIV does not survive well in the
environment.
HIV is found in varying concentrations or
amounts in blood, semen, vaginal fluid,
breast milk, saliva, and tears.
There have been rare occurrences of
transmission between family members in
households: usually resulting from contact
between skin or mucous membranes and
infected blood.
Some Recommended Precautions (from the
CDC) for health professionals and care
givers
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Gloves should be worn during contact with blood or other body
fluids that could possibly contain visible blood, such as urine,
feces, or vomit.
Cuts, sores, or breaks on both the care giver’s and patient’s
exposed skin should be covered with bandages.
Hands and other parts of the body should be washed
immediately after contact with blood or other body fluids, and
surfaces soiled with blood should be disinfected appropriately.
Practices that increase the likelihood of blood contact, such as
sharing of razors and toothbrushes, should be avoided.
Needles and other sharp instruments should be used only
when medically necessary and handled according to
recommendations for health-care settings. (Do not put caps
back on needles by hand or remove needles from syringes.
Dispose of needles in puncture-proof containers out of the
reach of children and visitors.)
Other environments
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CDC has only found one case of HIV
transmission from open mouth kissing
HIV might be able to be transmitted by biting
due to trauma and blood interaction
Contact with saliva, tears, or sweat has
never been shown to result in transmission
of HIV.
Studies conducted by researchers at CDC
and elsewhere have shown no evidence of
HIV transmission through insects--even in
areas where there are many cases of AIDS
and large populations of insects such as
mosquitoes.
Condom use
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Numerous studies among sexually
active people have demonstrated that
a properly used latex condom provides
a high degree of protection against a
variety of sexually transmitted
diseases, including HIV infection.
Acute Retroviral Syndrome
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Not all become acutely ill
Flu-like illness
Very contagious
HIV Antibodies
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Develop after infection (varies)
Seropositive (Enzyme immunoassay
followed by Western Blot or other tests
Clinic or home testing
Lymph node biopsy
Antigen detection (viral load)
Immunodeficiency
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Begins immediately after infection
Kills CD4+ T-lymphocyte cells
Category 1 >500 cells
Category 2 200-499 cells
Category 3 <200 cells
CD8 lymphocytes attack HIV
Triple drug therapy makes a
difference!!!!
Asymptomatic HIV Infection
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Herpes zoster (“shingles”)
Goal of antiretrovial therapy is to
reduce viral load to undetectable
Early HIV
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Category A: lymph node swelling,
acute infection
Category B: Candidiasis (oral or
vaginal), peripheral neuropathy, herpes
zoster, fatigue, low energy
Catergory C: 23 qualifying infections
e.g. pneumocystis carinni (pneumonia)
or kaposi’s sarcoma
Conditions Associated with AIDS
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27 clinical conditions can be used in
diagnosing AIDS along with HIV + status
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Include the presence of “opportunistic
infections” that take advantage of weakened
immune system
Also include cancer, clinical conditions, and
other infections
Conditions Associated with AIDS
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Opportunistic infections:
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Often caused by common bacteria present in healthy
people; immune suppression makes people with AIDS
vulnerable
Pneumocystis carinii pneumonia (PCP)
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Common organism multiplies in lungs
Fluid accumulates (pneumonia)
Mycobacterium avium intracellulare
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Most common tuberculosis in people with AIDS, may affect
many organs
Resistant to most antibiotics
Conditions Associated with AIDS
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Mycobacterium tuberculosis
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Bacterial pneumonia
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Occurs in lungs
Infectious, but treatable with antibiotics
Caused by several common bacteria
Patient may have many episodes
Toxoplasmosis
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Disease of brain and central nervous system (spinal cord)
Caused by parasite found in cat feces
Conditions Associated with AIDS
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Cancers:
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Kaposi’s sarcoma
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Lymphomas
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Cancer of the blood vessels
Red/purple splotches under skin
Cancer of the lymphatic system/brain
Invasive cervical cancer
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Can lead to uterine cancer if untreated
Clinical Conditions Associated
with AIDS
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Wasting syndrome
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HIV encephalopathy/ AIDS dementia
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severe weight loss, with weakness and diarrhea
Direct infection of the brain
Impairment of mental functioning, changes in mood
Other infections
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Candidiasis or “Thrush”: yeast infection of mouth
Herpes simplex: persistent lesions of mouth, lungs,
esophagus
Cytomegalovirus: infects brain, retina, lungs
Symptoms of HIV Infection and
AIDS
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Unexplained persistent
fatigue
Fever, chills, night sweats
Unexplained weight loss
Swollen lymph nodes
Pink, red, purple, or
brown blotches
Persistent dry cough
Persistent, fuzzy, white
spots in mouth, tongue,
or throat
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Memory loss or
depression
Abnormal pap smears
Persistent vaginal
candidiasis
Abdominal cramping
(due to Pelvic
inflammatory Disease)
Persistent Diarrhea
The Immune System and HIV
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Leukocytes – white blood cells
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Macrophages
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Antigens
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Stimulate immune system, react with antibodies
Antibodies
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Engulf foreign particles
Inactivate antigens, mark them for destruction
B cells and T cells
Treatment
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AZT (zidovudine)
Protease inhibitors
HAART (highly active anti-retroviral
therapy)
Fatality rate dropped from 90% to 5%
in US
Secondary treatment of infections &
tumors
AIDS and Its Treatments
Phases of Infection
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Time from HIV infection to AIDS variable
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Early phase
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flu-like symptoms
Intermediate phase
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Ranges from few months to 17 years
T cells decrease to 200-500/milliliter of blood
Advanced phase
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T cells drop to under 200, virus is detectable in
blood
Person with AIDS dies from opportunistic disease
Phases of Infection
Epidemiology of HIV
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Epidemic: rapid and wide spreading of a
contagious disease
Worldwide, over 36 million people have been
infected with HIV
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29 million people in sub-Saharan Africa
Five million people newly HIV infected each year
In the U.S., 816,000 people are infected
About 40,000 people a year are infected with
HIV in the U.S.
