HIV/AIDS Presented by Kunphen center for substance dependence and HIV/AIDS

HHuman IImmunodeficiency VVirus

A Acquired IImmuno IImmuno D Deficiency S Syndrome S Syndrome

HIV Transmission HIV enters the bloodstream through: HIV enters the bloodstream through: Open Cuts Open Cuts Breaks in the skin Breaks in the skin Mucous membranes Mucous membranes Direct injection Direct injection

HIV Transmission Common fluids that are a means of transmission: Common fluids that are a means of transmission: Blood Blood Semen Semen Vaginal Secretions Vaginal Secretions Breast Milk Breast Milk

HIV in Body Fluids Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids

Routes of Transmission of HIV Sexual Contact:Male-to-male Male-to-female or vice versa Female-to-female Blood Exposure: Injecting drug use/needle sharing Occupational exposure Occupational exposure Transfusion of blood products Transfusion of blood products Perinatal: Transmission from mom to baby Breastfeeding

HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus

Window Period This is the period of time after becoming infected when an HIV test is negative This is the period of time after becoming infected when an HIV test is negative 90 percent of cases test positive within three months of exposure 90 percent of cases test positive within three months of exposure 10 percent of cases test positive within three to six months of exposure 10 percent of cases test positive within three to six months of exposure

HIV Infection and Antibody Response InfectionOccurs AIDS Symptoms ---Initial Stage Intermediate or Latent Stage Illness Stage--- Flu-like Symptoms Or No Symptoms Symptom-free < ----

Importance of Early Testing and Diagnosis Allows for early treatment to maintain and stabilize the immune system response Allows for early treatment to maintain and stabilize the immune system response Decreases risk of HIV transmission from mother to newborn baby Decreases risk of HIV transmission from mother to newborn baby Allows for risk reduction education to reduce or eliminate high-risk behavior Allows for risk reduction education to reduce or eliminate high-risk behavior

HIV Testing Those recently exposed should be retested at least six months after their last exposure Those recently exposed should be retested at least six months after their last exposure Screening test (EIA/ELISA) vs. confirmatory test (IFA) Screening test (EIA/ELISA) vs. confirmatory test (IFA) EIA/ELISA (Reactive) EIA/ELISA (Reactive) Repeat EIA/ELISA (Reactive) IFA (Reactive) Positive for HIV Positive for HIV

EIA/ELISA Test Positive Negative Run IFA Confirmation Repeat Positive End Testing Repeat ELISA Every 3 months for 1 year Negative PositiveNegativeIndeterminate Repeat at 2-4 months Repeat at 3 weeks HIV Testing No HIV Exposure Low Risk HIV Exposure High Risk Negative HIV + Repeat every 6 months for continued High risk behavior

Once a person is infected they are always infected Once a person is infected they are always infected Medications are available to prolong life but they do not cure the disease Medications are available to prolong life but they do not cure the disease Those who are infected are capable of infecting others without having symptoms or knowing of the infection Those who are infected are capable of infecting others without having symptoms or knowing of the infection HIV AIDS

HIV Risk Reduction HIV Risk Reduction Avoid unprotected sexual contact Avoid unprotected sexual contact Use barriers such as condoms. Use barriers such as condoms. Limit multiple partners by maintaining a long-term relationship with one person Limit multiple partners by maintaining a long-term relationship with one person Talk to your partner about being tested before you begin a sexual relationship Talk to your partner about being tested before you begin a sexual relationship

HIV Risk Reduction Avoid drug and alcohol use to maintain good judgment Avoid drug and alcohol use to maintain good judgment Don’t share needles used by others for: Don’t share needles used by others for:Drugs Tattoos Tattoos Body piercing Body piercing Avoid exposure to blood products Avoid exposure to blood products

Condoms Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV Condoms = Safer sex Condoms = Safer sex Condoms ≠ Safe sex Condoms ≠ Safe sex

Condom Use Should be used consistently and correctly Should be used consistently and correctly Should be either latex or polyurethane Should be either latex or polyurethane Should be discussed with your partner before the sexual act begins Should be discussed with your partner before the sexual act begins Should be the responsibility of both partners for the protection of both partners Should be the responsibility of both partners for the protection of both partners Male and female condoms are available Male and female condoms are available

People Infected with HIV People Infected with HIV Can look healthy Can look healthy Can be unaware of their infection Can be unaware of their infection Can live long productive lives when their HIV infection is managed Can live long productive lives when their HIV infection is managed Can infect people when they engage in high-risk behavior Can infect people when they engage in high-risk behavior

HIV Exposure and Infection Some people have had multiple exposures without becoming infected Some people have had multiple exposures without becoming infected Some people have been exposed one time and become infected Some people have been exposed one time and become infected

HIV and Sexually Transmitted Diseases

STDs increase infectivity of HIV A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection

HIV and Sexually Transmitted Diseases STDs increase the susceptibility to HIV STDs increase the susceptibility to HIV Ulcerative and inflammatory STDs compromise the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV Ulcerative and inflammatory STDs compromise the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV Ulcerative STDs include: syphilis, chancroid, and genital herpes Ulcerative STDs include: syphilis, chancroid, and genital herpes Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis

HIV and Sexually Transmitted Diseases HIV and Sexually Transmitted Diseases The effect of HIV infection on the immune system increases the the risk of STDs The effect of HIV infection on the immune system increases the the risk of STDs A suppressed immune response due to HIV can: I ncrease the reactivation of genital ulcers I ncrease the reactivation of genital ulcers Increase the rate of abnormal cell growth Increase the rate of abnormal cell growth Increase the difficulty in curing reactivated or newly acquired genital ulcers Increase the difficulty in curing reactivated or newly acquired genital ulcers Increase the risk of becoming infected with additional STDs Increase the risk of becoming infected with additional STDs

HIV Post Exposure Prophylaxis

HIV Occupational Exposure HIV Occupational Exposure Review facility policy and report the incident Review facility policy and report the incident Medical follow-up is necessary to determine the exposure risk and course of treatment Medical follow-up is necessary to determine the exposure risk and course of treatment Baseline and follow-up HIV testing Baseline and follow-up HIV testing Four week course of medication initiated one to two hours after exposure Four week course of medication initiated one to two hours after exposure Liver function tests to monitor medication tolerance Liver function tests to monitor medication tolerance Exposure precautions practiced Exposure precautions practiced

HIV Non-Occupational Exposure HIV Non-Occupational Exposure No data exists on the efficacy of antiretroviral medication after non-occupational exposures No data exists on the efficacy of antiretroviral medication after non-occupational exposures The health care provider and patient may decide to use antiretroviral therapy after weighing the risks and benefits The health care provider and patient may decide to use antiretroviral therapy after weighing the risks and benefits Antiretrovirals should not be used for those with low-risk transmissions or exposures occurring more than 72 hours after exposure Antiretrovirals should not be used for those with low-risk transmissions or exposures occurring more than 72 hours after exposure PREVENTION --- FIRST

HIV Non-Occupational Exposure Provider Considerations: Provider Considerations: Evaluate HIV status of patient and risk history of source patient Evaluate HIV status of patient and risk history of source patient Provide necessary medical care and counseling Provide necessary medical care and counseling Evaluate risk event and factors for exposure Evaluate risk event and factors for exposure Determine elapsed time from exposure Determine elapsed time from exposure Evaluate potential for continuous HIV exposure Evaluate potential for continuous HIV exposure Obtain informed consent for testing and treatment Obtain informed consent for testing and treatment Evaluate pregnancy status of females Evaluate pregnancy status of females Monitor for drug toxicity and acute infection Monitor for drug toxicity and acute infection