april 27, 2015 – nurs 330 turn in info for group project: – group name -and- – names of group...
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April 27, 2015 – NURS 330
• Turn in info for Group Project:– Group Name -and-– Names of Group Members
• Guest Lecture: HIV/AIDS – Amber Wilburn, PhD, LA County Public Health
• Review 4/13/15 In-Class Assignment• Review Mid-term and Extra Credit
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County of Los Angeles Department of Public Health
Division of HIV and STD Programs
Amber Wilburn, PhDHealth Educator
The State of the HIV/AIDS Epidemic
MYTHS AND FACTS ABOUT HIV/AIDS
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Myth/Fact?
HIV is the same as AIDS
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HIV vs AIDS
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HIV AIDS
What it stands for
Human Immunodeficiency Virus
Acquired ImmunoDeficiency
Syndrome
What it is A virus: an agent that replicates inside a living cell
A syndrome: a collection of multiple symptoms or characteristics that often occur together
How it is diagnosed
A test that shows HIV antibodies or antigens in a person’s blood or saliva
• HIV positive test • A T- Cell count of < 200 -OR-• 1 or more opportunistic
infections
AIDS Criteria (CDC)
HIV positive test AND a T-Cell count of <200 or 14% (healthy T-Cell count ranges from 800-
1200)
ORHIV positive test AND one or more
opportunistic infections (OIs)/certain cancers
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If the T-Cell count goes up, or the opportunistic infection goes away, does the
person still have AIDS?
Special Characteristics of HIV
Weakens and compromises the immune system
HIV replicates in large quantities
Ability to mutate (change itself) very quickly
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Myth/Fact?
HIV only affects gay men and drug users
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Impact on Los Angeles County
LA County is second only to NYC among US metropolitan areas in cumulative number of reported AIDS cases
Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC
42% of all California AIDS cases are reported from LAC in 2010
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Myth/Fact?
Once a person is diagnosed with HIV/AIDS,
they will die soon
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HIV Spectrum of Disease
Exposure
No infection
Asymptomatic
Initial Symptoms
Lasts a few weeks
Mild flu-like symptoms: • Fever• Muscle aches• Swollen glands
Infection
Window period*
Asymptomatic
*Window Period: average time it takes the body to produce antibodies; usually 2 - 12 weeks, up to 6 months - 1 year (rare)
Asymptomatic Period
8 - 11 years
(Average progression, may vary depending on the person)
HIV Illness
Symptoms include:• Night sweats• Fevers• Fatigue• Diarrhea• Swollen lymph
nodes• Oral and
vaginal candidiasis
• PID• Pap Smear
positive for HPV
AIDS• T-Cells <200 • 1 or more
OIs (PCP, KS, TB, CMV, Candidiasis, etc.)
• Wasting syndrome
• HIV-related dementia
Common Opportunistic Infections Pneumocystis Jiroveci Pneumonia (PJP)
Formerly Pneumocystis Carinii Pneumonia (PCP)
CMV Infection
HIV Wasting Syndrome
Candidiasis (oral, esophageal, vaginal)
Kaposi’s Sarcoma
Tuberculosis
HIV - Related Dementia
Cervical Cancer
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Myth/Fact?
Casual contact CANNOT put you at risk for HIV
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You CANNOT get HIV from…
• Breathing • Coughing• Sneezing• Kissing• Hugging• Shaking hands• Sharing food or
drinks
• Drinking fountains• Telephones• Toilet seats• Pools/Tubs• Mosquito bite • Giving/donating
blood in US
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HIV Transmission
HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood.
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1 32 4
Infected Body FluidsInfected Body Fluids
HIV Transmission
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1 32
Unprotected SexUnprotected Sex
HIV Transmission
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Piercing/Tattooing
Insulin, hormone, vitamin
shots
Acu-punctur
e
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Exchanging Infected Blood
Exchanging Infected Blood
Sharing needles for any purpose
HIV TransmissionMother To Child Transmission
during pregnancy (in uterus)
during birth process (delivery)
breastfeeding (through breast milk/blood)
*Perinatal transmission can be significantly reduced to less than 2% with proper care
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TIME FOR AN ACTIVITY
“The Spectrum of Risk”
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Myth/Fact?
Having another STD puts a person at greater risk for
contracting HIV
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STDs and HIV
STDs increase the
concentration of “infection
fighting” CD4 cells in genital secretions, a
favorite target of HIV
STDs cause breaks in the skin on and
surrounding the penis, vagina and
anus, which provides a
perfect entry way for HIV
STD infection increases risk of contracting HIV (susceptibility)
-
HIV+ individuals who are also
infected with an STD have more
HIV in their genital
secretions
STDs and HIV
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HIV+ men who are also infected with an STD have much more HIV in their semen than
HIV+ men without an STD
STD infection increases risk of passing HIV to a partner (infectiousness)
+
? ? ?
Myth/Fact?
HIV testing is unnecessary because I would know if
my lover or I had it
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HIV TESTHIV Antibody test Looks for antibodies
Accuracy of the test
99.9%
Types of tests
Standard test – results will be known in
1 week
Rapid test – results will be known in 20-
40mins
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HIV TESTOther Test - Uni-Gold Recombigen HIV- results will be known in 10 min.
- Reveal G3 Rapid HIV-1 results will be known in 3 minutes - Multispot HIV 1/HIV-2- results will be known in 15 mi.
- Clearview HIV 1/2 Stat-Pak - results will be known in 15 mi.
- Clearview Complete HIV 1/2- results will be known in 15 mi. - Insti HIV-1- results in as little as 60 seconds
FDA has, for the first time, approved an over-the-counter HIV Rapid test (Oraquick) for home use.
