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Hiv aids part 1
- 1. HIV/AIDS Elaine Kauschinger PhD, MS, ARNP, FNP-BC Assistant Professor of Clinical Lead Faculty, Family Nurse Practitioner Program University of Miami School of Nursing & Health Studies
- 2. Objectives Discuss the epidemiology of HIV/AIDS at the international, national and state level Describe HIV-infected patients in terms of age, gender, ethnicity, and sexual orientation Discuss modes of transmission of HIV Identify clinical management and treatment Discuss counseling and testing Describe prevention & infection control Identify risk factors associated with occupational exposure 2
- 3. Florida License Requirements FS381.004.5 1 hour on HIV/AIDS CE requirement to be completed prior to the first renewal This HIV/AIDS presentation will be divided into 4 parts: Part 1: Epidemiology & transmission Part 2: Counseling & Testing Part 3: Clinical management & treatment Part 4: Prevention & infection control
- 4. HIV/AIDS: Part I Epidemiology & Transmission
- 5. HIV/AIDS: Basic Definitions Human Immune Deficiency Virus: HIV • Infected with HIV virus • Virus is a retrovirus – meaning that its genetic information is stored on a single-stranded RNA instead of the double-strand DNA found in most organisms Acquired Immune Deficiency Virus: AIDS • An incurable infectious viral disease that results in damage to the immune system in otherwise healthy people • Average progression, without treatment, from HIV infection to AIDS diagnosis is 10 years.
- 6. Basic Definitions Opportunistic Infections (OIs): • Infections by common microorganisms that usually do not cause problems in healthy individuals • OIs are the major health problems for AIDS patients CD4: • Type of lymphocyte (white blood cell) • Important part of the immune system • HIV most often infects CD4 cells to replicate the virus inside of these cells • HIV+ patients have their CD4 cells monitored routinely to gauge their progress.
- 7. HIV vs AIDS AIDS definition: Once an HIV • Mycobacterium patient receives a diagnosis of the following disorders, they TB receive a diagnosis of AIDS: Mycobacterium • Candida avium complex Pulmonary Esophageal • Progressive multifocal Not thrush leukoencephalopathy • Pneumocystis carinii • Recurrent pneumonia pneumonia (PCP) • Toxoplasmosis • Coccidiodomycosis – extrapulmonary • Wasting syndrome • Cervical cancer • CD4 < 200 or < 14% • Cytomgalovirus (CMV) lymph • HIV encephalopathy • Chronic Herpes Simples • Cryptosporidium Virus infections • Isospora • Kaposi’s sarcoma • Recurrent bacterial • Lymphoma infection • Recurrent pneumonia
- 8. History of HIV/AIDS History of HIV/AIDS epidemic in the U.S. is very recent. June 1981: the first description of what would soon be referred to as AIDS appeared in the Center for Disease Control’s (CDC) Morbidity and Mortality Weekly Report.
- 9. Initial Reports June 5, 1981: 5 cases of PCP in gay men from UCLA (MMWR) Gottlieb MS NEJM 2001;344:1788-91
- 10. Introduction CDC (2009) estimates 1.2 million people in the United States (US) are living with HIV infection. • About 33 million people living with HIV worldwide One in five (20%) of those people are unaware of their infection. Despite increases in the total number of people in the US living with HIV infection in recent years, the annual number of new HIV infections has remained relatively stable. • New infections continue at far too high of a level, with approximately 50,000 Americans becoming infected with HIV each year.
- 16. HIV/AIDS Total: >40 million E. W. Europe Europe/C. N. America E. Asia/Pacific 570,000 Asia 1.2 ~1 million 1.2 million million Caribbean N. Africa & 440,000 Middle SE Asia East 500,000 6.0 million Latin/South Sub-Saharan America Africa Australia 1.5 million 15,000 29.5 million 16
- 17. Modes of Transmission Sexual Perinatal • Intrapartum • Labor & Delivery • Breastfeeding Blood • IV drug use (IVDU) • Occupational exposure Healthcare workers infected in the work environment due to accidental exposure • Transfusion & blood products
- 18. Prevention of Transmission Avoidance of direct contact with sexual fluids Abstinence Safer sex & condom use Infection control practices Safer blood supply Mother-to-child (MTC) IVDU
- 19. Please continue to part 2
Notes de l'éditeur
- Epidemiology of HIV Infection through 2009
- From 2006 through 2009 the number of diagnoses of HIV infection among adults and adolescents remained stable in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006. In 2009, an estimated 42,793 adults and adolescents were diagnosed with HIV infection; of these, 76% of diagnoses were among males and 24% were among females. The estimated number of diagnoses of HIV infection among males increased 5% from 2006-2009. The estimated number among female adults and adolescents decreased 9% from 2006-2009. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting.
- In 2009, among adult and adolescent males diagnosed with HIV infection in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006, an estimated 74% of infections were attributed to male-to-male sexual contact and 8% were attributed to injection drug use. Approximately 14% of diagnosed infections were attributed to heterosexual contact and 4% attributed to male-to-male sexual contact and injection drug use. Most (85%) diagnosed HIV infections among adult and adolescent females were attributed to heterosexual contact, and 15% were attributed to injection drug use. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Heterosexual contact is with a person known to have or to be at high risk for HIV infection.
- In 2009, among the 32,538 adult and adolescent males diagnosed with HIV infection in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006, 46% were black/African American, 31% were white and 20% were Hispanic/Latino. Approximately 1% of diagnoses among males were Asian and males reporting multiple races, and less than 1% each was American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. Among the 10,255 adult and adolescent females diagnosed with HIV infection in 2009, 65% were black/African American, 17% were white and 16% were Hispanic/Latino. Approximately 1% of diagnoses were among Asians and females reporting multiple races, and less than 1% each was among American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Hispanics/Latinos can be of any race.
- The distribution of AIDS diagnoses by transmission category has shifted since the beginning of the epidemic. In 1985, male-to-male sexual contact accounted for an estimated 65% of all AIDS diagnoses; this proportion reached its lowest point in 1999 at 40% of diagnoses. Since then, the percentage of AIDS diagnoses attributed to male-to-male sexual contact has increased and in 2009 this transmission category accounted for 49% of all AIDS diagnoses. The estimated percentage of AIDS diagnoses attributed to injection drug use increased from 20% to 32% during 1985–1993 and decreased since that time accounting for 15% of diagnoses in 2009. The estimated percentage of AIDS diagnoses attributed to male-to-male sexual contact and injection drug use decreased from 9% in 1985 to 5% in 2009. The estimated percentage of AIDS diagnoses attributed to heterosexual contact increased from 3% in 1985 to 31% in 2009. The remaining AIDS diagnoses were those attributed to hemophilia or the receipt of blood or blood products and those in persons without an identified risk factor. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information, but not for incomplete reporting. Heterosexual contact is with a person known to have, or to be at high risk for, HIV infection.
- ABCs of prevention: A = abstinence, B = be faithful, C = use condoms (correctly & cosistently)