naadac hiv webinar v2 · naadac hiv webinar v2.pptx author: misti storie created date: 10/4/2013...

10/4/13

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HIV/AIDS: The Current "State of Affairs"

Presented by: Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical Supervisor, LAC, MAC

October 9, 2013

Earn Free Con*nuing Educa*on thru NAADAC -‐ www.naadac.org/educa*on

Webinar Organizer


Misti Storie, MS, NCC

Director of Training & Professional Development

NAADAC, the Associa9on for Addic9on Professionals

Using GoToWebinar

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 PowerPoint Slides

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Obtaining CE Credit

o  The educa9on delivered in this webinar is FREE to all professionals.

o  1 CE is FREE to NAADAC members and Accucare subscribers who aQend this webinar. Non-‐members of NAADAC and non-‐subscribers of Accucare receive 1 CE for $15.

o  If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)



o  A CE cer9ficate will be emailed to you within 21 days of submi^ng the quiz and payment (if applicable) – usually sooner.

o  Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.

Define HIV/AIDS and describe the transmission and course of these diseases

Name 3 symptoms of ini9al infec9on w/HIV and 3 condi9ons necessary for diagnosis w/AIDS

Name 5 risk factors for contrac9ng HIV

Explain the process of diagnosing HIV

Describe 4 harm reduc9on ac9vi9es that reduce the risk of HIV infec9on

Discuss treatment op9ons

Describe 3 classes of medica9ons used to prevent and/or slow progression of HIV

Discuss HIV in special popula9ons of concern

Webinar Objectives

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Presented By

Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical

Supervisor, LAC, MAC

hQp://www.nlm

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Overview 2013: HIV and AIDS Presenter: Mita M Johnson Content: •  Defini9on of Terms •  Can I have AIDS without HIV? •  Brief Timeline •  Sta9s9cs: HIV Infec9on and AIDS Diagnoses •  Transmission Routes •  HIV Infec9on: stages of disease progression •  Update: tes9ng •  Update: treatment medica9ons •  Implica9ons for clinicians and other professionals

Defini9on of Key Terms

hQp://www.ra9onalavenue.com/aids-‐the-‐miracle-‐cure-‐and-‐the-‐promises-‐ahead

  virus versus bacteria or parasite   Retrovirus   genotype   HIV: human immunodeficiency virus   AIDS: acquired immunodeficiency syndrome   immune system: T-‐cells, an9bodies, CD4 receptor site   seroconversion: sero-‐nega9ve and sero-‐posi9ve   false nega9ves and false posi9ves   infec9ous-‐ability: STIs and STDs   IDU: injec9on drug users   ART: an9-‐retroviral therapy

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What is HIV? Can I have AIDS without HIV?

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hQp://www.iayork.com/MysteryRays/2008/02/28/hiv-‐virulence-‐over-‐the-‐years/

T R A N S M I S S I O N

hQp://www.care-‐mates.com/blog/?m=200804

T R A N S M I S S I O N

hQp://www.piperreport.com/archives/2005_05.html

Primary Modes of Transmission: HIV •  specific bodily fluids: blood, semen/cum, pre-‐seminal fluid/pre-‐cum, rectal fluids, vaginal fluids, breast milk

• direct blood-‐to-‐blood contact: injec9on or damaged 9ssues or mucous membranes

• having unprotected sex: anal sex has the highest risk, vaginal sex has the second highest risk; abs9nence has lowest risk

•  sharing needles, syringes, rinse water, or other equipment/works used to prepare injec9on drugs

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hQp://www.tht.org.uk/myhiv/HIV-‐and-‐you/Simple-‐science/The-‐immune-‐system

Stages of HIV Disease Progression to AIDS

Acute Infec9on: 2 – 4 weeks aoer infec9on: worst flu ever: acute retroviral syndrome (ARS) or primary HIV infec9on.

Clinical latency: aoer acute phase: asymptoma9c HIV or chronic HIV infec9on: can last 8 years or longer depending on many variables.

