NURS 330 - Schedule for 4/28/14

• HIV Lecture – Disly Juarez, MPH• Return and Review Quiz• Group Activity• Distribute Study Guide for 5/5/14 Mid-term• In-Class Assignment

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County of Los Angeles Department of Public Health

Division of HIV and STD Programs

Disly Juarez, MPHHealth Educator

djuarezmunoz@ph.lacounty.gov

The State of the HIV/AIDS Epidemic

MYTHS AND FACTS ABOUT HIV/AIDS

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Video:

Myths/Facts about HIV

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Myth/Fact?

HIV is the same as AIDS

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HIV vs AIDS

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HIV AIDS

What it stands for

Human Immunodeficiency Virus

Acquired ImmunoDeficiency

Syndrome

What it is A virus: an agent that replicates inside a living cell

A syndrome: a collection of multiple symptoms or characteristics that often occur together

How it is diagnosed

A test that shows HIV antibodies or antigens in a person’s blood or saliva

• HIV positive test • A T- Cell count of < 200 -OR-• 1 or more opportunistic

infections

AIDS Criteria (CDC)HIV positive test AND a T-Cell count of <200 or 14%

(healthy T-Cell count ranges from 800-1200)

ORHIV positive test AND one or more opportunistic infections

(OIs)/certain cancers

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If the T-Cell count goes up, or the opportunistic infection goes away, does the

person still have AIDS?YES

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HIV & the Immune System

HIV attacks the T cells (aka CD4 cells) weakening the immune system

Over time HIV can lead to AIDS

Special Characteristics of HIV

Weakens and compromises the immune system

HIV replicates in large quantities

Ability to mutate (change itself) very quickly

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Myth/Fact?

HIV only affects gay men and drug users

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25,895

16,155

13,2503,200

Estimate ~ 61,700 living

with HIV & AIDS in LAC

3,200

Estimated Number of Persons Living with HIV and AIDS in LAC at End of 2013

(1) CDC estimates 15.8% of persons with HIV are unaware of their infection.(2) Reported cases includes half of 3,500 lab reports pending investigation and half of 3,300 cases reported to us only by code likely

to result in unduplicated named cases.

Estimate ~ 60,050 persons living

with HIV (including AIDS) in LAC

50,550

1,500

Source: LAC Division of HIV and STD Programs, reported as of 12/31/13.

9,500

Impact on Los Angeles County

LA County is second only to NYC among US metropolitan areas in cumulative number of reported AIDS cases

Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC

42% of all California AIDS cases are reported from LAC in 2010

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Persons living with HIV Infection from HIV/AIDS Annual Surveillance

Summary

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*Reported as of 2011, CDC. HIV Surveillance Report, Volume 23(1), February 28, 2013

** Reported as of 12/31/12, California Office of AIDS, HIV/AIDS Surveillance Section.

*** Report as of 12/31/12, LAC Division of HIV/STD Programs

Jurisdiction No. living with HIV/AIDS

U.S. (50 states) 872,990*

California 117,695**

LA County 45,474 ***

Transmission Category for Persons Living with HIV/AIDS

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Male (n=40,315)

Female (n=5,159)

as of December 31, 2012 by Gender in Los Angeles County

* Persons with an undetermined transmission category are assigned a risk factor using multiple imputation (MI) methods. Other risks include hemophilia or coagulation disorder, transfusion recipient, perinatal exposure and confirmed other risk.

** Data are provisional due to reporting delaySource: HIV/AIDS Surveillance Summary, data as of December 2012.

*Sometimes called “Prevalence Rate”; it is really a proportion.

988

768

486379

1090

200

400

600

800

1000

Black AI/AN White Latino A/PI

per 1

00,0

00 Po

pula

tion

Source: HIV/AIDS Surveillance Summary, data as of 12/31/2012.

Persons Living with HIV/AIDS in LAC per 100,000 population* by

Race/Ethnicity

Myth/Fact?

Once a person is diagnosed with HIV/AIDS, they will die soon

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HIV Spectrum of Disease

ExposureNo infection

Asymptomatic

Initial SymptomsLasts a few weeks

Mild flu-like symptoms: • Fever• Muscle aches• Swollen glands

InfectionWindow period*

Asymptomatic

*Window Period: average time it takes the body to produce antibodies; usually 2 - 12 weeks, up to 6 months - 1 year (rare)

Asymptomatic Period

8 - 11 years

(Average progression, may vary depending on the person)

HIV IllnessSymptoms include:• Night sweats• Fevers• Fatigue• Diarrhea• Swollen lymph

nodes• Oral and

vaginal candidiasis

• PID• Pap Smear

positive for HPV

AIDS• T-Cells <200 • 1 or more

OIs (PCP, KS, TB, CMV, Candidiasis, etc.)

