Welcome to Carolinas CARE Partnership. HIV A to Z: 6/30/2015. Objectives. The Basics and Beyond. Introductions Pre-Test Expectations

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1 Welcome to Carolinas CARE Partnership HIV A to Z: The Basics and Beyond Introductions Pre-Test Expectations Objectives Distinguish and define HIV and AIDS Brief history of the origin of HIV and AIDS Explain how HIV is transmitted Discuss specific substances and their associated risks Describe methods of prevention and harm reduction of HIV transmission Introduce biological and clinical aspects of HIV and AIDS Explain HIV testing and reporting procedures Identify current trends in HIV infection and understand relevant statistics Define viral load and CD4 count 1

2 Objectives Understand stages of HIV infection, including acute infection and progression to AIDS Understand significance of basic lab work Describe HAART (Highly Active Anti-Retroviral Therapy) Understand importance of treatment adherence Recognize opportunistic infections associated with AIDS Identify common psycho-social issues for people living with HIV HIV Human-a person. It can only transmit through human contact Immunodeficiency-inability to produce a normal complement of antibodies. It weakens the immune systems which is the body s defense mechanism. Virus-small infectious agent that can replicate only inside the living cells of organisms; Symptoms can be treated, but it is not curable HIV Is the virus that causes AIDS 2

3 AIDS Acquired-to get. It is not hereditary, but retrieved from an outside source Immune-having or producing antibodies or lymphocytes capable of reacting with a specific antigen Deficiency-an amount that is lacking or inadequate Syndrome- a group of signs and symptoms that occur together and characterize a particular abnormality or condition. In this case, they are highly life-threatening. AIDS Is a condition that results from HIV infection. Stigma Stigma can be internalized or externalized. -Internalized shame, guilt -Externalized discrimination, bullying, ostracism, making people use different bathrooms or eating utensils What effect do you think stigma has on HIV prevention, transmission, and treatment? 3

Blacks account for more than half of all persons diagnosed with HIV/AIDS.

4 Current U.S. Statistics An estimated one million people have HIV. 20% of them don t know it. Adults aged 30 to 39 years and 40 to 49 years accounted for the greatest number of new HIV reports in Blacks account for more than half of all persons diagnosed with HIV/AIDS. Although men still make up ¾ of all HIV/AIDS cases, the rate among women is rising. Heterosexual contact (women having sex with men) accounted for about 86% of cases and injecting drug use (using drug needles) accounted for 13% in women. Black female HIV rate was almost 23 times higher than that of White females. 4

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6 The Impact of AIDS in North Carolina Nationally, in 2011, North Carolina reported the 2nd highest number of AIDS cases from rural areas. As of 2011, 24,369 NC residents were HIV+ and 10,651 living with AIDS. Of those living with AIDS, Blacks made up 68%. There are currently about 7,000 people in NC living with HIV who aren t aware of their status. The Impact of AIDS in Mecklenburg County In 2013, 428 new cases of HIV were reported in Mecklenburg County Mecklenburg County has the highest number of reported HIV Infections in North Carolina HIV is the second leading cause of death for people ages in Mecklenburg County People age 50 and over represented an average of 15% of new cases between The most commonly reported modes of transmission for HIV in MC are Unknown (33%), Men having sex with men (25%), Injecting Drugs (20%) and Heterosexual Sex (16%). Ways HIV is NOT transmitted Sharing food Eating utensils Water fountains Toilet seats Coughing Sneezing Hugging Insect bites Sitting next to an HIV+ person Swimming Kissing Breathing the same air Animal bites Donating blood Telephones Everyday casual contact 6

By sharing unclean needles or syringes with an infected person.

7 Bodily fluids that transmit HIV Blood Semen (including pre-ejaculate fluid) Vaginal fluid Breast milk Ways HIV is transmitted By having unprotected sex with an infected partner anal, oral or vaginal. By sharing unclean needles or syringes with an infected person. From an infected mother to child during pregnancy, birth or breastfeeding. Bodily fluids that do not transmit HIV Sweat Tears Urine Saliva Vomit 7

8 Testing is Testing by itself is not prevention. A test is the only way of knowing if you are infected with HIV, the virus that causes AIDS. People infected with HIV may look and feel healthy for a long time, but they can infect others even if they don t look or feel sick. HIV test reporting in NC is name based (confidential), Most testing is done at county health departments, medical settings, and nontraditional sites Testing-Types Approved FDA Rapid tests include: OraQuick ADVANCE Rapid HIV-1/2 Antibody Test Uni-Gold Recombigen HIV Reveal G-3 Rapid HIV-1 Antibody Test MultiSpot HIV-1/HIV-2 Rapid Test Clearview HIV 1/2 STAT-PAK Clearview COMPLETE HIV ½ OraSure HIV-1 Alere Determine Conventional Blood-draw Testing-Types (continued) Every positive test requires a confirmatory test Western Blot and Elisa test for antibodies RNA analysis test for the presence of the virus 8

Trained personnel Testing-What to expect?

