NURS 330 - Schedule for 2/3/14
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HIV Lecture – Disly Juarez
Return and Review Quiz
Group Activity
Distribute Study Guide for 2/10/14 Mid-term
In-Class Assignment
The State of the HIV/AIDS
Epidemic
County of Los Angeles Department of Public Health
Division of HIV and STD Programs
Disly Juarez, MPH
Health Educator
djuarezmunoz@ph.lacounty.gov
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MYTHS AND FACTS ABOUT
HIV/AIDS
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Myth/Fact?
HIV is the same as AIDS
MYTH
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HIV
AIDS
Immune
Human
Immunodeficiency
Acquired
AIDS
Deficiency
HIV
Virus
Syndrome
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Special Characteristics of HIV
 Weakens and compromises the immune system
 HIV replicates in large quantities
 Ability to mutate (change itself) very quickly
 Progressively destroys body’s ability to fight
infections and certain cancers
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HIV/AIDS Defined
CDC definition (AIDS):
• HIV+ test, T-cell count of < 200
(healthy T-cell count ranges from 8001200)
- or –
• HIV+ test, and one or more opportunistic
infections (OIs) or certain cancers*
“AIDS” applies to most advanced stage of
HIV infection
*TB, Pneumocystis pneumonia, Candidiasis,
Kaposi’s sarcoma, cervical cancer
Myth/Fact?
HIV only affects gay men and drug users
MYTH
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• Although the AIDS rate in Los Angeles County is
lower than the rate in other areas of the US, in
sheer number, Los Angeles County is second
only to New York City in the cumulative number
of reported AIDS cases among major
metropolitan areas.
• Only 4 states, including the rest of California,
have reported more cases than LAC
• LAC has reported 36% of all California AIDS
cases.
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Myth/Fact?
Once a person is diagnosed with HIV/AIDS,
they will die soon
MYTH
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Manifestations of HIV Infection
No physical symptoms, and healthy results on tests of
immune function.
No physical symptoms, but show some signs of
immune system damage on medical tests of the
immune system.
Mild or severe symptoms of HIV disease.
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HIV Spectrum of Disease
Exposure
No infection
Asymptomatic
Infection
Initial Symptoms
Window
period*
Lasts a few weeks
Asymptomatic
Mild flu-like
symptoms:
• Fever
• Muscle aches
• Swollen glands
Asymptomatic
Period
8 - 11 years
(Average
progression,
may vary
depending on
the person)
HIV Illness
Symptoms include:
• Night sweats
• Fevers
• Fatigue
• Diarrhea
• Swollen lymph
nodes
• Oral and
vaginal
candidiasis
• PID
• Pap Smear
positive for HPV
AIDS
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T-Cells
<200
1 or more
OIs (PCP,
KS, TB,
CMV,
Candidiasis,
etc.)
Wasting
syndrome
HIV-related
dementia
*Window Period: average time it takes the body to produce antibodies; usually 2 - 12 weeks, up to 6 months - 1 year
(rare)
Common Opportunistic Infections
Pneumocystis carinii Pneumonia (PCP)
CMV Infection
HIV Wasting Syndrome
Candidiasis (oral, esophageal, vaginal)
Kaposi’s Sarcoma
Tuberculosis
HIV - Related Dementia
Cervical Cancer
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Myth/Fact?
Casual contact CANNOT put you at risk for
HIV
FACT
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HIV Transmission
People cannot get HIV from:
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Breathing
Coughing
Sneezing
Kissing (dry)
Sharing or touching gum
Drinking from water fountains
Sharing food or drinks
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Causal touching
Telephones
Pools/tubs
Shaking hands
Toilet seats
Giving/donating blood
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HIV Transmission
By Infected Body Fluids:
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Blood
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Semen,
pre-cum
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Vaginal
secretions
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Breast
milk
HIV is NOT transmitted by urine, feces, saliva, sweat, tears
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or giving/donating blood.
HIV Transmission
By Unprotected Sex:
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Anal
2
Vaginal
3
Oral
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HIV Transmission
By Exchanging Infected Blood
Sharing needles for
any purpose
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Injection
drug use
Piercing/
tattooing
Insulin,
hormone
vitamin
shots
Acupuncture
HIV Transmission
Mother To Child Transmission
during pregnancy (in uterus)
during birth process (delivery)
breastfeeding (through breast milk/blood)
Perinatal transmission can be significantly reduced to less than 2% through the use of anti-HIV
drugs during pregnancy (AZT)
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Myth/Fact?
HIV testing is unnecessary because I would
know if my lover or I had it
MYTH
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HIV TEST
 HIV Antibody test
Looks for antibodies
 Accuracy of the test
99.9%
 Types of tests
Standard test – results will be known in 1 week
Rapid test – results will be known in 20 minutes
 Test settings
Anonymous
Confidential
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HIV Diagnosis (Testing)
Antibody tests
- Uni-Gold Recombigen HIV- results will be known in 10 min.