Epidemiology of HIV
Populations most affected by
HIV/AIDS
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HIV/AIDS occurs in all population groups
Four populations most affected by HIV /AIDS
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Men who have sex with men
Injection drug users
Heterosexual persons
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Higher rates for people who use drugs, exchange sex for
drugs, have other STIs
Infants whose mothers have untreated HIV infections
African Americans are disproportionately
affected
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Since the mid 1990s: more African-Americans with
AIDS than white Americans in US
Populations most affected by
HIV/AIDS
Modes of Transmission
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Vaginal or anal intercourse, oral sex
without a latex or polyurethane condom
or barrier
Sharing needles - drug use,
tattooing/piercing
Passing virus from mother to fetus
Modes of Transmission
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Breastfeeding from HIV-positive mother
Sharing sex toys
Accidental contamination with infected
blood
Contaminated blood transfusions or organ
transplants performed before April 1, 1985
Sexual Transmission
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Anal intercourse
Vaginal intercourse
Oral sex
Sex toys
STIs and HIV transmission
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STIs increase likelihood of HIV infection
two to five times
An HIV-infected person also infected with
STI is three to five times more likely to
transmit HIV through sexual contact
Uncommon Transmission Modes
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Nonsexual contact
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Health care worker risk low with standard
infection control precautions
Accidents
Blood transfusions and organ donations
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Blood has been screened for HIV since 1985
Organs, semen donations screened for HIV
U.S. AIDS Demographics
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People of Color
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Gay community
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Most due to exposure at birth, HIV positive mother
Teens and college students
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Risk from drug use, at-risk sex partners: 26% of cases
Children and HIV
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Men who have sex with men 55% of 2001 AIDS cases
Women and HIV
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Increasing infection among African Americans
Half of new infections among young people 13-24
Older adults
U.S. AIDS Demographics
by Infection
U.S. AIDS Demographics
by Race
Poverty, Ethnicity and HIV
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In 2001, minorities were 68% of diagnosed
AIDS cases
Race and ethnicity are not risk factors:
they correlate with homelessness, access
to health care
Poverty, Ethnicity and HIV
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AIDS leading cause of death in African-American
women 25-34, African-American men 35-44
African-American HIV infection rate 16 times
that of Non-Hispanic Whites
Hispanic AIDS incidence four times that of nonHispanic Whites
Southern U.S. has disproportionate share of
cases
Prevention
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Be aware that alcohol and drug use
increases risky behaviors
Develop communication skills to be able
to discuss risks and prevention with
partners
Be aware of information on HIV testing
Become familiar with condoms
Education about HIV/AIDS
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Prevention has reduced new infections from
150,000/year to 40,000/year
Obstacles to education: blame and denial
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AIDS seen as disease of marginalized group, not “us”
HIV/AIDS education in schools
Outreach programs
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Heterosexual adults
Men who have sex with men
Youths
Drug users
HIV Testing
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Tests should be taken 12 weeks after high-risk
behavior, repeated 6 months after an uncertain
result
Types of tests
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OraQuick Rapid HIV-1 Antibody test
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Takes 20 minutes, 99.6% accurate
ELISA - enzyme-linked immunosorbent assay
Western blot –rechecks ELISA results
Viral load tests measure HIV in bloodstream
Notifying current and past partners
HIV Drugs
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Nucleoside reverse transcriptase inhibitors (RT
inhibitors)
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Protease inhibitors
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Interrupt virus reproduction at later stage
Fusion Inhibitor
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Interrupt virus making copies at early stage
Block HIV before it enters the cell
HAART – Highly Active Antiretroviral Therapy
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RT inhibitors and protease inhibitors combined
Reduces HIV in blood to undetectable levels
The case of Fritz
Fritz is a 43-year-old single white man that has been HIV
positive for the past six years. He has been getting medical
treatment at a county public health AIDS clinic and has been
taking AZT for the past 5 years.
Fritz has been employed full-time as a hairdresser at the
same medium-sized salon for over 12 years. Lately he has
been having problems with fatigue and has complained of loss
of concentration and becoming forgetful. He has been
occasionally forgetting what his customers tell him and has
been making some mistakes while cutting and setting hair.
Likewise, he has become rather tired standing all day. A friend
who received vocational rehabilitation services years ago for a
different condition referred Fritz to VR services. Fritz indicated
that he has not told him employer that he is HIV positive, but
has a good working relationship with the owner of the salon.
Fritz’s physician does not think that he has the symptoms of
AIDS as of yet.
Discussion on the case of Fritz
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What are the possible functional
limitations associated with Fritz’s
medical condition that would influence
his rehabilitation potential?
How would you explain Fritz’s
disability to his employer?
What vocational changes (if any)
would you suggest?
Links
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CDC HIV transmission fact sheet:
http://www.cdc.gov/hiv/resources/facts
heets/transmission.htm