Course Book : #101 - HIV / AIDS Update

AIDS/ HIV

Meets Florida Requirement

COURSE # 101

Author: Monica Oram, RN, BSN

Author: Monica Oram, RN, BSN
This course is intended for the reader to be able to achieve the following objectives:
1.Understand difference between HIV and AIDS.
2.Know the myths of HIV and AIDS.
3.Understand HIV and AIDS Statistics.
4.Learn three methods used for HIV Screening.
5.Understand Universal Precautions.
6.Understand How HIV is transmitted.
7.Understand Legal Right associated with HIV/ AIDS.
8.Understand Current treatment associated with HIV and AIDS.

     In the world today, approximately 33.6 million people are estimated to be living with HIV/AIDS. Of these, 32.4 Million are Adults, 14.8 Million are women, and 1.2 million are children under the age of 15. The highest incidence of HIV and AIDS per 100,000 people are found that in California, they are ranked as #1 in the nation for HIV and AIDS cases, Followed by New York at #2, and then Florida at #3, with New Jersey ranking #4 and the little state of Connecticut ranking in at #5.  
     The last cumulative count was done in 1999 by the CDC, and indicates that for every case of  AIDS known, there are at least 10 people who are infected with HIV. The most recent estimate of HIV prevalence indicates that there are approximately 1 in 400 people in the world currently living with HIV, and 1 in 250 Americans are currently living with the HIV infection.  In Florida, it is estimate that 1 in 150 are infected with the HIV Virus. Florida also ranks SECOND in the nation for HIV Pediatric cases.  Alarming statistic for the Dade County Area( Miami, Florida) shows that 1 in every 50-60 people are HIV infected!    
   
Difference Between HIV and AIDS
     AIDS is caused by the Human Immunodeficiency Virus (HIV). HIV kills and damages the body’s immune system by destroying the body’s ability to fight off infections and certain cancers. People with AIDS may get life threatening diseases called opportunistic infections, which are caused by viruses and/or bacteria that normal healthy people are able to fight off with out any problems.

     HIV is the virus that causes AIDS. A person cannot get AIDS without first having the HIV Virus.  HIV attacks the immune system, and weakens the body’s ability to fight off infections. The body becomes so weak it cannot fight off diseases that it comes in contact with. Once the body is infected with the disease of HIV, the virus quickly begins to reproduce inside the blood cells of the infected person. Currently, there is no cure for HIV. There are many medications that are thought to slow down the process of cell reproduction and will allow the infected person to live longer. The best prevention for HIV is by way of community education, and modifying any behaviors that are risky. AIDS is the end stage of HIV infection.
Understanding the Signs and Symptoms
     Early AIDS symptoms can include fever, loss of appetite, weight loss, chronic fatigue, and skin rashes. Later on, the person may develop and experience unusual types of cancers or infections, including pneumonia, that the body can no longer fight off. Some people who carry the HIV virus have no symptoms for as long as 10 -15 years. And others may not develop AIDS until many years after they become infected. Researchers are working hard to fight AIDS, and they learn more every day. But, unfortunately there is still no cure.
How The Immune System Is Overpowered
     Acquired immunity develops after we are born to help us fight off infections through out life, like colds and flu, ect. The cells in our bodies produce antibodies that can attack and destroy disease causing germs to ward off infections. The immune system is a network of cells and organs that work together to fight off infections. The antibodies try to fight back by signaling out the “Bad Cells” and attaching to them, the phagocytes then try to “eat” them in order to try and destroy them. The T-cells are able to fight infection and are there to also help the body ward off infections. This is how a normal immune system is designed to work.
     When HIV invades the body, by entering the blood stream, it uses the immune system against itself in order to reproduce and survive. As the body recognizes the invasion of the “Bad Cells”,  some of the HIV is destroyed when the T-Cells try to fight back. The problem arises when the HIV virus compromises the whole immune system. The HIV cells are able to “disguise themselves to appear as “good cells”, and them reproduce at a very fast rate. The body thinks they are the good cells, and accepts them as their own, therefore allowing reproduction to take place in the  body. Once HIV is in the body it becomes a retrovirus.

     Once inside the T-Cells, it uses reverse transcriptase enzymes to translate its genetic make up of RNA ( (ribonucleic acid ) into t-Cell DNA ( deoxyribonucleic acid) The infected cells become a mass producing factory that produces new viral cells that finally take over and destroy the T Cells.

