New Hope for Clients at Risk for HIV/AIDS By William Pearson, CST LCSC BSN Candidate

What Does the Face of HIV/AIDS Look Like? Gay Drug User Poor

What Does the Face of HIV/AIDS Look Like? Young Old Rich Hetero

HIV/AIDS in the United States  More than 1.2M are living with HIV  The number of people living with HIV has ↑  The annual number of NEW infections is stable at ≈ 50K.  In 2013 ≈26K people diagnosed with AIDS

HIV/AIDS in the United States by Race & Sexual Orientation  Men sex with Men 63% new infections 2010  Heterosexual women 20% new infections 2010  IV Drug user 8% new infections 2010  African American 44% new infection 2010  Hispanic/Latino 21% new infection 2010  White 25% new infection /statistics/

Cultural Diversity Full of variations Religious Family Structure Communication styles Languages Socio-economic Values & Beliefs Age

Overcoming Barriers According to Sheffield and Casale (2004) Carefully explore what each patient believes about his or her health, what would be appropriate treatment, and who should be involved in medical decision making. Use professional interpreters to help overcome language barriers Use case managers to help overcome social barriers.

Overcoming Barriers According to Sheffield and Casale (2004) Patients infected with HIV face a complex array of medical, psychological, and social challenges. A strong provider-patient relationship, the assistance of a multidisciplinary care team, and frequent office visits are usually required to provide excellent care.

Overcoming Barriers According to Sheffield and Casale (2004) The stigma associated with HIV/AIDS places a major psychological burden on patients. Confidentiality is critical, as is a careful assessment of each patient’s emotional support system

Overcoming Barriers According to Sheffield and Casale (2004) Efforts of understand and acknowledge the beliefs of patients from a variety of cultural backgrounds are necessary to establish trust between providers and patients.

Prevention Methods Abstain from risky behaviors – Unprotected sex, IV drug use Condoms/Barriers – Male, Female & Dental dams Choose less risky sex practices – Consistent partner, Oral sex, Sex without bodily fluid exchange Pharmacological – PrEP

PrEP Pre-exposure prophylaxis – Prevention option for people who are at high risk of getting HIV. It is to be used consistently, as a pill taken every day, and to be used with other prevention options. – According to the (Centers for Disease Control and Prevention [CDC], 2015): The risk of getting HIV infection was up to 92% lower for those who took PrEP consistently.

PrEP – On May 14, 2014, the US Public Health Service released the first comprehensive clinical practice guidelines for PrEP. The guidelines were developed by a federal inter-agency working group led by CDC, and reflect input from providers, HIV patients, partners, and affected communities. (CDC, 2015)

PrEP Provide clear criteria for determining a person’s HIV risk and indications for PrEP use. Require that patients receive HIV testing to confirm negative status before starting PrEP. Underscore importance of counseling about adherence and HIV risk reduction, including encouraging condom use for additional protection Recommend regular monitoring of HIV infection status, side effects, adherence, and sexual or injection risk behaviors. Include a providers’ supplement with additional materials and tools for use when prescribing PrEP.

PrEP emtricitabine and tenofovir (Truvada) Antiviral drugs that work by preventing HIV cells from multiplying in the body.

PrEP Some people in clinical studies had early side effects such as an upset stomach or loss of appetite, but these were mild and usually went away in the first month. Scientists do not yet have an answer on how long it takes PrEP to become fully effective after you start taking it. Some studies suggest that if you take PrEP everyday, it reaches its maximum protection in blood in 20 days, in rectal tissue at about 7 days, and in vaginal tissue at about 20 days. (CDC, 2015)

PEP Post-exposure prophylaxis – The use of antiretroviral drugs AFTER a single high-risk event to stop HIV from making copies of itself and spreading through your body. – Must be started within 72 hours (3 days) after exposure. – Two or three drugs will be prescribed and must be taken for 28 days. – It is NOT always effective; it does not guarantee that someone exposed to HIV will not become infected. (CDC, 2015)

Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents Goals for Treatment according to (National Institute for Health [NIH], 2015) – Reduce HIV-associated morbidity and prolong the duration and quality of survival – Restore and preserve immunologic function – Maximally and durably suppress plasma HIV viral load – Prevent HIV transmission

Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents “More than 25 antiretroviral (ARV) drugs in 6 mechanistic classes are Food and Drug Administration (FDA) approved for treatment of HIV infection. These six classes include the nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), a fusion inhibitor (FI), a CCR5 antagonist, and integrase strand transfer inhibitors (INSTIs). In addition, two drugs (pharmacokinetic [PK] enhancers or boosters) are used solely to improve the pharmacokinetic profiles of some ARV drugs (e.g., PIs and the INSTI elvitegravir [EVG]).” (NIH, 2015)

Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents “The initial ARV regimen for a treatment-naive patient generally consists of two NRTIs, usually abacavir plus lamivudine (ABC/3TC) or tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC), plus a drug from one of three drug classes: an INSTI, an NNRTI, or a PK-enhanced PI. As shown in clinical trials and by retrospective evaluation of cohorts of patients in clinical care, this strategy for initial treatment has resulted in HIV RNA decreases and CD4 T lymphocyte (CD4) cell increases in most patients.” (NIH, 2015)

Things to Remember when Caring for Clients with HIV/AIDS They are all INDIVIDUALS The virus does not define them Most do not want sympathy, they want empathy They do not want your biases forced upon them Use of Standard Precautions is appreciated unless otherwise indicated, they know they carry an infectious disease You never know who “they” is…it could be anybody. Please remember they are human and need to be treated as such

References Sheffield, J.V.L MD, & Casale, G.A. MD MSPH (2004). Approach to the Patient. A Guide to Primary Care of People with HIV/AIDS (Chapter 2). Retrieved from U.S. Department of Health & Human Services. (2015). HIV/AIDS Basics. Retrieved from Centers for Disease Control and Prevention. (2015). HIV/AIDS. Retrieved from

References Continued Centers for Disease Control and Prevention. (2015). HIV/AIDS. Retrieved from Department of Health & Human Services. (2012). Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents. Retrieved from arvguidelines/9/treatment-goals

References Continued Truvada. (n.d.). Retrieved October 3,2015 from Drugs.com Photos courtesy of Google images