AIDS: number of CD4 cells has fallen below 200 cells per cubic milliliter of blood and increased vulnerability for opportunis9c infec9ons.

hQp://aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/hiv-‐in-‐your-‐body/stages-‐of-‐hiv/

HIV Tes9ng:   Types of HIV tests:

•  An9body tests •  An9gen tests •  PCR (Polymerase chain reac9on) test •  Home test kits

  test loca9ons   tes9ng frequency   pre-‐post test counseling   opt-‐out tes9ng   confiden9al and anonymous tes9ng -‐ HIPAA

hQp://www.aids.gov/hiv-‐aids-‐basics/preven9on/hiv-‐tes9ng/hiv-‐test-‐loca9ons/index.html

Drugs Tackle Each Stage of the HIV Life Cycle

hQp://i-‐base.info/guides/star9ng/hiv-‐lifecycle

Overview of HIV Treatment Drug Categories – based on their ac9ons  Nucleoside/Nucleo9de Reverse Transcriptase Inhibitors (NRTIs)

• NRTIs are “nukes” that act as faulty building blocks in the reproduc9on of viral DNA

• nukes block HIV’s ability to use a special type of enzyme (reverse transcriptase) to correctly build the new gene9c material (DNA) that the virus needs

• Medica9ons that act as NRTIs include:

▪ Combivir (lamivudine/zidovudine) ▪ Emtriva (emtricitabine, or FTC) ▪ Epivir (lamivudine, or 3TC) ▪ Epzicom (abacavir/lamivudine) ▪ Retrovir (zidovudine, AZT, or ZDV) ▪ Trizivir (abacavir/lamivudine/zidovudine) ▪ Truvada (emtricitabine/tenofovir) ▪ Videx EC and Videx (didanosine, or ddI) ▪ Viread (tenofovir DF, or TDF) ▪ Zerit (stavudine, or d4T) ▪ Ziagen (abacavir, or ABC)

hQp://www.aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/treatment-‐op9ons/overview-‐of-‐hiv-‐treatments/

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Drug Categories – based on their ac9ons  Non-‐Nucleoside Reverse Transcriptase Inhibitors (NNRTIs):

• NNRTIs are “non-‐nukes” that act in a manner very similar to NRTIs; non-‐nukes block HIV’s ability to use the enzyme reverse transcriptase to correctly build the new gene9c material (DNA) that the virus needs

• NNRTIs work directly on the enzyme to prevent it from working correctly

• Medica9ons that act as NNRTIs include: ▪ Edurant (rilpivirine, or RPV) ▪ Intelence (etravirine, or ETR) ▪ Rescriptor (delavirdine, or DLV) ▪ Sus9va (efavirenz, or EFV) ▪ Viramune XR and Viramune (nevirapine, or NVP)


Drug Categories – based on their ac9ons  Protease Inhibitors (PIs):

• When HIV replicates within the T cells, it creates long strands of its own gene9c material. These long strands have to be cut into shorter strands in order for HIV to create mul9ple copies of itself.

•  The enzyme that acts to cut up these long strands is called protease. Protease inhibitors (stoppers) block this enzyme and prevent those long strands of gene9c material from being cut up into func9onal pieces.

• Medica9ons that act as Protease Inhibitors include: ▪ Ap9vus (9pranavir, or TPV) (must be taken with Norvir) ▪ Crixivan (indinavir sulfate, or IDV) ▪ Invirase (saquinavir, or SQV) (must be taken with Norvir) ▪ Kaletra (lopinavir/ritonavir, or LPV/r) ▪ Lexiva (fosamprenavir calcium, or FPV) ▪ Norvir (ritonavir, or RTV) ▪ Prezista (darunavir, or DRV) (must be taken with Norvir) ▪ •Reyataz (atazanavir sulfate, or ATV) ▪ Viracept (nelfinavir, or NFV)


Drug Categories – based on their ac9ons  Entry/Fusion Inhibitors:

•  These medica9ons work to block the virus from ever entering your cells in the first place.

• HIV needs a way to aQach and bond to your CD4 cells, and it does that through special structures on cells called receptor sites. Receptor sites are found on both HIV and CD4 cells (they are found on other types of cells too).

•  Fusion inhibitors can target those sites on either HIV or CD4 cells and prevent HIV from "docking" into your healthy cells.

• Medica9ons that act as Entry/Fusion Inhibitors include: ▪ Fuzeon (enfuvir9de, T-‐20, ENF) ▪ Selzentry (maraviroc, or MVC)


Drug Categories – based on their ac9ons  Integrase Inhibitors:

• HIV uses your cells’ gene9c material to make its own DNA (a process called reverse transcrip9on) – think “photocopy machine”. Once that happens, the virus has to integrate its gene9c material into the gene9c material of your cells. This is accomplished by an enzyme called integrase.