HIV Infection Cycle
     First, there is a window period in which the time a person becomes infected and until the body develops enough antibodies for an accurate positive HIV test to detect presence of HIV in the blood. This is a window period. It can range from 2 weeks to 6 months. The person with HIV is infectious during this window period. Then there is an incubation period. In the incubation period, and HIV infected person normally shows no signs or symptoms and appear to be healthy and not sick. This is particularly a major concern, because it is in this phase that others are becoming infected through unsafe sex, and exposure to blood and body fluids. The person who is infected does not look or feel sick, and therefore usually does not modify any of the identifiable risky behaviors associated with the spread of the disease. The HIV infected person may not develop any signs or symptoms for a period of 5-10 years or more, once infected. The Phase of AIDS, is when symptoms appear and the immune system begins to break down. The person may not be considered to have “full blown AIDS” but they begin to show signs and symptoms.  AIDS is confirmed with a positive HIV test , and if found to be positive it is repeated for a confirmation  of results.  It will also indicate that an HIV person has one or more opportunistic infections, once the symptoms begin to appear.  For example, it is not until  the person begins experiencing a flu like infection, before they generally seek medical advise and then be tested for HIV. The most common opportunistic infection includes PCP. ( pneumocystis carinii pneumonia), yeast infections primarily in the mouth and esophagus, Kaposi’s Sarcoma
(Blood Cancer). One indicator that a person has AIDS is when it is discovered that the person has a CD4 count below 200. A normal person has about 500-1500 cells per micro liter CD4 count cells.
Myths about HIV and AIDS
Myth: If I am HIV positive, that means I have AIDS
Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed to the virus, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over a period of time.

Myth: HIV is the same as AIDS.
Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.

Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing.
Fact: HIV is not spread through casual contact. There is a slight chance that you could become HIV infected through kissing if you or the infected person both had open bleeding sores in the mouth, and the infected person’s blood gets into yours.

Myth: I can get HIV from telephones, toilet seats, or door knobs.
Fact: The HIV virus cannot live outside of the body. You cannot become infected through saliva, unless there is visible blood and you have an open area for the virus to enter.

Myth: I can get HIV from eating food that was prepared by an infected person.
Fact: HIV dies quickly outside of the body. Once any body fluid is dry, you can be absolutely sure the virus is dead.

Myth: I can become infected with HIV from a mosquito.
Fact: Although it sounds very possible, you can not get HIV infected from a mosquito, fleas, ticks, or lice. For this to happen, the HIV would have to live in the insect’s saliva or salivary glands. HIV is a human virus and cannot survive out of the human body.

Myth: I can get HIV from breathing the same air as an infected person.
Fact: HIV is not airborne, and does not transmit by air. You cannot get HIV by being in the same room with an HIV infected person.  

Screening Tests For HIV
     The standard method of testing for HIV is by a blood test called the EIA test. The EIA test is the enzyme immunoassay test. It is done by collecting a blood sample, and tested in a lab. A negative screen indicates the person is not infected. A positive test indicates the person is possibly HIV infected, and will be confirmed with a second test to rule out an absolutely positive result. This second test is called the Western Blot to confirm the diagnosis.
A negative test result does not necessarily mean a person is in fact negative, if the person is known to engage in risky behaviors, they could be in the window period, and would not necessarily have a positive test result. These individuals should be retested in 6 months to confirm the outcome of negative or positive.
     There is a new rapid test available from the Food and Drug Administration, known as the SUDS test. The suds test is Single Use Diagnostic System. A result can be obtained in 5 to 30 minutes.  A positive test is confirmed by the western blot test.
     One will also want to remember that an HIV test on an infant could show the HIV status of the mother due to antibodies being transferred from mother to baby.
Methods of Transmission
     HIV can be spread through unprotected sex. Unprotected sex refers to having sex without the use of a latex condom or a dental dam for oral sex. HIV is transmitted through blood and body fluids such as blood, semen, vaginal lining and fluids, and breast milk. HIV is transmitted by sexual intercourse, babies born to infected mothers and breast feeding, body fluids and blood, and sharing IV drug needles.  
     Prevention includes understanding and learning all you can to be safe. Education is a key importance in the spread of HIV. Do not have unprotected sex, know the status of your sexual partners,  Do not share needles with anyone, Avoid risky behavior that can expose you to contact with blood or body fluids. Always use latex condoms, and know how to use them correctly.
     As far as workplace exposure, it is important to know to never recap any needles. There should always go directly in the sharps box after use. Make certain the sharps box is never over filled more than 2/3 full when disposing needles. Wear gloves at all times when an exposure to any blood or body fluid is a possibility. Use face masks, and eye protection if a fluid splash is possible. Prescription eye glasses will not be adequate protection. Do not expose your skin to soiled equipment or soiled linens. Use resuscitation barriers for Mouth to mouth contact in Cardio- Pulmonary Resuscitation.  

Terms To Be Familiar With  
     
Acquired Immunodeficiency Syndrome- AIDS… The severe manifestation of infection with the HIV Virus. The CDC lists a number of opportunistic infections and cancers that, in the presence of HIV infection. Constitutes an AIDS diagnosis. There are also instances of presumptive diagnoses when a person’s HIV status is unknown. This was especially true before 1985. Prior to 1985, the blood supply was not tested, and there was no antibody test available. In 1993, CDC expanded the criteria for an AIDS diagnosis to include CD4 and T cell counts at or below 200 cells per micro liter in the presence of HIV infection.

Acute HIV infection- The four to seven week period of rapid viral replication immediately following exposure. An estimated 30-60% of individuals with Primary HIV infection develop an acute syndrome characterized by fever, malaise, lymphadenopathy, pharyngitis, headache, myalgia, amd sometimes a skin rash. Following primary infection, seroconversion and broad HIV -1 specific immune response occur within 30 - 60 days.

