HIV/AIDS Flashcards
Global HIV/AIDS Epidemic
- An estimated 33.3 million people are living with HIV worldwide as of 2009
- 30.8 million adults
- 15.9 million women
- 2.5 million children under 15 years of age
- Approximately 2.6 million new HIV infections occurred in 2009
- Estimated 1.8 million deaths occurred in 2009 due to AIDS
- People living longer with HIV/AIDS may play a role in increasing the # of + persons
- Vertical transmission = from mother to baby
- 13-18 yo increasing
- An estimated 33.4 million people were living with HIV in 2008—
- Women: 15.7 million - Men: 15.6 million
- Children: 2.1 million
Awareness of HIV Status in the US
- HIV estimated prevalence: 1,056,400 - 1,156,400
- Undiagnosed: 232,700
- Estimated newannual infections (2006): 56,300
HIV Transmission
HIV is transmitted through contact with contaminated body fluids, such as:
- Blood and blood products
- Semen
- Vaginal secretion
- HIV is not transmitted through other body fluids such as saliva, tears, or sweat
- HIV is not transmitted via air, water, or insects (including mosquitoes)
- Saliva doesnt have a lot of the virus, if they have open sores then maybe
- Post exposure prophylaxis – have around 72 hrs., but the sooner the better, used also for those with sexual assault
Modes of Transmission for HIV: Part 1
- Unprotected sexual contact is one of the most common methods of transmitting HIV
- Unprotected anal intercourse has a higher risk of HIV transmission than unprotected vaginal intercourse
- Unprotected receptive anal intercourse has a higher risk of HIV transmission than unprotected insertive anal intercourse
- Unprotected oral intercourse has a much lower risk of HIV transmission than anal or vaginal intercourse
Risk of HIV transmission from sexual contact may also increase with:
- Multiple sex partners
- Presence of other sexually transmitted diseases (STDs)
Modes of Transmission for HIV: Part 2
- HIV can be transmitted by shared needles
- In addition to needles, sharing syringes, rinse water, or other equipment used to prepare intravenous drugs can also increase the risk of HIV infection
- Mothers can transmit HIV to their babies during pregnancy, birth, or breast-feeding
- Receiving blood transfusions, blood products, or organ/tissue transplants contaminated with HIV
- While originally an important mode of transmission, this risk is now extremely low in the US due to rigorous testing of the blood supply and donated organs/tissue
Modes of Transmission for HIV: Part 3
Less common modes of HIV transmission include:
- Occupational exposures such as accidental needle sticks
- Tattooing or body piercing with unsterile instruments
- Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids, such as in a health care setting
Though unlikely, transmission can also occur in the following situations if blood is present in the mouth of the person infected with HIV (eg, bleeding gums)
- Person with HIV bites someone else and breaks the skin
- Open-mouth kissing
- Person with HIV chews food and then transfers it to someone else (usually a child)
HIV Prevention
Health care professionals can counsel patients on ways to prevent transmission of HIV, including:
- Abstaining from sexual activity or being in a long-term mutually monogamous relationship with an uninfected partner
- Using latex condoms correctly and consistently
- Considering male circumcision, which has been shown to reduce the risk of transmission during vaginal sex
- Not injecting drugs. If the patient is unable to stop injecting drugs, encourage the use of clean needles when injecting
Post-exposure Prophylaxis (PEP)
- When started within 48-72 hours after exposure to HIV and continued for 28 days, antiretroviral therapy is thought to decrease the risk of HIV transmission
- Exposures can be occupational (eg, health care providers) or behavioral (eg, unprotected sex)
- The risk of infection from exposure to HIV should be considered and weighed against the possible toxicities associated with different PEP regimens
PREP
-The concept of providing antiretroviral therapy, the same that could be used to treat HIV, in hopes of preventing the acquisition of HIV to an uninfected person
Who would be a candidate for PREP?
-in a relationship with someone who is +, pay and play parties (parties where sex acts are done for meth), drug seekers, people who sell their body for goods
Risks?
-bone mass depletion (= fx? Not known yet), kidney function decline
Does it work?
-YES, large studies shown, and when not taken it doesnt work, 95% compliance/adherence
-Gel used in sex workers in Africa doesnt really work
Purpose of Routine HIV Screening
- HIV infection is consistent with all generally accepted CDC criteria that justify routine screening
- HIV infection is a serious health condition that can be diagnosed before symptoms develop
- HIV can be detected by reliable, inexpensive, and noninvasive screening tests
- The costs of screening are reasonable in relation to the anticipated benefits
- Infected patients have years of life to gain if treatment is initiated early, before symptoms develop
CDC Recommendations for Routine HIV Screening in the US: Details
- Routine screening for HIV infection is recommended in people aged 13–64 years in all health care settings*
- Screening should be voluntary and undertaken only with the patient’s knowledge and understanding of the testing planned
- All patients initiating treatment for tuberculosis (TB) should be screened routinely for HIV infection
- All patients seeking treatment for STDs should be screened routinely for HIV during each visit for a new complaint, regardless of whether the patient is known or suspected to have specific behavior risks for HIV infection
Types of HIV Tests
- The most common type of HIV screening test uses an enzyme immunoassay [enzyme immunoassay (EIA) or enzyme linked immunosorbant assay (ELISA)] to look for antibodies to HIV
- Test can use blood, oral fluid, or urine
- Rapid testing is available, with results in about 20 minutes
- To make a diagnosis, a positive enzyme immunoassay must be confirmed with Western blot or immunofluorescent assay
- An RNA (or pro-viral DNA) test detect viral genetic material
- This test can be used for detecting acute HIV infection and can detect HIV before antibodies are made
- This test can be used to screen the blood supply
- P24 antigen/HIV antibody combination testing is approved for detection of acute HIV infection
HIV Targets the Immune System
- HIV targets the immune system by specifically infecting CD4 cells
- Over time, HIV depletes the body of CD4 cells, causing an immune deficiency
- This immune deficiency leads to increased risk of infections that those with normal immune function would not be susceptible
CDC Clinical Disease Classifications
- Category A: HIV infection without symptoms
- Category B: symptomatic conditions attributable to HIV infection that don’t meet category C definitions: Examples: thrush, idiopathic thrombocytopenic purpura
- Category C: clinical conditions attributable to HIV infection or CD4 cell count <14%: Equivalent to a diagnosis of AIDS, Examples: PCP, Kaposi’s sarcoma, wasting
- Once patient has reached clinical category C, the patient remains in that category even if their clinical condition improves
HIV and Organ Damage
-Although immune deficiency from HIV infection can cause significant morbidity and mortality, the direct effects of the virus itself as well as inflammation associated with HIV can also lead to end-organ damage
Conditions associated with organ damage due to HIV
- HIV-associated nephropathy (HIVAN)
- Co-infection with hepatitis B or C
- Cardiovascular disease
- Non-AIDS associated malignancies
- Neurocognitive decline