•  Integrase inhibitors block this enzyme and prevent the virus from adding its DNA into the DNA in your CD4 cells. Preven9ng this process prevents the virus from replica9ng and making new viruses.

• Medica9ons that act as Integrase Inhibitors include: ▪ Isentress (raltegravir, or RAL) ▪ Dolutegravir (or DTG) (inves9ga9onal drug) ▪ Elvitegravir (or EVG) (inves9ga9onal drug)


Drug Combina9ons: Fixed-‐dose Combina9ons •  These are not a separate class of HIV medica9ons but combina9ons of the above classes and a great advancement in HIV medicine.

•  They include an9retrovirals which are combina9ons of 2 or more medica9ons from one or more different classes. These an9retrovirals are combined into one single pill with specific fixed doses of these medicines.


Treatment Considera*ons:   What are the CDC guidelines for

when to begin treatment?   What is involved in ini9a9ng

treatment?   What medical tests might be

ordered?   Is a thorough assessment of service

and support needs ini9ated?   What lifestyle changes are there to

consider?   Medica9on side effects?

  short-‐term   long-‐term

  Medica9on adherence.   When is treatment stopped or

changed?   What is drug resistance?   Are there clinical trials out there?   Alterna9ve therapy?   Adjunc9ve therapies?

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Risk Factors for Contrac9ng HIV

Risk Factors for Contrac9ng HIV  A person who has a current STD is at higher risk for picking up HIV or herpes or other infec9on.

 A person with Chlamydia is 3 to 4 9mes more likely to contract HIV.  A person with herpes is at higher risk for picking up HIV due to a taxed immune system.

 Any disease that causes lesions increases the possibility of blood-‐to-‐blood or blood-‐to-‐semen contact.

 All substances affect the body’s immune system and its ability to resist any disease organism. Alcohol and illicit drugs (1) suppress the immune system, and (2) alter the individual’s judgment to the extent that engaging in high risk behaviors such as unprotected sex is more likely. (Hatcher, A., 2010)

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Co-‐Factors which Increase Disease Progression

hQp://hepcproject.typepad.com

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Copyright 2012

Harm Reduc9on?

  abs9nence   easily accessible, free condoms   easily accessible, free tes9ng   counseling   needle exchange programs   bleach   universal precau9ons  myths

What are the most pressing issues in HIV care today?

•  access to treatment – access to care – access to resources & support • non-‐HIV primary care – care con9nuum – cascade of care • figh9ng HIV s9gma and ignorance •  inflamma9on and accelerated aging •  funding for health coverage for uninsured and underinsured •  emerging comorbidi9es: non-‐HIV chronic diseases •  cultural competence and sensi9vity versus culturally incompetent • morbidity and mortality rates •  test and treat

hQp://www.thebodypro.com/content/72261/what-‐is-‐the-‐most-‐pressing-‐issue-‐in-‐hiv-‐care-‐today.html?getPage=14

Thank you for participating!

1001 N. Fairfax Street., Ste. 201 Alexandria, VA 22314 phone: 703.741.7686/800.548.0497 fax: 703.741.7698/800.377.1136 [email protected] www.naadac.org/educa9on

Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical Supervisor, LAC, MAC [email protected]

[email protected] www.myaccucare.com

10/4/13

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Obtaining CE Credit

o  The educa9on delivered in this webinar is FREE to all professionals.

o  1 CE is FREE to NAADAC members and Accucare subscribers who aQend this webinar. Non-‐members of NAADAC and non-‐subscribers of Accucare receive 1 CE for $15.

o  If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)



o  A CE cer9ficate will be emailed to you within 21 days of submi^ng the quiz and payment (if applicable) – usually sooner.

o  Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.

10/4/13

10

Thank you for participating!

1001 N. Fairfax Street., Ste. 201 Alexandria, VA 22314 phone: 703.741.7686/800.548.0497 fax: 703.741.7698/800.377.1136 [email protected] www.naadac.org/educa9on

Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical Supervisor, LAC, MAC [email protected]

[email protected] www.myaccucare.com

naadac hiv webinar v2 · naadac hiv webinar v2.pptx author: misti storie created date: 10/4/2013...

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