AIDS Dementia Complex- (ADC) A degenerative neurological condition attributed to HIV infection, characterized by a group of clinical presentations including the loss of coordination. Mood swings, and loss of inhibitions, and wide spread common central nervous system complications of HIV infection.

AIDS related Complex- (ARC) A term that is used by some clinicians to describe a variety of symptoms found in some persons living with HIV.

Antibody- Molecule in the blood or secretions that tag, destroy, or neutralizes bacteria, viruses, or harmful toxins in the blood. Antibodies are a class of proteins known as immunoglobulins, which are produced and secreted by B-lymphocytes in response to stimulation by antigens. Antibodies are specific to invading organisms.

CD4+ Cells- A type of T helper cell that is involved in protecting the body against infection. Destruction of CD4 cells is the major cause of immunodeficiency seen in AIDS.

T-Cells- are white blood cells that are derived from the Thymus gland, that participates in a variety of cell mediated immune reactions. Three different types of T cells exist, Helper T’s, Killer T’s, and Suppressor T’s..  They are the body’s  “border police” responsible for finding infected or cancerous cells.      

Treatment and Medical Management
     Currently, there is no cure for HIV or AIDS.  There are a variety of medications that will slow down the reproduction phase of the cells. Normally treatment modality will consist of a combination of several types of antiretroviral drugs. The treatment outcome will largely depend upon the compliance of the patient taking these drugs as prescribed. There are many side effects that are often worse than the symptoms, and compliance is a big issue with many HIV positive patients.
     Currently some drugs being used include AZT, Dapsone, DDC, DDI, Pentamidine, Saquinavir, to mention a few.
AZT- Azidothymidine, also known as retrovir or zidovudine. The first antiretroviral drug against HIV infection to be introduced by The FDA in 1987. It is a thymidine analog that suppresses replication of HIV virus.
Dapsone- An approved oral antibiotic of the sulfone class used to treat and as prophylaxis of PCP and toxoplasmosis.
DDC-  Dideoxycytidine, is a nucleoside analog drug that inhibits the replication of HIV. FDA approved treatment selected for patients with advanced HIV disease.
DDI - Dideoxyinosine, is a nucleoside analog drug that inhibits the replication of HIV. Also prescribed for patients with advanced HIV disease.
Pentamidine- An approved antiprotozoal drug used for the treatment and prevention of PCP. ( pneumocystis Carinii Pneumonia)
Saquinavir- A peptide based, protease inhibitor. FDA approved for combination use with nucleoside analogs for treatment of advanced HIV infection.
   Ethical Concerns

     The main concern is that the patient requires emotional and psychological support. It is no longer important how he became infected, but how to deal with the disease process at this point. There are laws set in place that protects the patients right to privacy. Consent forms must be obtained in advance before any testing may be done. Only a Doctor or a specially trained individual can deliver test results. They may never be given by phone or in the mail. The individual must undergo pre and post counseling when being tested.  





Standard Precautions

The best way as stated by the CDC, is to avoid contracting HIV and developing AIDS, you should follow strict CDC guidelines and standard precautions. The rule of thumb is, “Treat all people as if they have HIV, when providing care” therefore, the use of gloves and personal protective equipment is essential in preventing the spread of HIV. Handwashing is critical, use of vinyl or latex gloves is also essential when in contact with any blood or body fluid.

References
Center for Disease Control
www.cdc.gov

AMJ
www.amj.org

MMWR

National Aids Clearinghouse
www.fda.gov

AIDS/ HIV

Meets Florida Requirement

COURSE # 101

Author: Monica Oram, RN, BSN

Author: Monica Oram, RN, BSN
This course is intended for the reader to be able to achieve the following objectives:
1.Understand difference between HIV and AIDS.
2.Know the myths of HIV and AIDS.
3.Understand HIV and AIDS Statistics.
4.Learn three methods used for HIV Screening.
5.Understand Universal Precautions.
6.Understand How HIV is transmitted.
7.Understand Legal Right associated with HIV/ AIDS.
8.Understand Current treatment associated with HIV and AIDS.

     In the world today, approximately 33.6 million people are estimated to be living with HIV/AIDS. Of these, 32.4 Million are Adults, 14.8 Million are women, and 1.2 million are children under the age of 15. The highest incidence of HIV and AIDS per 100,000 people are found that in California, they are ranked as #1 in the nation for HIV and AIDS cases, Followed by New York at #2, and then Florida at #3, with New Jersey ranking #4 and the little state of Connecticut ranking in at #5.  
     The last cumulative count was done in 1999 by the CDC, and indicates that for every case of  AIDS known, there are at least 10 people who are infected with HIV. The most recent estimate of HIV prevalence indicates that there are approximately 1 in 400 people in the world currently living with HIV, and 1 in 250 Americans are currently living with the HIV infection.  In Florida, it is estimate that 1 in 150 are infected with the HIV Virus. Florida also ranks SECOND in the nation for HIV Pediatric cases.  Alarming statistic for the Dade County Area( Miami, Florida) shows that 1 in every 50-60 people are HIV infected!    
   