Test settings Anonymous
Confidential
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Informed Consent12 yrs of age or older
Benefits of Testing……..
Where to test? Private medical doctor County clinic Community-based organizations
www.hivla.org 1-800-367-AIDS (2437)
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Myth/Fact?
A person who is HIV positive must tell partners
their status
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What are the differences between ethical and legal aspects?
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California’s “Willful Exposure” Law (1998)aka “Recalcitrant Behavior”:Willfully exposing another to HIV through unprotected sex 8 years of imprisonment Intention to infect others with HIV through sex
To be prosecuted under the law, one would have to do ALL of the following: Have anal or vaginal sex Know that they are HIV + Fail to disclose their HIV status Fail to use a condom Have a specific intent to infect another person
Actual knowledge of HIV infection without more evidence of “specific intent” is insufficient for prosecution. 29
CONFIDENTIALITY LAWS
Disclosing a person’s HIV+ status to a third party without the individual’s specific signed consent, is illegal;
Penalties and damages for unauthorized disclosure of HIV status is a $5,000-$10,000 fine and/or jail sentence.
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Rehabilitation Act of 1973 and American with Disabilities Act (ADA) 1990 Prohibits discrimination against a person with a disability, including HIV disease or AIDS. infection.This prohibits discrimination with regards to employment, public services, public accommodations, and medical care.
Housing Discrimination
Care DiscriminationA doctor or dentist cannot refuse to treat an HIV+ person
California Anti-Discrimination LawsFair Employment and Housing Act (FEHA) and Unruh Civil Rights Act 31
FEDERAL ANTI-DISCRIMINATION LAWS
PREVENTION
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It is not who we are but what we do
that puts us at risk for HIV infection
The Prevention “Toolbox”
1. Abstinence
2. Safer SexMale Condom (Activity)Female CondomDental Dams
3. Safer Needle UseNot Sharing NeedlesCleaning Needles (3x3x3 Method)Needle Exchange
4. Harm Reduction
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PREVENTION: Abstinence
Abstinence: not having sex of any kind or sharing needles. Not exchanging any bodily fluids is the only 100% sure way to avoid becoming infected with HIV.
If one is not going to abstain, what other options do they have?
– Monogamous relationship – Using barriers (Safer Sex)
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PREVENTION: The Female Condom
• The female condom• Needle exchange
PREVENTION: Standard Precautions
Infection control measures that reduce the risk of transmission of blood-born germs from patients to health care workers
Wash hands thoroughly
Wear gloves
Use masks and eye protection
Wear a gown
Carefully handling and disposing of sharp instruments during and after use.
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TREATMENT
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TREATMENT
Goals of HIV/AIDS treatment:
Reduce HIV-related morbidity and prolong survival,
Improve quality of life,
Restore the immune system,
Suppress the viral load, and
Prevent vertical HIV transmission (mother to child).
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What are Anti-retrovirals (ARVs) ?
Anti-retrovirals are drugs that interrupt the HIV replication process and help preserve the health of the immune system
These drugs must be taken in combinations in order to have a lasting effect. The three drug combination is commonly known as a “triple cocktail”
Using a combination of anti-retrovirals creates multiple obstacles to HIV replication. This is designed to keep the virus from replicating freely and reduce the possibility of a mutation.
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When to start anti-HIV medications?2 schools of thought:
1.Treatment should begin if there are severe symptoms of HIV infection or a diagnosis of AIDS with a CD4 count of 350 cells/mm3 or less
2.Starting treatment immediately following diagnosis
Because of the complexity of selecting and following a regimen, the severity of the side-effects, and the importance of compliance to prevent resistance, it is extremely important to engage patients in treatment decisions.
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Current classes of Anti-HIV medications Entry inhibitors Fusion inhibitors Non-Nucleoside Reverse Transcriptase
Inhibitors (NRTIs) Nucleoside Reverse Transcriptase Inhibitors
(NRTIs) Protease Inhibitors Integrase inhibitors
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Who Pays For Treatment?
HMO insurance
Medi-Cal
Medicare Part D
ADAP
Shared cost
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Complementary Therapy
General Health Maintenance
Psychological Well-Being
Spiritual Well-Being
Social Well-Being
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Treatment as Prevention What is ‘Treatment as Prevention’?
The use of antiretroviral drugs (ARVs)in HIV-positive individuals to reduce the risk of transmitting the virus to others
How does ‘Treatment as Prevention’ work? Consistent use of ARVs lowers an HIV positive person’s viral
load. Less virus in the body means less virus to be transmitted.
In general, people who have a suppressed viral load (<200 copies/ml) are much less likely to transmit HIV to sex and/or needle sharing partners
Large international study of serodiscordant couples showed ART for the HIV infected partner reduced HIV transmission by 96% (Cohen et al, NEJM 2011)
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PEP vs. PrEPPEP PrEP
What it stands for
What it is Use of 2-3 ARVs AFTER HIV exposure
Use of 2 ARVs taken BEFORE HIV exposure
Who it’s for HIV negative person exposed to HIV during a single event
HIV negative person engaging in high risk activities who may be unable to use other prevention methods
When to take it
Within 72 hours after exposure and for 28 days thereafter
7 days before an exposure and daily until risk goes away
Where to get it
Emergency rooms, Intensive care units, Primary doctorIn LAC: Oasis Clinic and LA LGBT Center
Doctor, certain clinics where PrEP studies are being done
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Recent Advancements Maturation inhibitors
Multi-class Combination Products
Immune based therapies
Gene Therapy
Vaccine
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QUESTIONS?
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For More Information, Contact:
http://publichealth.lacounty.gov/dhsp/
Amber Wilburn, [email protected]
213-351-8094