. Presented by UIC-CON

Transcription

1 . Presented by UIC-CON

2 Upon completion of this training, learners will better able to: Define HIV & AIDS Review the prevalence of HIV/AIDs in the U.S. Explain the transmission, persons at risk, and common presentation of HIV Discuss prevention strategies Identify risks and mitigation strategies for managing a participant with HIV/AIDS 2

3 HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life 3

4 3 Categories: 1. Category A: Asymptomatic (no symptoms) HIV infection without a history of symptoms or AIDS-defining conditions 2. Category B: HIV infection with symptoms that are directly attributable to HIV infection (or a defect in T-cell mediated immunity) or that are complicated by HIV infection 3. Category C: HIV infection with AIDS defining opportunistic infections These 3 categories are further subdivided on the basis of the CD4 + T-cell blood count, as follows: > 500/µL: Categories A1, B1, C /µL: Categories A2, B2, C2 < 200/µL: Categories A3, B3, C3 4

5 Acquired Immunodeficiency Syndrome (AIDS) is a disease of the immune system due to infection with HIV virus HIV destroys the CD4 T lymphocytes (CD4 cells) of the immune system, leaving the body vulnerable to life-threatening infections and cancers AIDS is the most advanced stage of HIV, however thanks to better antiviral medication treatments, many people with HIV don t develop AIDS HIV typically turns into AIDS in about 10 years 5

6 Once infection has progressed to AIDS, the survival period is usually less than 2 years in untreated patients. Persons in whom the infection does not progress long-term may not develop AIDS for 15 years or longer, although many still exhibit laboratory evidence of CD4 T-cell decline or dysfunction 6

7 AIDS manifests as recurrent, severe, and occasionally life-threatening infections or opportunistic malignancies/cancers HIV infection can cause AIDS-associated dementia/encephalopathy and HIV wasting syndrome (chronic diarrhea and weight loss with no identifiable cause) 7

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9 About 50,000 people get infected with HIV each year 2015, there were 39,513 new HIV infections in the U.S. People aged 50 and over accounted for 17% of new HIV cases 1.1 million people living with HIV in

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13 Gay and bisexual men accounted for 68% of new HIV cases Heterosexual made up 23% of new cases.

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15 A blood-borne virus typically transmitted via: Sexual intercourse Shared intravenous drug paraphernalia Mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding 15

16 Males who are sexually active with males (MSM) comprise the single largest group of individuals in the U.S. who are infected with HIV Black MSM are disproportionately affected by HIV infection (black MSM are 2 times more likely to become infected, controlling for risk factors*) CDC. HIV surveillance Report 2012 *EXPLORE study: 16

17 Non-Modifiable Modifiable Age Lifestyle IV drug user Gender Lifestyle unsafe sex Race 17

18 Modifiable Risk Factors Actions IV drug user Do not share drug equipment. Blood can get into needles, syringes, and other equipment. If the blood has HIV in it, the infection can be spread to the next user. Needle exchange HIV testing & Counseling Unsafe sex Abstinence (not having sex) is the best way to prevent the spread of HIV infection and some other STDs. If abstinence is not possible, use condoms whenever you have sex vaginal, anal, or oral. HIV Testing & Counseling 18

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21 Acute retroviral syndrome (ARS) (acute seroconversion) occurs early in the new infection (usually 2-4 weeks after transmission) Approximately 50%-70 % of HIV-positive persons will experience a flu-like illness (fever, malaise, generalized rash, pharyngitis, generalized lymphadenopathy, and/or myalgias). The asymptomatic period of HIV infection is generally benign and can last from a few months to up to 15 years This varies from person to person and is usually associated with the level of HIV viral load Clinical Latency Period: Many patients will be asymptomatic during the clinical latency period, but various nonspecific findings on physical examination and in lab tests are associated with HIV AIDS 21

22 Between 20% and 25% of the 1.2 million people in the United States living with HIV infection do not know that they are HIV-positive, according to background information in new guidelines U.S. Preventive Services Task Force (USPSTF) recommends routine HIV screening for all individuals aged 15 to 65 years and for all pregnant women 22

23 Studies have shown that HIV is often diagnosed late in the disease process, when the individual has already developed AIDS, which typically occurs 8 to 11 years after HIV infection This points to missed opportunities to offer HIV testing and diagnose the infection before AIDS develops, which would enable the individuals to employ precautions to protect their partners from becoming infected and help control their HIV infection level 23

24 If you have had several sexual partners If you had unprotected sex with someone who is or could be HIV positive, including someone whose sexual history you do not know Injected drugs with needle, syringe, or other equipment that someone else used first Have had or are getting tested for TB or STDs including herpes and hepatitis Have had sex for drugs or money Had sex with someone who has a history of any of the above 24

