Infectious Diseases in Healthcare Focusing on HIV/ AIDS

1. Infectious Diseases in HealthcareFocusing on HIV/ AIDS SM II

2. Objective • The purpose of this unit is to increase your knowledge and understanding of HIV and AIDS and review some important information about other infectious diseases commonly encountered in healthcare.

3. Dates and Statistics- HIV/ AIDS HIV Transmission and Infection HIV Testing Stages of HIV Infection How HIV Works in the Body Treatment for HIV Tuberculosis Hepatitis B Hepatitis C Risk of BBP Transmission Disinfecting and Disposal Treatment after Potential Exposure Legal and Ethical Issues Psychosocial Issues Outline

4. Dates and Statistics- HIV/ AIDS

5. Dates and Statistics- HIV/ AIDS • In 1999, an international team of researchers reported that they traced the origin of HIV-1 to a subspecies of chimpanzees native to west equatorial Africa. The researchers believe that HIV-1 was introduced into the human population when hunters became exposed to infected blood.

6. Dates and Statistics- HIV/ AIDS • AIDS was first recognized in the United States in 1981. • The first reported case in Washington State was in 1982. • In 1983, HIV was discovered to be the cause of AIDS. • The first HIV antibody test was available in 1985.

7. Dates and Statistics- HIV/ AIDS • Globally, most of the people who are infected with HIV have not been tested and are unaware that they are living with the virus. • The CDC estimates that 25% of people with HIV are unaware that they have the disease.

8. Dates and Statistics- HIV/ AIDS • The CDC estimates that there are between 1,039,000 and 1,185,000 persons infected with HIV in the US. • The CDC estimates that there are 40,000 people in the US who become newly infected with HIV each year.

9. Dates and Statistics- HIV/ AIDS • 2000: 3 million deaths from AIDS worldwide. • 2005: The United Nations AIDS Program estimates there were 38.6 million people in the world living with HIV or AIDS. • 2005: An estimated 4.1 million people worldwide became infected with HIV. Half of the new infections were in people between the ages of 15 and 24.

10. Dates and Statistics- HIV/ AIDS • 2004: Estimated 41,000+ cases of AIDS in the United States. • 2004: Estimated 15,000+ deaths of persons with AIDS, down from 17,000+ in 2000.

11. Dates and Statistics- HIV/ AIDS • The discovery of antiviral “combination” drug therapies in 1996 resulted in a dramatic increase in the number of deaths due to AIDS (in the people taking the drug therapies).

12. HIV Transmission and Infection

13. HIV Transmission and Infection • HIV is considered to be a fragile virus when exposed to air and room temperatures and is not spread by casual contact. • It must be acquired.

14. HIV Transmission and Infection • In order for HIV transmission to occur, this means: • There must be a source of HIV (pathogen present). • There must be a sufficient dose of the virus (sufficient quantity). • There must be access to the bloodstream of another person (correct entry site).

15. HIV Transmission and Infection • Anyone infected with the virus is potentially a source of HIV infection. • Transmission occurs primarily through infected: • Blood • Semen • Vaginal Secretions • Breast Milk • From Infected Mother to Baby either before or during birth

16. HIV Transmission and Infection • Unless visibly contaminated with blood the following are not generally considered capable of transmitting HIV: • Sweat • Tears • Saliva • Urine • Feces

17. HIV Transmission and Infection • Other bodily fluids such as: • Cerebrospinal Fluid • Synovial Fluid (joint) • Pleural Fluid (lung) • Pericardial Fluid (heart) • Amniotic Fluid • May be considered infectious if the source is HIV positive. • However, these fluids are not generally found outside a hospital setting.

18. HIV Transmission and Infection • HIV is not transmitted through the air. • Sneezing, breathing and coughing do not transmit HIV. • Touching, hugging and shaking hands do not transmit HIV. • HIV transmission is not possible from food that is prepared by an HIV-infected people.

19. HIV Transmission and Infection • HIV is not transmitted through casual contact in the workplace. • No cases of HIV transmission have been linked to sharing computers, food, telephone, paper, water fountains, swimming pools, bathrooms, desks, office furniture, toilet seats, showers, tools, equipment, coffee pots or eating facilities.

20. HIV Transmission and Infection • However, personal items which may be contaminated with blood, such as toothbrushes and razors, should not be shared.

21. HIV Transmission and Infection • There aren’t any documented cases of HIV transmission through participation in athletics.

22. HIV Testing

23. HIV Testing • The first HIV antibody test was available in 1985. • Currently antibody tests have a two step process: • Screening Test • And if the screening test is reactive a: • Confirmatory Test

24. HIV Testing • The first test is a screening test that screens for the presence of antibodies to HIV in blood, urine or oral fluid. • Screening tests are inexpensive tests that are highly accurate.

25. HIV Testing • There are conventional screening tests where a specimen is collected from a person and sent to the laboratory for testing. • If the screening test is negative, results are given to the patient. • If the screening test is positive, an addition confirmatory test is performed on the same specimen before results are given to the patient.

26. HIV Testing • There are also rapid screening tests where the test is conducted at the testing site. • Since testing is done at the testing site, results are often available in an hour or so. • “Reactive” or positive test results must be confirmed by additional testing.