Difference Between HIV and AIDS
     AIDS is caused by the Human Immunodeficiency Virus (HIV). HIV kills and damages the body’s immune system by destroying the body’s ability to fight off infections and certain cancers. People with AIDS may get life threatening diseases called opportunistic infections, which are caused by viruses and/or bacteria that normal healthy people are able to fight off with out any problems.

     HIV is the virus that causes AIDS. A person cannot get AIDS without first having the HIV Virus.  HIV attacks the immune system, and weakens the body’s ability to fight off infections. The body becomes so weak it cannot fight off diseases that it comes in contact with. Once the body is infected with the disease of HIV, the virus quickly begins to reproduce inside the blood cells of the infected person. Currently, there is no cure for HIV. There are many medications that are thought to slow down the process of cell reproduction and will allow the infected person to live longer. The best prevention for HIV is by way of community education, and modifying any behaviors that are risky. AIDS is the end stage of HIV infection.
Understanding the Signs and Symptoms
     Early AIDS symptoms can include fever, loss of appetite, weight loss, chronic fatigue, and skin rashes. Later on, the person may develop and experience unusual types of cancers or infections, including pneumonia, that the body can no longer fight off. Some people who carry the HIV virus have no symptoms for as long as 10 -15 years. And others may not develop AIDS until many years after they become infected. Researchers are working hard to fight AIDS, and they learn more every day. But, unfortunately there is still no cure.
How The Immune System Is Overpowered
     Acquired immunity develops after we are born to help us fight off infections through out life, like colds and flu, ect. The cells in our bodies produce antibodies that can attack and destroy disease causing germs to ward off infections. The immune system is a network of cells and organs that work together to fight off infections. The antibodies try to fight back by signaling out the “Bad Cells” and attaching to them, the phagocytes then try to “eat” them in order to try and destroy them. The T-cells are able to fight infection and are there to also help the body ward off infections. This is how a normal immune system is designed to work.
     When HIV invades the body, by entering the blood stream, it uses the immune system against itself in order to reproduce and survive. As the body recognizes the invasion of the “Bad Cells”,  some of the HIV is destroyed when the T-Cells try to fight back. The problem arises when the HIV virus compromises the whole immune system. The HIV cells are able to “disguise themselves to appear as “good cells”, and them reproduce at a very fast rate. The body thinks they are the good cells, and accepts them as their own, therefore allowing reproduction to take place in the  body. Once HIV is in the body it becomes a retrovirus.

     Once inside the T-Cells, it uses reverse transcriptase enzymes to translate its genetic make up of RNA ( (ribonucleic acid ) into t-Cell DNA ( deoxyribonucleic acid) The infected cells become a mass producing factory that produces new viral cells that finally take over and destroy the T Cells.

HIV Infection Cycle
     First, there is a window period in which the time a person becomes infected and until the body develops enough antibodies for an accurate positive HIV test to detect presence of HIV in the blood. This is a window period. It can range from 2 weeks to 6 months. The person with HIV is infectious during this window period. Then there is an incubation period. In the incubation period, and HIV infected person normally shows no signs or symptoms and appear to be healthy and not sick. This is particularly a major concern, because it is in this phase that others are becoming infected through unsafe sex, and exposure to blood and body fluids. The person who is infected does not look or feel sick, and therefore usually does not modify any of the identifiable risky behaviors associated with the spread of the disease. The HIV infected person may not develop any signs or symptoms for a period of 5-10 years or more, once infected. The Phase of AIDS, is when symptoms appear and the immune system begins to break down. The person may not be considered to have “full blown AIDS” but they begin to show signs and symptoms.  AIDS is confirmed with a positive HIV test , and if found to be positive it is repeated for a confirmation  of results.  It will also indicate that an HIV person has one or more opportunistic infections, once the symptoms begin to appear.  For example, it is not until  the person begins experiencing a flu like infection, before they generally seek medical advise and then be tested for HIV. The most common opportunistic infection includes PCP. ( pneumocystis carinii pneumonia), yeast infections primarily in the mouth and esophagus, Kaposi’s Sarcoma
(Blood Cancer). One indicator that a person has AIDS is when it is discovered that the person has a CD4 count below 200. A normal person has about 500-1500 cells per micro liter CD4 count cells.
Myths about HIV and AIDS
Myth: If I am HIV positive, that means I have AIDS
Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed to the virus, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over a period of time.

Myth: HIV is the same as AIDS.
Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.

Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing.
Fact: HIV is not spread through casual contact. There is a slight chance that you could become HIV infected through kissing if you or the infected person both had open bleeding sores in the mouth, and the infected person’s blood gets into yours.

Myth: I can get HIV from telephones, toilet seats, or door knobs.
Fact: The HIV virus cannot live outside of the body. You cannot become infected through saliva, unless there is visible blood and you have an open area for the virus to enter.

Myth: I can get HIV from eating food that was prepared by an infected person.
Fact: HIV dies quickly outside of the body. Once any body fluid is dry, you can be absolutely sure the virus is dead.

Myth: I can become infected with HIV from a mosquito.
Fact: Although it sounds very possible, you can not get HIV infected from a mosquito, fleas, ticks, or lice. For this to happen, the HIV would have to live in the insect’s saliva or salivary glands. HIV is a human virus and cannot survive out of the human body.