• Wasting syndrome

• HIV-related dementia

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

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You CANNOT get HIV from…

• Breathing • Coughing• Sneezing• Kissing• Hugging• Shaking hands• Sharing food or

drinks

• Drinking fountains

• Telephones• Toilet seats• Pools/Tubs• Mosquito bite • Giving/donating

blood in US

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HIV Transmission

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Blood Semen, Pre-cum

Vaginal Secretio

ns

Breast Milk

HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood.

1 32 4

Infected Body Fluids

HIV Transmission

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Anal Vaginal Oral1 32

Unprotected Sex

HIV Transmission

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InjectionDrug Use

Piercing/Tattooing

Insulin, hormone, vitamin

shots

Acu-punctur

e

1 32 4

Exchanging Infected Blood :

Sharing needles for any purpose

HIV TransmissionMother 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% with proper care

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TIME FOR AN ACTIVITY

“The Spectrum of Risk”

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Myth/Fact?

Having another STD puts a person at greater risk for

contracting HIV

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STDs and HIV

STDs increase the

concentration of “infection

fighting” CD4 cells in genital secretions, a

favorite target of HIV

STDs cause breaks in the skin on and

surrounding the penis, vagina and

anus, which provides a

perfect entry way for HIV

STD infection increases risk of contracting HIV (susceptibility)

-

HIV+ individuals who are also

infected with an STD have more

HIV in their genital

secretions

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STDs and HIV

HIV+ men who are also infected with an STD have much more HIV in their semen than

HIV+ men without an STD

STD infection increases risk of passing HIV to a partner (infectiousness)

+

? ? ?

Myth/Fact?

HIV testing is unnecessary because I would know if my lover

or I had it

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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-

40mins

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HIV TESTOther Test - 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 mi. - 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. 

Test settings Anonymous

Confidential

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HIV TESTInformed Consent12 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) 32

Myth/Fact?

A person who is HIV positive must tell partners their status

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What are the differences between ethical and legal aspects?

 

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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 ANTI-DISCRIMINATION 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 DiscriminationA doctor or dentist cannot refuse to treat an HIV+ person

California Anti-Discrimination LawsFair Employment and Housing Act (FEHA) and Unruh Civil Rights Act 37

PREVENTION

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It is not who we are but what we do

that puts us at risk for HIV infection

The Prevention “Toolbox”1. Abstinence

2. Safer SexMale Condom (Activity)Female CondomDental Dams

3. Safer Needle UseNot Sharing NeedlesCleaning Needles (3x3x3 Method)Needle Exchange

4. Harm Reduction39

PREVENTION: Abstinence

Abstinence: not having sex of any kind or sharing needles. Not exchanging any bodily fluids is the only 100% sure way to avoid becoming infected with HIV.

If one is not going to abstain, what other options do they have?

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PREVENTION: Needle use

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Needle Exchange van in Berkley, CA

PREVENTION: Standard Precautions Infection control measures that reduce the

risk of transmission of blood-born germs from patients to health care workers

Wash hands thoroughly Wear gloves Use masks and eye protection Wear a gown Carefully handling and disposing of sharp

instruments during and after use.

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TREATMENT

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• 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

TREATMENTWhat are Anti-retrovirals (ARVs) ?

• Anti-retrovirals are drugs that interrupt the HIV replication process and help preserve the health of the immune system

• These drugs must be taken in combinations in order to have a lasting effect. The three drug combination is commonly known as a “triple cocktail”

• Using a combination of anti-retrovirals creates multiple obstacles to HIV replication. This is designed to keep the virus from replicating freely and reduce the possibility of a mutation.

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When to start anti-HIV medications?

2 schools of thought:

1.Treatment should begin if there are severe symptoms of HIV infection or a diagnosis of AIDS with a CD4 count of 350 cells/mm3 or less

2.Starting treatment immediately following diagnosis

Because of the complexity of selecting and following a regimen, the severity of the side-effects, and the importance of compliance to prevent resistance, it is extremely important to engage patients in treatment decisions. 46

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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Complementary Therapy General Health Maintenance

Psychological Well-Being

Spiritual Well-Being

Social Well-Being

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Recent advancements 

Immune based therapies

Maturation inhibitors

Multi-class Combination Products

Gene Therapy

Vaccine

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QUESTIONS?

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For More Information Contact

http://publichealth.lacounty.gov/dhsp/

Disly Juarez, MPHdjuarezmunoz@ph.lacounty.gov

213-351-8102