Andrew De Saro, EMT-B, BS, DC, DICCP, PhC(hon) HIV and AIDS Andrew De Saro, EMT-B, BS, DC, DICCP, PhC(hon)

safety & Awareness OPIM’s PPE All Fluids are infectious until proven otherwise Be mindful of your surrounding

Routes of transmission Contact – most common Direct - indirect Droplet – coughing, talking, sneezing Air – small particulates (TB or Varicella) Food – Salmonella, E. coli, Listeria Vector – fleas, mosquitoes, birds, & rodents

Airborne pathogens Influenza SARS Tuberculosis Meningitis Pertussis 1-3 days incubation approx 3-10 days Swine & Avian Tuberculosis 6 weeks to show positive Meningitis 2-10 days Pertussis avg 9-10 days (6-20)

Airborne pathogens Measles Mumps Rubella Varicella avg 14 days (7-21) 14-25 day range Rubella avg 14 days (12-23) Varicella 2-3 weeks

Blood Borne Pathogens Hepatitis – A, B, & C HIV

What is HIV? Retrovirus Incapable of Reproduction HIV to AIDS Controversy HIV vs AIDS

HIV History 1st HIV case 1959 1st US HIV case 1981 (CDC) 1st Time CDC uses AIDS 1982 1st FDA Approved Home Test 2002 2016: 36.7 mill have HIV worldwide 1 mill AIDS-related Illness Deaths 2017: 20.9 mill getting antiretroviral therapy (AZT or HAART)

Transmission Sexual Intercourse with infected partner Pregnancy, Childbirth, & Breastfeeding Sharing Needles with infected persons

How HIV is NOT Transmitted Through the Air – coughing or sneezing Living with an Infected Person Through Food or Water Sharing Clothes or Shaking Hands Through Sweat or Tears Sharing Toilets and Bathrooms Sharing Cups, Plates, or Utensils Vectors – mosquitoes, fleas or other insects Touching, Hugging, or Kissing          

Signs and Symptoms Fatigue Night Sweats Sudden Weight Loss Reoccurring Infections Cancer

Clinical Findings Endocrinologic Manifestations Skin Manifestations Gynecologic Manifestations HIV-Related Malignancies Kaposi’s sarcoma non-Hodgkin’s lymphoma Primary Brain lymphoma Invasive cervical carcinoma

Differential Diagnosis Essentials of Diagnosis Risk Factors Systemic Complaints Opportunistic Infections Aggressive cancers Neurologic manifestations

Confirmation of HIV Infection Positive HIV Test Repeatedly positive ELISA – 2 or more Western Blot  the final confirmation Positive 10-14 days after HIV infection most within 3-4 weeks Symptom onset usually 2-3 weeks for 80-90% of infected patients. Monitor CD4+ & HIV RNA assay (standard viral load test)

Pathogenesis 3 phases Primary (Acute) Phase Latent Phase Chronic Phase Early HIV infection Intermediate HIV infection Chronic Phase Late HIV infection AIDs CD4+ T cells drop below 200 cells per µL

Pathophysiology Immediate Th1 and Th2 response Autoimmunity Immunodeficiency Neurological Dysfunction

Documentation Incident Report Testing Period Employee file concerning exposure Record Keeping Worker Comp. Counseling

Something else to think about: "Have you more faith in a spoonful of medicine than in the power that animates the living world?" BJ Palmer