25 HIV testing routine for everyone aged Persons at risk should be tested every year If not tested by your primary care provider: 1.Visit gettested.cdc.gov Texting your zip code to KNOW-IT (566948) or Call CDC-INFO ( ) 2. Get a home testing kit (Home Access HIV-1 Test System or the OraQuick HIV Test) 25

26 The tests check for a protein (p24)that your body makes in response to the HIV infection, 2-8 weeks after exposure. Antibody Screening Tests: ELISA tests Antibody/Antigen Combination Tests: can detect HIV 20 days earlier that antibody screening tests. (rapid version of test gives results in 20 minutes) RNA Tests: looks for the virus itself and diagnose 10 days after exposure but very expensive. 26

27 The new OTC OraQuick In-Home HIV Test gives results AT HOME in 20 to 40 minutes. It became available in October 2013 in most retail pharmacies...and is similar to the rapid test used in some Providers' offices Patients using OraQuick use a swab to get an oral fluid sample then place it in a vial of solution. In 20 to 40 minutes, the device gives one line for a negative result...and two lines for positive The OTC test has a sensitivity of 92% to detect HIV...and specificity of 99.98% to rule it out. This means 1 in 12 people with HIV will get a false negative...and 1 in 5000 people without HIV will get a false positive Remember the most accurate readings don't occur until 3 months after exposure...when there are enough antibodies for detection It is just a SCREENING test...and a lab blood test is required for confirmation. Encourage people at risk to get tested...nearly 20% of people with HIV in the U.S. aren't aware that they have it. Early treatment can improve outcomes and reduce transmission 27

28 Find out results If you screened with the at home kit and it was positive, get a second follow-up blood test to confirm If you have HIV (+) start treatment quickly to get the most benefit. Take medications as prescribed and protect your sex partners If you are HIV negative, ask provider how to best present it. 28

29 Morbidity and mortality from HIV/AIDS has decreased significantly and people with HIV are living longer and developing chronic diseases common to aging such as diabetes, cardiovascular disease, and osteoporosis This shift is attributable to the introduction of highly active antiretroviral therapy (HAART) drugs Typically these drugs are given as a three-drug regimen (in combination forms) HIV viruses may become resistant to some drugs Many of these drugs interact with commonly prescribed drugs 29

30 For years, most AIDS experts have recommended starting antiretroviral drugs (drugs that work against HIV) when the CD4 count fell below 350. One reason for waiting was that HIV-fighting drugs can cause unpleasant side effects. NEW GUIDELINES recommend: Treatment should begin as soon as possible, regardless of the CD4 count FDA recently approved Truvada (a combination of two antiretroviral drugs) to reduce the risk of becoming infected with HIV by sexual transmission of the virus. BOTTOM LINE: For anyone who is HIV positive, it makes sense to start treatment right away when the CD4 count is under 500. People who can benefit from treatment when the CD4 count is above 500 include women who are pregnant, those with hepatitis B or C, and those over age 60 30

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32 Research Studies Breakthroughs: HPTN 052*: 96% reduction in HIV transmission to partners with early initiation of ART (drugs) iprex**: Chemoprophylaxis for HIV prevention in MSM and transgender women who have sex with men had 44% reduction in HIV incidence * Cohen, MS, et al. N Engl J Med, 2011:365: **Grant, RM, et al. N Engl J Med 2010: 363:

33 PrEP is a way for people who do not have HIV but are at substantial risk to prevent HIV by taking a pill everyday The pill (brand name Truvada) contains 2 medications (tenofovir and emtricitabine) When taken consistently, PrEP has been shown to reduce the risk of HIV infection by up to 92% PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods for greater protection MANAGEMENT: people who use PrEP must see their health care provider for follow-up every 3 months 33

34 PEP is the use of antiretroviral drugs after a single highrisk event to stop HIV seroconversion PEP must be started ASAP to be effective and always within 72 hours of HIV exposure PEP 101, consumer guide sheet: 34

35 Lessons learned to date: Target at-risk black MSM in community Health system navigation helpful for some Many persons need support for significant social needs (e.g. housing, employment, etc.) 35

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40 Today, an estimated 1.1 million people are living with HIV in the United States. Thanks to better treatments, people with HIV are now living longer and with a better quality of life than ever before. If your participant is living with HIV, it s important to make choices that keep him/her healthy and protects others The virus weakens the immune system and the person s ability to fight infections and cancer. The person is more likely to suffer other health problems. 40