Myth: I can get HIV from breathing the same air as an infected person.
Fact: HIV is not airborne, and does not transmit by air. You cannot get HIV by being in the same room with an HIV infected person.  

Screening Tests For HIV
     The standard method of testing for HIV is by a blood test called the EIA test. The EIA test is the enzyme immunoassay test. It is done by collecting a blood sample, and tested in a lab. A negative screen indicates the person is not infected. A positive test indicates the person is possibly HIV infected, and will be confirmed with a second test to rule out an absolutely positive result. This second test is called the Western Blot to confirm the diagnosis.
A negative test result does not necessarily mean a person is in fact negative, if the person is known to engage in risky behaviors, they could be in the window period, and would not necessarily have a positive test result. These individuals should be retested in 6 months to confirm the outcome of negative or positive.
     There is a new rapid test available from the Food and Drug Administration, known as the SUDS test. The suds test is Single Use Diagnostic System. A result can be obtained in 5 to 30 minutes.  A positive test is confirmed by the western blot test.
     One will also want to remember that an HIV test on an infant could show the HIV status of the mother due to antibodies being transferred from mother to baby.
Methods of Transmission
     HIV can be spread through unprotected sex. Unprotected sex refers to having sex without the use of a latex condom or a dental dam for oral sex. HIV is transmitted through blood and body fluids such as blood, semen, vaginal lining and fluids, and breast milk. HIV is transmitted by sexual intercourse, babies born to infected mothers and breast feeding, body fluids and blood, and sharing IV drug needles.  
     Prevention includes understanding and learning all you can to be safe. Education is a key importance in the spread of HIV. Do not have unprotected sex, know the status of your sexual partners,  Do not share needles with anyone, Avoid risky behavior that can expose you to contact with blood or body fluids. Always use latex condoms, and know how to use them correctly.
     As far as workplace exposure, it is important to know to never recap any needles. There should always go directly in the sharps box after use. Make certain the sharps box is never over filled more than 2/3 full when disposing needles. Wear gloves at all times when an exposure to any blood or body fluid is a possibility. Use face masks, and eye protection if a fluid splash is possible. Prescription eye glasses will not be adequate protection. Do not expose your skin to soiled equipment or soiled linens. Use resuscitation barriers for Mouth to mouth contact in Cardio- Pulmonary Resuscitation.  

Terms To Be Familiar With  
     
Acquired Immunodeficiency Syndrome- AIDS… The severe manifestation of infection with the HIV Virus. The CDC lists a number of opportunistic infections and cancers that, in the presence of HIV infection. Constitutes an AIDS diagnosis. There are also instances of presumptive diagnoses when a person’s HIV status is unknown. This was especially true before 1985. Prior to 1985, the blood supply was not tested, and there was no antibody test available. In 1993, CDC expanded the criteria for an AIDS diagnosis to include CD4 and T cell counts at or below 200 cells per micro liter in the presence of HIV infection.

Acute HIV infection- The four to seven week period of rapid viral replication immediately following exposure. An estimated 30-60% of individuals with Primary HIV infection develop an acute syndrome characterized by fever, malaise, lymphadenopathy, pharyngitis, headache, myalgia, amd sometimes a skin rash. Following primary infection, seroconversion and broad HIV -1 specific immune response occur within 30 - 60 days.

AIDS Dementia Complex- (ADC) A degenerative neurological condition attributed to HIV infection, characterized by a group of clinical presentations including the loss of coordination. Mood swings, and loss of inhibitions, and wide spread common central nervous system complications of HIV infection.

AIDS related Complex- (ARC) A term that is used by some clinicians to describe a variety of symptoms found in some persons living with HIV.

Antibody- Molecule in the blood or secretions that tag, destroy, or neutralizes bacteria, viruses, or harmful toxins in the blood. Antibodies are a class of proteins known as immunoglobulins, which are produced and secreted by B-lymphocytes in response to stimulation by antigens. Antibodies are specific to invading organisms.

CD4+ Cells- A type of T helper cell that is involved in protecting the body against infection. Destruction of CD4 cells is the major cause of immunodeficiency seen in AIDS.

T-Cells- are white blood cells that are derived from the Thymus gland, that participates in a variety of cell mediated immune reactions. Three different types of T cells exist, Helper T’s, Killer T’s, and Suppressor T’s..  They are the body’s  “border police” responsible for finding infected or cancerous cells.      

