AIDS

By: Annabel Lapuz-Carungin, MD, RMT, PT, RN, RM, MAN

H I V

Human Immunodeficiency Virus

Acquired

Immuno D Deficiency S Syndrome

HIV Transmission
HIV enters the bloodstream through:
Open Cuts

Breaks in the skin

Mucous membranes Direct injection

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

HIV in Body Fluids

Blood 18,000

Semen 11,000

Vaginal Fluid 7,000

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 Injecting drug use/needle sharing Occupational exposure Transfusion of blood products Transmission from mom to baby Breastfeeding

Blood Exposure:

Perinatal:

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

90 percent of cases test positive within three months

of exposure
10 percent of cases test positive within three to six

months of exposure

HIV Infection and Antibody Response

---Initial Stage---- ---------------Intermediate or Latent Stage-------------Flu-like Symptoms Or No Symptoms

---Illness Stage---

Symptom-free

AIDS Symptoms

---Virus Antibody
Infection Occurs

6 month

~ Years

~ Years

~ Years

~ Years----

<

Importance of Early Testing and Diagnosis

Allows for early treatment to maintain and stabilize

the immune system response

Decreases risk of HIV transmission from mother to

newborn baby
Allows for risk reduction education to reduce or

eliminate high-risk behavior

HIV Testing
Requires a blood or oral fluid sample
HIV test detects the bodys antibody response to HIV

infection
The test does NOT detect the HIV virus

HIV Testing
Those recently exposed should be retested at least six

months after their last exposure. Screening test (EIA/ELISA) vs. confirmatory test (IFA) EIA/ELISA (Reactive) Repeat EIA/ELISA (Reactive) IFA (Reactive) Positive for HIV

HIV Testing
EIA/ELISA Test
Negative No HIV Exposure Low Risk
NEGATIVE

Positive

HIV Exposure High Risk Repeat ELISA Every 3 months for 1 year Repeat every 6 months for continued High risk behavior
POSITIVE

Repeat Positive Run IFA Confirmation

Indeterminate Repeat at 3 weeks

NEGATIVE Repeat at 2-4 months

POSITIVE

END TESTING

NEGATIVE

HIV
+

Philippines Law for HIV Testing

Requires informed consent No premarital testing requirement

Prenatal testing not required but recommended

School notification not required for positive staff or

students (universal precautions)

Philippines Law for HIV Testing (cont.)

Allows testing of individuals:

14 years of age or older without parental consent Mandatory testing for prison inmates in grade 1, grade 2,

regional facilities, and the state penitentiary as defined in NDCC:23-07-07.5

Court ordered testing for defendants charged with a sex

offense as defined in NDCC: 23-07.7-01

HIV

AIDS

Once a person is infected they are always infected 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

HIV Risk Reduction

Avoid unprotected sexual contact Use barriers such as condoms and dental dams 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

HIV Risk Reduction

Avoid drug and alcohol use to maintain good judgment Dont share needles used by others for:
Drugs Tattoos Body piercing

Avoid exposure to blood products

Condoms
Using condoms is not 100 % effective in preventing transmission of sexually transmitted infections including HIV

Condoms = Safer sex Condoms Safe sex

Condom Use
Should be used consistently and correctly

Should be either latex or polyurethane

Should be discussed with your partner before the

sexual act begins Should be the responsibility of both partners for the protection of both partners Male and female condoms are available

People Infected with HIV

Can look healthy Can be unaware of their infection Can live long productive lives when their HIV infection

is managed
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 been exposed one time

and become infected

When you have sex with someone, you are having sex with everyone they have had sex with for the last ten years.
C. Everett Koop
Former Surgeon General

HIV and Sexually Transmitted Diseases

STIs increase infectivity of HIV
A person co-infected with an STI 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

HIV and Sexually Transmitted Diseases

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 STDs include: syphilis, chancroid, and genital herpes Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis

HIV and Sexually Transmitted Diseases

The effect of HIV infection on the immune system

increases the the risk of STDs

A suppressed immune response due to HIV can:
Increase the reactivation of genital ulcers

Increase the rate of abnormal cell growth Increase the difficulty in curing reactivated or newly acquired genital ulcers Increase the risk of becoming infected with additional STDs

HIV Occupational Exposure

Review facility policy and report the incident

Medical follow-up is necessary to determine the

exposure risk and course of treatment Baseline and follow-up HIV testing Four week course of medication initiated one to two hours after exposure Liver function tests to monitor medication tolerance Exposure precautions practiced

HIV Non-Occupational Exposure

PREVENTION --- FIRST

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.

Antiretrovirals should not be used for those with lowrisk transmissions or exposures occurring more than 72 hours after exposure.

HIV Non-Occupational Exposure

Provider Considerations:
Evaluate HIV status of patient and risk history of source

patient Provide necessary medical care and counseling Evaluate risk event and factors for exposure Determine elapsed time from exposure Evaluate potential for continuous HIV exposure Obtain informed consent for testing and treatment Evaluate pregnancy status of females Monitor for drug toxicity and acute infection

Annabel Lapuz-Carungin, MD, RMT, PT, RN, RM, MAN