- Reveal G3 Rapid HIV-1 results will be known in 3 minutes
- Multispot HIV 1/HIV-2- results will be known in 15 mi.
- Clearview HIV 1/2 Stat-Pak - results will be known in 15 mi.
- Clearview Complete HIV 1/2- results will be known in 15 min.
- Insti HIV-1- results in as little as 60 seconds
FDA has, for the first time, approved an over-the-counter
HIV Rapid test (Oraquick) for home use.
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17 yrs. of older
Must confirm if reactive
HIV TEST
Informed Consent
12 yrs of age or older
Benefits of Testing……..
Where to test?
Private medical doctor
County clinic
Community-based organizations
www.hivla.org
1-800-367-AIDS (2437)
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Myth/Fact?
A person who is HIV positive must tell
partners their status
MYTH
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California’s “Willful Exposure” Law (1998)/aka
“Recalcitrant Behavior”:
Willfully exposing another to HIV through unprotected sex
8 years of imprisonment
Intention to infect others with HIV through sex
To be prosecuted under the law, one would have to do ALL of the following:
Have anal or vaginal sex
Know that they are HIV +
Fail to disclose their HIV status
Fail to use a condom
Have a specific intent to infect another person
Actual knowledge of HIV infection without more evidence of “specific intent” is
insufficient for prosecution.
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CONFIDENTIALITY LAWS
Disclosing a person’s HIV+ status to a third party without the
individual’s specific signed consent, is illegal;
Penalties and damages for unauthorized disclosure of HIV
status is a $5,000-$10,000 fine and/or jail sentence.
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FEDERAL ANTIDISCRIMINATION LAWS
• Rehabilitation Act of 1973 and American with
Disabilities Act (ADA) 1990
Prohibits discrimination against a person with a disability, including HIV
disease or AIDS infection. This prohibits discrimination with regards to
employment, public services, public accommodations, and medical care.
• Housing Discrimination
• Care Discrimination
A doctor or dentist cannot refuse to treat an HIV+ person
• Fair Employment and Housing Act (FEHA) and Unruh
Civil Rights Act
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PREVENTION
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PREVENTION
“It is not who we are but what we do that puts us at risk for HIV
infection”
 Harm reduction
 Abstinence
 Safer Sex
Male Condom (Activity)
Female Condom
Dental Dams
 Needle use
Not Sharing Needles
Cleaning Needles (3x3x3 Method)
Needle Exchange
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The Female Condom
PREVENTION
Universal Precautions
“Infection control measures that reduce the risk of transmission
of blood-born germs from patients to health care workers”
 Wash hands thoroughly
 Wear latex gloves
 Use masks and eye protection
 Wear a gown
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Carefully handling and disposing of sharp instruments
during and after use.
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PREVENTION
BREAST FEEDING
It is recommended that HIV+ women do not breastfeed
Infants.
POST–EXPOSURE PROPHYLAXIS (PEP)
Exposure to HIV within the prior 72 hours
Approve for 13 yrs of age or older
For more information call 213-351-7699
PRE-EXPOSURE PROPHYLAXIS (PREP)
It refers to anti-HIV medication used daily or before
sexual encounters
Start prior to potential exposure
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TREATMENT
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TREATMENT
Goals of HIV/AIDS treatment;
 Reduce HIV-related morbidity and prolong survival,
 Improve quality of life,
 Restore the immune system,
 Suppress the viral load, and
 Prevent vertical HIV transmission (mother to child).
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Treatment as Prevention
• Science Magazine named 'HIV Treatment as Prevention' as the
breakthrough of 2011
• The HIV Prevention Trials Network (HPTN)
052 study of 1,700 sero-discordant couples reported that ARVs
reduced the risk of heterosexual transmission by 96%.
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TREATMENT
 What are Anti-retrovirals (ARVs) ?
Antiretrovirals are drugs that interrupt the HIV replication
process and help preserve the health of the immune system.
 When to start anti-HIV medications?
Treatment should begin if:
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Current classes of Anti-HIV
medications
 Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
 Non-Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
 Protease Inhibitors
 Entry inhibitors
 Fusion inhibitors
 Integrase inhibitors
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Who Pays For Treatment?
 HMO insurance
 Medi-Cal
 Medicare Part D
 ADAP
 Shared cost
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Recent Advancements
 Immune based therapies
 Maturation inhibitors
 Multi-class Combination Products
 Gene Therapy
 Vaccine
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Complementary Therapy
 General Health Maintenance
 Psychological Well-Being
 Spiritual Well-Being
 Social Well-Being
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QUESTIONS?
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For More Information
Contact
http://publichealth.lacounty.gov/dhsp/
Disly Juarez, MPH
djuarezmunoz@ph.lacounty.gov
213-351-8102