Treatment and Medical Management
     Currently, there is no cure for HIV or AIDS.  There are a variety of medications that will slow down the reproduction phase of the cells. Normally treatment modality will consist of a combination of several types of antiretroviral drugs. The treatment outcome will largely depend upon the compliance of the patient taking these drugs as prescribed. There are many side effects that are often worse than the symptoms, and compliance is a big issue with many HIV positive patients.
     Currently some drugs being used include AZT, Dapsone, DDC, DDI, Pentamidine, Saquinavir, to mention a few.
AZT- Azidothymidine, also known as retrovir or zidovudine. The first antiretroviral drug against HIV infection to be introduced by The FDA in 1987. It is a thymidine analog that suppresses replication of HIV virus.
Dapsone- An approved oral antibiotic of the sulfone class used to treat and as prophylaxis of PCP and toxoplasmosis.
DDC-  Dideoxycytidine, is a nucleoside analog drug that inhibits the replication of HIV. FDA approved treatment selected for patients with advanced HIV disease.
DDI - Dideoxyinosine, is a nucleoside analog drug that inhibits the replication of HIV. Also prescribed for patients with advanced HIV disease.
Pentamidine- An approved antiprotozoal drug used for the treatment and prevention of PCP. ( pneumocystis Carinii Pneumonia)
Saquinavir- A peptide based, protease inhibitor. FDA approved for combination use with nucleoside analogs for treatment of advanced HIV infection.
   Ethical Concerns

     The main concern is that the patient requires emotional and psychological support. It is no longer important how he became infected, but how to deal with the disease process at this point. There are laws set in place that protects the patients right to privacy. Consent forms must be obtained in advance before any testing may be done. Only a Doctor or a specially trained individual can deliver test results. They may never be given by phone or in the mail. The individual must undergo pre and post counseling when being tested.  





Standard Precautions

The best way as stated by the CDC, is to avoid contracting HIV and developing AIDS, you should follow strict CDC guidelines and standard precautions. The rule of thumb is, “Treat all people as if they have HIV, when providing care” therefore, the use of gloves and personal protective equipment is essential in preventing the spread of HIV. Handwashing is critical, use of vinyl or latex gloves is also essential when in contact with any blood or body fluid.

References
Center for Disease Control
www.cdc.gov

AMJ
www.amj.org

MMWR

National Aids Clearinghouse
www.fda.gov

AIDS/ HIV

Meets Florida Requirement

COURSE # 101

Author: Monica Oram, RN, BSN

Author: Monica Oram, RN, BSN
This course is intended for the reader to be able to achieve the following objectives:
1.Understand difference between HIV and AIDS.
2.Know the myths of HIV and AIDS.
3.Understand HIV and AIDS Statistics.
4.Learn three methods used for HIV Screening.
5.Understand Universal Precautions.
6.Understand How HIV is transmitted.
7.Understand Legal Right associated with HIV/ AIDS.
8.Understand Current treatment associated with HIV and AIDS.

     In the world today, approximately 33.6 million people are estimated to be living with HIV/AIDS. Of these, 32.4 Million are Adults, 14.8 Million are women, and 1.2 million are children under the age of 15. The highest incidence of HIV and AIDS per 100,000 people are found that in California, they are ranked as #1 in the nation for HIV and AIDS cases, Followed by New York at #2, and then Florida at #3, with New Jersey ranking #4 and the little state of Connecticut ranking in at #5.  
     The last cumulative count was done in 1999 by the CDC, and indicates that for every case of  AIDS known, there are at least 10 people who are infected with HIV. The most recent estimate of HIV prevalence indicates that there are approximately 1 in 400 people in the world currently living with HIV, and 1 in 250 Americans are currently living with the HIV infection.  In Florida, it is estimate that 1 in 150 are infected with the HIV Virus. Florida also ranks SECOND in the nation for HIV Pediatric cases.  Alarming statistic for the Dade County Area( Miami, Florida) shows that 1 in every 50-60 people are HIV infected!    
   
Difference Between HIV and AIDS
     AIDS is caused by the Human Immunodeficiency Virus (HIV). HIV kills and damages the body’s immune system by destroying the body’s ability to fight off infections and certain cancers. People with AIDS may get life threatening diseases called opportunistic infections, which are caused by viruses and/or bacteria that normal healthy people are able to fight off with out any problems.

     HIV is the virus that causes AIDS. A person cannot get AIDS without first having the HIV Virus.  HIV attacks the immune system, and weakens the body’s ability to fight off infections. The body becomes so weak it cannot fight off diseases that it comes in contact with. Once the body is infected with the disease of HIV, the virus quickly begins to reproduce inside the blood cells of the infected person. Currently, there is no cure for HIV. There are many medications that are thought to slow down the process of cell reproduction and will allow the infected person to live longer. The best prevention for HIV is by way of community education, and modifying any behaviors that are risky. AIDS is the end stage of HIV infection.
Understanding the Signs and Symptoms
     Early AIDS symptoms can include fever, loss of appetite, weight loss, chronic fatigue, and skin rashes. Later on, the person may develop and experience unusual types of cancers or infections, including pneumonia, that the body can no longer fight off. Some people who carry the HIV virus have no symptoms for as long as 10 -15 years. And others may not develop AIDS until many years after they become infected. Researchers are working hard to fight AIDS, and they learn more every day. But, unfortunately there is still no cure.
How The Immune System Is Overpowered
     Acquired immunity develops after we are born to help us fight off infections through out life, like colds and flu, ect. The cells in our bodies produce antibodies that can attack and destroy disease causing germs to ward off infections. The immune system is a network of cells and organs that work together to fight off infections. The antibodies try to fight back by signaling out the “Bad Cells” and attaching to them, the phagocytes then try to “eat” them in order to try and destroy them. The T-cells are able to fight infection and are there to also help the body ward off infections. This is how a normal immune system is designed to work.
     When HIV invades the body, by entering the blood stream, it uses the immune system against itself in order to reproduce and survive. As the body recognizes the invasion of the “Bad Cells”,  some of the HIV is destroyed when the T-Cells try to fight back. The problem arises when the HIV virus compromises the whole immune system. The HIV cells are able to “disguise themselves to appear as “good cells”, and them reproduce at a very fast rate. The body thinks they are the good cells, and accepts them as their own, therefore allowing reproduction to take place in the  body. Once HIV is in the body it becomes a retrovirus.

