Hepatitis & HIV/AIDS

Hepatitis HAV HBV HCV U.S. Stats 25,000 new infections/yr Transmission Ingestion of fecal matter Contact w/ infectious body fluids Contact w/ infected blood Severity Usually no lasting damage, rarely fatal Most fully recover; Some develop liver disease; ~3,000 die / yr 60-70% develop chronic liver disease; 1-5% will die from liver cancer Vaccine? Vaccine available No vaccine Symptoms Fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, joint pain, jaundice 43, CDC, 2012

HIV Human Immunodeficiency Virus = The cause of AIDS AIDS = the end-stage of HIV disease

In what year were the first cases of AIDS reported? B: 1981 C: 1991 D: 2001

HIV About 30-40 million people worldwide are living with HIV How many of those live in the US? Approximately 1 million Approximately 1 in 5 of them don’t know they have HIV

More HIV About 40,000 Americans become HIV-infected every year. About 10% of new cases are already drug-resistant in US. ½ of all new HIV infections in the US occur in people under 25 years of age. 6th leading cause of death for ages 25-44 Potential years of life lost

HIV in Oregon

HIV infection involves 2 elements: 1: A virus 2: Humans Monkeys have SIV, not HIV

Which of the following is NOT a way that a person can become infected with HIV? A: Sharing a drinking glass B: Unprotected sex C: Injecting drug use D: None of the above – they are all ways that a person could become infected with HIV.

How is HIV most commonly spread? Sexual Transmission = most common Are all sexual behaviors equally risky? What is meant by “having sex”? Need to define: Ex: President Clinton “I did not have sexual relations with that woman.” Ex: “Sexually active”

#2 reason for HIV spread Sharing needles and syringes Direct blood-to-blood transmission Most efficient transmission The drugs themselves do not transmit HIV Ex: sharing steroid needles, tattoo, ear piercing

Which drug is MOST involved in HIV transmission? Alcohol Sexual risks, sexual assaults and other risks while under the influence.

Exposure to how many viruses are necessary to become infected with HIV? Exposure to at least 1,000 HIVs are necessary for infection. Immune system responds to HIV Overexposure necessary Ex: Ejaculate contains about 100 million sperm “Low sperm count” = 20 million sperm

Where are the most HIVs in a person infected with HIV? Lymph nodes

However, we are concerned with body fluids Body fluids with the most risk have a high viral load Not all body fluids have the same viral loads.

What body fluid has the most HIV? Blood, including menstrual blood Ex: 2 billion HIVs in 1 pint of blood in person with end-stage AIDS Viral load varies with disease stage Note: “Non-detectable HIV” does not mean the person is disease free.

What body fluid has the 2nd most HIV? Semen Including pre-seminal fluid (pre-cum) High HIV levels in semen still possible even though “non-detectable” in blood

What body fluid has the 3rd most HIV? Vaginal fluid Vaginal fluid can help prevent micro-tears in the vagina. Micro-tears are portals on entry for HIV.

What body fluid has the 4th most HIV? Breast milk 10-20% risk of HIV transmission to infant from breastfeeding IF mom not being treated. Note: some areas of the world have such poor water quality that the death risk to the infant is greater with exposure to the water than to breast milk with HIV.

Any other body fluids that carry HIV? Saliva Extremely small amounts of HIV in saliva More HIV when blood is in the saliva Blood-free saliva is a “theoretical risk” Ex: At least 1 quart of saliva to get 1,000 HIVs NO documented case from exposure to saliva only. Tears Would require approximately 2 quarts (64 oz) of tears directly into a body to get 1,000 HIVs Theoretical risk only No known HIV case ever acquired through tears.

Is the skin an effective barrier? YES Skin-to-skin contact is NOT a risk for HIV. No risk: handshake, hugs, kissing Blood on outer skin does not seep in What is the exception? A fresh opening in the skin = portal of entry for HIV

Portals of entry for viruses Mucosal surfaces (inner skin) HIV may seep through: Mouth, penis, vagina, anus, urethra, etc.

General rule: No one else’s body fluids touches your mucosal surfaces unless you know her/his HIV status

What mucosal surface can HIV enter the easist? Anal Canal Epithelium of the rectum is fragile and only 1- cell layer thick Easily torn with penetration Microtears are additional portals of entry for HIV Irritated areas, hemorrhoids, HPV are all portals of entry for HIV

Vagina is portal of entry for HIV Epithelium of vagina is 7-cell layers thick

Who is at higher risk to become infected with HIV during vaginal intercourse – the male or the female?

Why? 1) Vagina has larger mucosal area than penis 2) Micro-tears during intercourse = portals of entry 3) More HIV in semen than in vaginal fluids 4) More semen exposure 5) Women more likely to have unknown vaginal infection leading to irritated tissues, more T cells fighting infection 6) Semen contains immuno-suppressant

got it from vaginal intercourse That said… Worldwide, most males who have HIV got it from vaginal intercourse

#3 portal of entry Penis Urethra mucosal surface is portal of entry

Mouth A few cases of HIV transmission documented through oral sex – both performing and receiving Ex: blood in the saliva or cuts/sores around mouth Micro-abrasions increase risk: floss, brush, biting lips Ex: monkeys transmit SIV through oral sex Recommend condoms/barriers for oral and anal sex

Given “dangerous” body fluids and “dangerous” mucosal skins, what is the MOST risky sexual behavior? Anal intercourse Which is more risky – penetrator or recipient? Answer: Recipient of anal sex is MOST risky behavior for HIV

There is a continuum for safer sex “Unprotected sex is group sex” “Safe sex” = outer skin-to-skin contact One person must be HIV-infected before it can be transmitted through sex Know the HIV-status of your partner You can’t tell by looking Be an agent of your own care

Why don’t mosquitoes transmit HIV? HIV is treated like food and digested along with the blood meal. Even if it did, too few HIV to initiate an infection. No documented HIV transmission after years of study Mosquitoes bite more infants & old people HIV rates are lowest in infants & old people

“Yes, you can get HIV from mosquitoes if you have unprotected anal sex with a mosquito.” Randy Shilts, “And the Band Played On”

HIV Testing According to the CDC, which of the following groups should get routinely tested for HIV during health/medical visits? A: Anyone between 18 and 44 B: Anyone between 13 and 64 C: Just young people, between 15 and 24 D: Only those at high risk regardless of age

HIV testing ELISA, confirmed with Western Blot Positive P24 antigen test Home tests Recently approved

Anything new? The Affordable Care Act of 2010 2013 Budget Reduce number of new infections Increase access to care Reduce HIV-related disparities 2013 Budget Estimated $28.4 billion for domestic and global HIV/AIDS activities