27. HIV Testing • There is a small chance that HIV screening tests may detect proteins related to other autoimmune diseases and “react” to these proteins with a “positive” result. • Any positive screening test need to be confirmed by a confirmatory test called the Western Blot Test.

28. HIV Testing • The Western Blot Test is done to verify the presence of HIV antibodies. • The Western Blot Test is much more specific (but more expensive) than the screening tests.

29. HIV Testing • Note: The virus is the disease. The virus causes infection. Antibodies are the immune system’s response to the disease. Antibodies are not the disease and do not cause the disease, they fight the infection.

30. HIV Testing • It is important to remember that HIV antibody testing has a “window period”. • Until the infected person’s immune system makes enough antibodies to be detected, the test will be negative even though the person is infected with HIV.

31. HIV Testing • Some infected people are able to produce antibodies as early as two weeks after infection and almost everybody who is infected will produce enough antibodies by 12 weeks. • Therefore, to be sure people should test three months after the last potential HIV exposure.

32. HIV Testing • A positive screening test and Western Blot Test (confirmatory test) means: • The person is infected with HIV. • The person can spread the virus to others. • The person is infected for life.

33. HIV Testing • Remember, if the test is negative it means one of two things: • The person is not infected with HIV OR • The person became infected recently and has not produced enough antibodies to be detected by the test

34. HIV Testing • If a person is tested confidentially (he or she gives real name), a positive HIV test result is reported to the local healthcare officer. • Anonymous testing does not involve giving a real name so a positive HIV result is not reportable.

35. HIV Testing • It is important to remember that information about a person’s HIV status is confidential and must not be shared with others. • People who perform HIV counseling and testing must sign strict confidentiality agreements. • Patient records are kept in locked files.

36. How HIV Works in the Body

37. How HIV Works in the Body • HIV enters the bloodstream and seeks out “T-helper lymphocyte”, the white blood cells (lymphocytes) essential to the functioning of the immune system. • One of the functions of the T-helper lymphocytes is to regulate the immune system response in the event of an attack from disease-causing organisms such as bacteria or viruses. • When HIV infects the T-helper lymphocytes, the cell sends signals to other cells which produce antibodies.

38. How HIV Works in the Body • Antibodies are produced by the immune system to help get rid of specific foreign invaders that can cause disease. • Producing antibodies is an essential function of our immune system. • The body makes a specific antibody for each disease. • When our immune system is working properly, it protects against these foreign invaders.

39. How HIV Works in the Body • HIV infects and destroys the T-helper lymphocytes and damages their ability to signal for antibody protection. • This results in the eventual decline of the immune system.

40. How HIV Works in the Body • HIV Affects: • The kind and number of blood cells • The amount of fat and muscle distribution in the body • The structure and functioning of the brain • The normal functioning of the immune system • The body’s basic metabolism

41. How HIV Works in the Body • HIV Can Cause: • Confusion or dementia • Diarrhea • Fatigue • Fever • Nausea or vomiting • Painful joints, muscles or nerve pain • Difficulty breathing • Vision or hearing loss • Chronic pneumonias, sinusitis or bronchitis • Loss of muscle tissue and body weight

42. How HIV Works in the Body • It is important to know that children show significant differences in their HIV disease progression. • Without drug treatment, most children are very sick by age 7. • Significant improvements have been made and in 1994, it was discovered that a short course of the medication AZT for HIV positive pregnant women would dramatically decrease the number of children infected in he womb.

43. Stages of HIV Infection

44. Stages of HIV Infection • After viral transmission, the first stage of HIV disease is primary/ acute HIV infection, typically lasting only a week or two, when the virus first establishes itself in the body. • During the first few weeks of HIV infection, an infected person has a very high amount of virus in his or he bloodstream. • An HIV infected person may become infectious to other within 5 days of viral transmission.

45. Stages of HIV Infection • Remember, during primary infection, most people are unaware they have HIV. • The most common symptoms noticed by persons newly infected by HIV are fever, swollen glands, rash, fatigue and a sore throat. • These symptoms are also common with many other types of infections (like mononucleosis).

46. Stages of HIV Infection • The “Window Period” is the period of time between when the body first becomes infected with HIV and when the body is able to produce antibodies to HIV. • It may take between two weeks to three months for antibodies to develop. Most people develop antibodies by 6 to 12 weeks. • During the window period, the person is “infectious”, meaning he or she can pass the virus to someone else, and will remain infectious throughout life.

47. Stages of HIV Infection • The window period is the time when a person may not produce sufficient antibodies to be detectable on an HIV antibody test. • This means they might get a negative result on an antibody test, while actually having HIV. • This is why a newly infected person can infect others before antibodies develop, when high amounts of virus in the blood are present, and the newly infected person does not yet know they have HIV.

48. Stages of HIV Infection • After the acute stage of HIV infection, people infected with HIV continue to look and feel completely well for long periods, usually for many years. • This is generally referred to as the asymptomatic stage.

49. Stages of HIV Infection • During this time, the virus is replicating and slowly destroying T-helper lymphocytes and the immune system. • This means that although the person may look and feel healthy, he or she can infect other people, especially if the person has not been tested and doesn’t know he or she is infected.

50. Stages of HIV Infection • Without antiretroviral therapy, there is an average of ten years between the time a person is infected with HIV and the start of persistent symptoms of AIDS.