     Once inside the T-Cells, it uses reverse transcriptase enzymes to translate its genetic make up of RNA ( (ribonucleic acid ) into t-Cell DNA ( deoxyribonucleic acid) The infected cells become a mass producing factory that produces new viral cells that finally take over and destroy the T Cells.

HIV Infection Cycle
     First, there is a window period in which the time a person becomes infected and until the body develops enough antibodies for an accurate positive HIV test to detect presence of HIV in the blood. This is a window period. It can range from 2 weeks to 6 months. The person with HIV is infectious during this window period. Then there is an incubation period. In the incubation period, and HIV infected person normally shows no signs or symptoms and appear to be healthy and not sick. This is particularly a major concern, because it is in this phase that others are becoming infected through unsafe sex, and exposure to blood and body fluids. The person who is infected does not look or feel sick, and therefore usually does not modify any of the identifiable risky behaviors associated with the spread of the disease. The HIV infected person may not develop any signs or symptoms for a period of 5-10 years or more, once infected. The Phase of AIDS, is when symptoms appear and the immune system begins to break down. The person may not be considered to have “full blown AIDS” but they begin to show signs and symptoms.  AIDS is confirmed with a positive HIV test , and if found to be positive it is repeated for a confirmation  of results.  It will also indicate that an HIV person has one or more opportunistic infections, once the symptoms begin to appear.  For example, it is not until  the person begins experiencing a flu like infection, before they generally seek medical advise and then be tested for HIV. The most common opportunistic infection includes PCP. ( pneumocystis carinii pneumonia), yeast infections primarily in the mouth and esophagus, Kaposi’s Sarcoma
(Blood Cancer). One indicator that a person has AIDS is when it is discovered that the person has a CD4 count below 200. A normal person has about 500-1500 cells per micro liter CD4 count cells.
Myths about HIV and AIDS
Myth: If I am HIV positive, that means I have AIDS
Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed to the virus, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over a period of time.

Myth: HIV is the same as AIDS.
Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.

Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing.
Fact: HIV is not spread through casual contact. There is a slight chance that you could become HIV infected through kissing if you or the infected person both had open bleeding sores in the mouth, and the infected person’s blood gets into yours.

Myth: I can get HIV from telephones, toilet seats, or door knobs.
Fact: The HIV virus cannot live outside of the body. You cannot become infected through saliva, unless there is visible blood and you have an open area for the virus to enter.

Myth: I can get HIV from eating food that was prepared by an infected person.
Fact: HIV dies quickly outside of the body. Once any body fluid is dry, you can be absolutely sure the virus is dead.

Myth: I can become infected with HIV from a mosquito.
Fact: Although it sounds very possible, you can not get HIV infected from a mosquito, fleas, ticks, or lice. For this to happen, the HIV would have to live in the insect’s saliva or salivary glands. HIV is a human virus and cannot survive out of the human body.

Myth: I can get HIV from breathing the same air as an infected person.
Fact: HIV is not airborne, and does not transmit by air. You cannot get HIV by being in the same room with an HIV infected person.  

Screening Tests For HIV
     The standard method of testing for HIV is by a blood test called the EIA test. The EIA test is the enzyme immunoassay test. It is done by collecting a blood sample, and tested in a lab. A negative screen indicates the person is not infected. A positive test indicates the person is possibly HIV infected, and will be confirmed with a second test to rule out an absolutely positive result. This second test is called the Western Blot to confirm the diagnosis.
A negative test result does not necessarily mean a person is in fact negative, if the person is known to engage in risky behaviors, they could be in the window period, and would not necessarily have a positive test result. These individuals should be retested in 6 months to confirm the outcome of negative or positive.
     There is a new rapid test available from the Food and Drug Administration, known as the SUDS test. The suds test is Single Use Diagnostic System. A result can be obtained in 5 to 30 minutes.  A positive test is confirmed by the western blot test.
     One will also want to remember that an HIV test on an infant could show the HIV status of the mother due to antibodies being transferred from mother to baby.
Methods of Transmission
     HIV can be spread through unprotected sex. Unprotected sex refers to having sex without the use of a latex condom or a dental dam for oral sex. HIV is transmitted through blood and body fluids such as blood, semen, vaginal lining and fluids, and breast milk. HIV is transmitted by sexual intercourse, babies born to infected mothers and breast feeding, body fluids and blood, and sharing IV drug needles.  
     Prevention includes understanding and learning all you can to be safe. Education is a key importance in the spread of HIV. Do not have unprotected sex, know the status of your sexual partners,  Do not share needles with anyone, Avoid risky behavior that can expose you to contact with blood or body fluids. Always use latex condoms, and know how to use them correctly.
     As far as workplace exposure, it is important to know to never recap any needles. There should always go directly in the sharps box after use. Make certain the sharps box is never over filled more than 2/3 full when disposing needles. Wear gloves at all times when an exposure to any blood or body fluid is a possibility. Use face masks, and eye protection if a fluid splash is possible. Prescription eye glasses will not be adequate protection. Do not expose your skin to soiled equipment or soiled linens. Use resuscitation barriers for Mouth to mouth contact in Cardio- Pulmonary Resuscitation.  

