1. HIV 101: The Basics HHS Game Jam September 26, 2014
Susan Robilotto, DO -- Clinical Advisor
Marlene Matosky, MPH, RN -- Nurse Consultant
HIV/ AIDS Bureau
Health Resources and Services Administration
U.S. Department of Health and Human Services

2. Acronyms AIDS – Acquired Immunodeficiency Syndrome
ART – Antiretroviral Therapy
CD4 – or T-helper lymphocyte
HIV – Human Immunodeficiency Virus
PEP – Post-exposure prophylaxis
PLWH – Persons living with HIV
PrEP – Pre-exposure prophylaxis
STD/STI – Sexually transmitted diseases/ infections

3. What is HIV?
HIV stands for Human Immunodeficiency Virus. It is the virus that causes Acquired Immunodeficiency Syndrome, or AIDS.
A virus is a very small infective agent that is able to multiply only within the living cells of a host.
Unlike some other viruses, the human body cannot get rid of HIV.
That means that once you have HIV, you have it for life. (There is no cure.)

4. AIDS
This is the stage of infection that occurs when the immune system is badly damaged and one becomes vulnerable to infections and infection-related cancers called opportunistic illnesses.
When the number of CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), a person is considered to have progressed to AIDS.
(Normal CD4 counts are between 500 and 1,600 cells/mm3 in adults/youth.)
People with AIDS need medical treatment to prevent death.

5. HIV in the United States
About 50,000 people in the United States get infected with HIV each year.
About 1.1 million people were living with HIV at the end of 2010, the most recent year this information was available.
Of those people, about 16% do not know they are infected.
In the United States, about 15,500 people with AIDS died in 2010.
The South has the highest number of individuals living with HIV.

6. HIV Around the World
HIV disease continues to be a serious health issue for parts of the world. Worldwide, there were about 2.3 million new cases of HIV in 2012.
About 35.3 million people are living with HIV around the world.
In 2012, more than 9.7 million people living with HIV in low- and middle-income countries had access to antiretroviral therapy (ART).
An estimated 1.6 million people died from AIDS-related illnesses in 2012, and an estimated 36 million people with AIDS have died worldwide since the epidemic began.
Sub-Saharan Africa bears the biggest burden of HIV/AIDS, with nearly 1 in 20 adults living with HIV.
Other regions significantly affected by HIV/AIDS include Latin America and the Caribbean, Eastern Europe and Central Asia, and South and Southeast Asia.

7. Where did HIV come from?
Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans.
They believe that the chimpanzee version of the immunodeficiency virus (called simian immunodeficiency virus, or SIV) most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood.
Studies show that HIV may have jumped from apes to humans as far back as the late 1800s.
Over decades, the virus slowly spread across Africa and later into other parts of the world.
We know that the virus has existed in the United States since at least the mid- to late 1970s.

8. Stages of HIV
HIV disease has a well-documented progression. Untreated, HIV is almost universally fatal because it eventually overwhelms the immune system — resulting in Acquired Immunodeficiency Syndrome (AIDS).
HIV treatment helps people at all stages of the disease, and treatment can slow or prevent progression from one stage to the next.
The stages are:
Acute Infection
Clinical Latency
AIDS

9. Acute Infection
Within 2 to 4 weeks after infection with HIV, one may feel sick with flu-like symptoms.
During this period of infection, large amounts of HIV are being produced in the body.
The virus uses important immune system cells called CD4 cells (T-helper cells) to make copies of itself and destroys these cells in the process. Because of this, the CD4 count can fall quickly.
The ability to spread HIV is highest during this stage because the amount of virus in the blood is very high.
Eventually, one’s immune response will begin to bring the amount of virus in the body back down to a stable level. At this point, the CD4 count will then begin to increase, but it may not return to pre-infection levels.

10. Clinical Latency
This period is sometimes called asymptomatic HIV infection (with no obvious symptoms) or chronic HIV infection.
During this phase, HIV is still active, but may reproduce at lower levels than during initial infection.
A person may not have any symptoms or get sick during this time.
People who are on antiretroviral therapy (ART) may live with clinical latency for several decades.
People who are not on ART, this period can last up to a decade, but some may progress through this phase faster.
Can last up to a decade
Toward the middle and end of this period, the viral load begins to rise and CD4 cell count begins to drop; one may begin to have symptoms of HIV infection as the immune system becomes too weak to protect a person.

11. How can one tell if he/she is infected?
The only way to know if one is infected with HIV is to be tested!
Of the available HIV tests, some may become positive within 2 weeks of a person becoming infected while others may not turn positive for up to 90 days.
One cannot rely on symptoms to know whether HIV is present.
Many people who are infected with HIV do not have any symptoms at all for 10 years or more
Some people who are infected with HIV report having flu-like symptoms (often described as “the worst flu ever”) 2 to 4 weeks after exposure (known as primary infection).
Symptoms of primary infection can include:
Fever
Enlarged lymph nodes
Sore throat
Rash
These symptoms can last anywhere from a few days to several weeks.