41 Stay Healthy Tell your partners Don t take risks Abstinence (not having sex) is the best way to prevent the spread of HIV infection and some other STDs. If abstinence is not possible, use condoms whenever you have sex vaginal, anal, or oral Do not share drug equipment. Blood can get into needles, syringes, and other equipment. If the blood has HIV in it, the infection can be spread to the next user Do not share items that may have your blood on them, such as razors or toothbrushes 41

42 Current Illinois HCBS Waivers: Persons with HIV or AIDS Fact Sheet: Current Active Waiver (pdf): 42

43 Follow recommended guidelines, including: Control Modifiable Risk factors Interventional approaches Monitor medication compliance: antiviral drug treatment regime Partner PreEP- pre exposure prophylaxis HIV counseling/support groups 43

44 AIDS Foundation of Chicago (312) Center on Halsted (773) TPAN (773_ National: AIDS United 44

45 ASSESS: Physical, cognitive and behavioral changes and assess functional abilities, compare to baseline. Help participant adapt to an altered lifestyle. Altered lifestyle may include loss of functional abilities including ability to move, use bathroom, talk, eat and think. PREVENT: transmission of HIV and rapid deterioration of health related to HIV and chronic illnesses. Resources/Services: P.T.: role with HIV is to minimize deteriorating effects of illness including loss of strength, need for ambulatory devices. Experts in treatment of musculoskeletal and neuromuscular problems that affect the ability to move and function in daily life O.T.: role with HIV is to assess function daily living skills. OT will prepare the participant for a return to home and to develop skills such as cooking, grocery shopping, banking, and budgeting Community Nurse assists participant with HIV and chronic illnesses related to HIV in attaining maximum optimal health, and adapting to an altered lifestyle. Social Worker: assists the participant with HIV to obtain needed services and arrange supportive resources 45

46 Arrange for and monitor caregiver(s) and/or services. Develop and monitor a back up plan, personal resource list and caregiving schedule that includes available family member(s), caregivers and agencies, contact numbers, expected duties and schedules, and who to contact when there are service problems. Provide contact numbers on the Personal Resource List for access to safe activities through consumer support group, peer supports, recovery specialists and/or community outreach programs (e.g., libraries, churches, NAMI, GROW, CILs, etc.). Arrange for Personal Emergency Response System (PERS) and monitor delivery/installation. Develop and monitor backup plan with participant of what they should do if caregiver(s) do not show up or perform the needed activities. Arrange for the delivery of medical supplies, durable medical equipment, or other medical devices. Arrange for and monitor necessary safety items, assistive technology/devices and/or home modifications to enhance home safety and accessibility. Educate participant on harmful or dangerous activities. 46

47 Arrange for and monitor education on the importance of taking medication(s) as prescribed, proper administration, side effects and overdose precautions. Arrange for and monitor education on diagnoses/conditions. Arrange, verify and monitor appointment(s) with healthcare provider for new onset or worsening symptoms. Monitor participant for risk(s) and update care plan to prevent future accidental hospitalizations and ED visits. Assess and monitor participant's risk of falls by completing a Falls Risk Assessment. Monitor participant for significant weight loss or gain on a regular basis. Arrange and monitor transportation services to lab or healthcare facility. Arrange for and monitor home care provider to draw lab tests or blood work. Educate participant on lab test results and any follow up instructions. Arrange for review of medication(s) with a healthcare provider and monitor. Arrange for and monitor visiting nurse, family member or informal caregiver to provide medication administration and medication monitoring. 47

48 Compassionate, knowledgeable care coordinators can improve the likelihood that persons newly diagnosed with HIV infection will obtain the appropriate information to make good choices, prevent spread of the disease, and improve their own morbidity and mortality risks. In summary, care coordinators should: Have providers verify presence of HIV infection with blood tests, obtain baseline labs, and perform a comprehensive physical assessment Have participant consult with an HIV specialist for plan of care (HIV Clinic) Reassure participant that with 100 % adherence to therapy, life expectancy is much longer than it was when HIV infection first came to the forefront when medication options were limited 48

49 Thank you all for being here and for your commitment to enhancing the care provided to your participant, clients and members. Through advocacy, care coordination, and teamwork we can ensure the health and well-being of our clients

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51 For other patient brochures about living with HIV visit the Act Against AIDS site: Greaterthan.org Aids Legal Council (312) W Harrison St, Chicago Updated guidelines for antiretroviral post-exposure prophylaxis after sexual, injection drug use, or other non-occupational exposure to HIV U.S PEP 101, Consumer guide sheet: 51

52 Access Medicine CDC: ports/#supplemental. Harvard Health Blog» New guidelines urge immediate treatment after HIV infection Howard LeWine, M.D., Chief Medical EditorInternet Publishing, Harvard Health Publications Medscape 52