Terms To Be Familiar With  
     
Acquired Immunodeficiency Syndrome- AIDS… The severe manifestation of infection with the HIV Virus. The CDC lists a number of opportunistic infections and cancers that, in the presence of HIV infection. Constitutes an AIDS diagnosis. There are also instances of presumptive diagnoses when a person’s HIV status is unknown. This was especially true before 1985. Prior to 1985, the blood supply was not tested, and there was no antibody test available. In 1993, CDC expanded the criteria for an AIDS diagnosis to include CD4 and T cell counts at or below 200 cells per micro liter in the presence of HIV infection.

Acute HIV infection- The four to seven week period of rapid viral replication immediately following exposure. An estimated 30-60% of individuals with Primary HIV infection develop an acute syndrome characterized by fever, malaise, lymphadenopathy, pharyngitis, headache, myalgia, amd sometimes a skin rash. Following primary infection, seroconversion and broad HIV -1 specific immune response occur within 30 - 60 days.

AIDS Dementia Complex- (ADC) A degenerative neurological condition attributed to HIV infection, characterized by a group of clinical presentations including the loss of coordination. Mood swings, and loss of inhibitions, and wide spread common central nervous system complications of HIV infection.

AIDS related Complex- (ARC) A term that is used by some clinicians to describe a variety of symptoms found in some persons living with HIV.

Antibody- Molecule in the blood or secretions that tag, destroy, or neutralizes bacteria, viruses, or harmful toxins in the blood. Antibodies are a class of proteins known as immunoglobulins, which are produced and secreted by B-lymphocytes in response to stimulation by antigens. Antibodies are specific to invading organisms.

CD4+ Cells- A type of T helper cell that is involved in protecting the body against infection. Destruction of CD4 cells is the major cause of immunodeficiency seen in AIDS.

T-Cells- are white blood cells that are derived from the Thymus gland, that participates in a variety of cell mediated immune reactions. Three different types of T cells exist, Helper T’s, Killer T’s, and Suppressor T’s..  They are the body’s  “border police” responsible for finding infected or cancerous cells.      

Treatment and Medical Management
     Currently, there is no cure for HIV or AIDS.  There are a variety of medications that will slow down the reproduction phase of the cells. Normally treatment modality will consist of a combination of several types of antiretroviral drugs. The treatment outcome will largely depend upon the compliance of the patient taking these drugs as prescribed. There are many side effects that are often worse than the symptoms, and compliance is a big issue with many HIV positive patients.
     Currently some drugs being used include AZT, Dapsone, DDC, DDI, Pentamidine, Saquinavir, to mention a few.
AZT- Azidothymidine, also known as retrovir or zidovudine. The first antiretroviral drug against HIV infection to be introduced by The FDA in 1987. It is a thymidine analog that suppresses replication of HIV virus.
Dapsone- An approved oral antibiotic of the sulfone class used to treat and as prophylaxis of PCP and toxoplasmosis.
DDC-  Dideoxycytidine, is a nucleoside analog drug that inhibits the replication of HIV. FDA approved treatment selected for patients with advanced HIV disease.
DDI - Dideoxyinosine, is a nucleoside analog drug that inhibits the replication of HIV. Also prescribed for patients with advanced HIV disease.
Pentamidine- An approved antiprotozoal drug used for the treatment and prevention of PCP. ( pneumocystis Carinii Pneumonia)
Saquinavir- A peptide based, protease inhibitor. FDA approved for combination use with nucleoside analogs for treatment of advanced HIV infection.
   Ethical Concerns

     The main concern is that the patient requires emotional and psychological support. It is no longer important how he became infected, but how to deal with the disease process at this point. There are laws set in place that protects the patients right to privacy. Consent forms must be obtained in advance before any testing may be done. Only a Doctor or a specially trained individual can deliver test results. They may never be given by phone or in the mail. The individual must undergo pre and post counseling when being tested.  





Standard Precautions

The best way as stated by the CDC, is to avoid contracting HIV and developing AIDS, you should follow strict CDC guidelines and standard precautions. The rule of thumb is, “Treat all people as if they have HIV, when providing care” therefore, the use of gloves and personal protective equipment is essential in preventing the spread of HIV. Handwashing is critical, use of vinyl or latex gloves is also essential when in contact with any blood or body fluid.

References
Center for Disease Control
www.cdc.gov

AMJ
www.amj.org

MMWR

National Aids Clearinghouse
www.fda.gov