9 Testing ELISA for HIV antibody Easy to perform High sensitivity & specificity Cost effective Testing-Western Blot High specificity Expensive Labor intensive Trained personnel Testing-What to expect? Pre-test counseling Test Post-test counseling -Test result counseling: Negative -Test result counseling: Positive 9

10 The Role of DIS Division of Public Health must conduct partner notification programs for both HIV and syphilis. The Disease Intervention Specialist (DIS) is a specially trained health professional that performs STD intervention activity. These include investigations to locate infected patients, exposed partners and provide assurance that patients are referred to proper treatment and examination. Currently North Carolina has prioritized HIV/syphilis as primary diseases for hands on intervention. Prevention vs. Harm Reduction Ways not to get HIV Ways to lower the risk of getting HIV Prevention of HIV Infection Abstaining from needle sharing and sex 10

11 Harm Reduction Being faithful, mutual monogamy Consistent and correct condom use What about Undetectable/virally suppressed HIV+ Partner Negative Partner on PreP Seeking prenatal care early in and often during the pregnancy Specific Risk Crack Heroin Alcohol Crystal Meth Ecstasy/MDMA/Designer Drugs Cocaine Marijuana Bath Salts Prevention for Positives Re-infection (super-infection or coinfection) when a person living with HIV gets infected a second time while having unprotected sex with another HIV infected person. The other strain of HIV may not respond and be resistant to the medication. The re-infected person s immune system must start all over in trying to fight it off. 11

In the News PrEP Using Truvada in high risk negatives to prevent infection 100% effective in those who take it correctly $14,000 per year Drug resistance Side effects In Home HIV Testing Cost No

12 In the News PrEP Using Truvada in high risk negatives to prevent infection 100% effective in those who take it correctly $14,000 per year Drug resistance Side effects In Home HIV Testing Cost No pre-test counseling No post-test counseling Confirmatory? HIV education? Referrals for services? Trends and News Toddler with functional cure Gardner s Cascade Why is this important? Research from UNC-Chapel Hill (5/2011) shows that if a person s virus is suppressed, s/he is 96% LESS LIKELY to pass the virus on to his/her partners. Moving people further down the cascade lowers the risk of transmission, lowers the community s viral load and the burden of new infections. 12

Basic Lab Terms CD4 Cell (T-helper Cell,T4 Cell)-type of white blood cell that is targeted by HIV and turn the cell into a production factory for more HIV Normal cell range 600-1200 Recommended

13 Basic Lab Terms CD4 Cell (T-helper Cell,T4 Cell)-type of white blood cell that is targeted by HIV and turn the cell into a production factory for more HIV Normal cell range Recommended checks semi annually or annually Viral Load-measure the amount of HIV RNA in the blood RNA indicates that the virus is actively replicating Stages of HIV Viral transmission 2-3 wks Acute Retroviral syndrome 2-3 wks Recovery + Seroconversion 2-4 wks Asymptomatic chronic HIV infection Avg. 8 yrs Symptomatic HIV infection / AIDS Avg. 1.3 yrs Life Cycle of HIV 13

14 Opportunistic Infections Protozoal: toxoplasmosis, cryptosporidosis Fungal: candidiasis, cryptococcosis histoplasmosis, pneumocystis carinii Bacterial: Mycobacterium avium complex (MAC), atypical mycobacterial disease, salmonella, septicaemia multiple, syphilis or recurrent bacterial infection Viral: CMV, HSV, VZV, JCV, HPV Opportunist tumors: Kaposi s Sarcoma and Malignant lymphomas Opportunistic Infections- Recurrent Bacterial Infections Tuberculosis (TB) Candidiasis (Thrush) Chronic diarrhea (more than 1 month s duration) Cryptococcosis Pneumocystis carinii pneumonia (PCP) Toxoplasmosis HIV Treatment: Goals HAART Medications slow the spread of HIV in the body HAART Medications make the immune system stronger Other Medications such as sulfa drugs, antibiotics, and anti-fungals prevent or treat opportunistic infections 14

Fatigue Anemia Digestive Problems Gas and bloating Diarrhea Lipodystrophy Neuropathy

15 Treatment Options Highly Active Antiretroviral Therapy (HAART) 3 or more antiretroviral drugs from 2 or more different classes HIV Medications-Side Effects Fatigue Anemia Digestive Problems Gas and bloating Diarrhea Lipodystrophy Neuropathy HIV Medications-Resistance What is Resistance? How does resistance develop? Types of Resistance 15

16 HIV Medications- Patient/Client Issues Cost Pill burden Complex dosing schedules Drug interactions Cure not possible Drug toxicity Need for strict adherence HIV Medications- Patient/Client Issues Considerations Before Initiating HAART Patient readiness Medical eligibility/sustainable medication supply Opportunistic Infections treated/stabilized Concurrent medical conditions & medications Psycho-Social Issues Meeting Basic Needs Social Stigma Disclosure Emotional, Physical, Family Support Stress Rejection Isolation Medication Adherence 16

Ethics Cases Tuskegee Syphilis Henrietta Lacks (The Immortal Life of Henrietta Lacks MUST READ) Deep Sleep Therapy Doctors Trial Human Radiation Experiments Specific Populations What are specific

17 Ethics Cases Tuskegee Syphilis Henrietta Lacks (The Immortal Life of Henrietta Lacks MUST READ) Deep Sleep Therapy Doctors Trial Human Radiation Experiments Specific Populations What are specific psychosocial needs of or issues pertaining to specific populations? Men who have sex with Men (MSM) Black MSM Young Black MSM Women Black Women Latina Women Youth Sex workers Seniors Substance Users/Abusers Mentally Ill Working poor/uninsured Adolescents infected prenatally Questions 17

18 Review Test Your Knowledge Contact me with questions! Shannon Warren Program Director Carolinas CARE Partnership

10/17/2015. Chapter 55. Care of the Patient with HIV/AIDS. History of HIV. HIV Modes of Transmission

10/17/2015. Chapter 55. Care of the Patient with HIV/AIDS. History of HIV. HIV Modes of Transmission Chapter 55 Care of the Patient with HIV/AIDS All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. History of HIV Remains somewhat obscure The earlier