12. HIV Testing Where can a person get tested? Types of tests Oral
Public clinics
Private doctors’ offices and clinics
Home testing kits
Types of tests
Oral
Swabbing of cheek
Blood sample
Finger prick
Venous blood sample (blood draw)

13. Who can be infected by HIV in the U.S.?
Anyone who has had sex
Special populations including:
Men who have Sex with Men (MSM) [more than 60% of all new HIV diagnoses]
African-Americans (8 times greater risk than whites)
Hispanic/Latino (3 times greater risk than whites)
Youth/Adolescents (26% of all new HIV infections, African American youth 2 times greater risk than other youth)
Substance abusers including Injection Drug Users (IDU), crack cocaine, methamphetamine

14. How is HIV Transmitted?
In the United States, HIV is spread mainly by having sex (vaginal/anal) or sharing injection drug equipment such as needles with someone who has HIV.
HIV can be transmitted by only 6 fluids from an HIV-infected person
Blood
Semen (cum)
Pre-seminal fluid (pre-cum)
Rectal fluids
Vaginal fluids
Breast milk
These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to possibly occur.
Mucous membranes can be found inside the rectum, the vagina, the opening of the penis, and the mouth.

15. Ways HIV Can be Transmitted (1)
Being born to an infected mother. HIV can be passed from mother to child during pregnancy, or birth.
Being stuck with an HIV-contaminated needle or other sharp object. This is a risk for health care workers, those who inject drugs, and those potentially receiving tattoos or piercings in unclean settings.
Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV.
This risk is extremely small because of rigorous testing of the US blood supply and donated organs and tissues.

16. Ways HIV Can be Transmitted (2)
Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing, and is very rare.
Deep, open-mouth kissing if the person with HIV has sores or bleeding gums and blood is exchanged. HIV is not spread through saliva. Transmission through kissing alone is extremely rare.
Oral sex—using the mouth to stimulate the penis, vagina, or anus (fellatio, cunnilingus, and rimming).
Giving fellatio (mouth to penis oral sex) and having the person ejaculate (cum) in your mouth is riskier than other types of oral sex.

17. How HIV is Not Transmitted!
HIV is not spread by day-to-day contact in the workplace, schools, or social settings.
HIV is not spread through shaking hands, hugging, or a casual kiss.
One cannot become infected from a toilet seat, a drinking fountain, a door knob, dishes, drinking glasses, food, cigarettes, pets, or insects.
HIV is not spread through the air, and it does not live long outside the body.
There is no evidence of HIV transmission from mosquitoes or any other insects—even in areas where there are many cases of HIV and large populations of mosquitoes. Unlike organisms that are transmitted by insect bites, HIV does not reproduce (and does not survive) in insects.

18. HIV Prevention Primary Prevention Secondary Prevention of HIV
--Means Preventing HIV infection through
Safer sex
Not sharing needles
Abstinence
PrEP (Pre-Exposure Prophylaxis)
PEP (Post-Exposure Prophylaxis)
Secondary Prevention of HIV
-- Means reducing the risk of giving HIV to other people by maximizing health outcomes of Persons Living with HIV (PLWH) through
Anti-Retroviral treatment (ART) to suppress the virus
Risk screening & reduction methods
Partner notification
Pre-conception & Perinatal care

19. Prevention with Positives Services
Linkage to and retention in HIV medical care
Initiation and adherence to HIV medication (treatment as prevention strategy)
Risk screening and risk-reduction interventions
Partner services
Sexually transmitted disease (STD) services
Reproductive health care for women and men
Prevention of HIV transmission related to pregnancy
Other medical and social services that influence HIV transmission (e.g. substance use, mental illness)

20. HIV Care and Treatment
PLWH who take antiretroviral therapy (ART= HIV medication) and suppress HIV (“undetectable” levels in the blood) greatly reduce the risk of giving the virus others.
Those who do not take ART as prescribed (non-adherence) are at risk to (1) not control HIV in their body, (2) have their HIV mutate and become drug resistant. Both of these situations can lead to a higher risk of giving HIV (and possibly drug resistant strains) to sexual partners and needle-sharing partners.

21. For more Information CDC HIV website
Subject matter expert panels on Friday night
Subject matter experts available throughout the Game Jam

22. Questions??

23. Clinical Advisor/ Medical Officer
Contact Information
Susan Robilotto, DO
Clinical Advisor/ Medical Officer
HHS/ HRSA/ HAB