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

4. Florida License Requirements
FS381.004.5
 1 hour on HIV/AIDS CE requirement
to be completed prior to the first
renewal of RN license
 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

5. HIV/AIDS: Part I
Epidemiology &
Transmission

6. 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.

7. 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

8. HIV vs AIDS
 AIDS definition: Once an HIV • Mycobacterium
patient receives a diagnosis of
the following disorders, they  Tuberculosis (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

9. 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

10. Initial Reports of HIV
 June 5, 1981: 5 cases of PCP
in gay men from UCLA
(MMWR)
Gottlieb MS NEJM 2001;344:1788-91

11. Introduction
 CDC (2009) estimates 1.7 million people in the
United States (US) are living with HIV infection.
• About 33.2 million people living with HIV worldwide
 About 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.

17. 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

18. 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

19. 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

20. Part 2: Counseling
& Testing

21. HIV
 2 types and subtypes
• HIV 1: predominant strain
• Subtype A: Europe, Mideast
• Subtype B: North America, Latin America, Asia
& Europe
• HIV 2
 HIV testing can now screen for both HIV 1 &
HIV 2
 First a serum (blood test) is performed
using the screening test – the ELISA. If this
is positive, a confirmatory test (Western
Blot) is then performed.

22. HIV
ELISA
If positive: confirm If negative: No
with Western Blot further testing

23. At Risk Populations
 Patients who are sexually active
 Homosexual and/or bisexual
 Pregnancy
 Commercial sex workers
 Newly diagnosed with tuberculosis
 Intravenous drug users
 Healthcare workers with exposure
via needle sticks or other
occupational exposure injuries

24. CDC Recommendations
 Clinicians should add screening for
HIV transmission risk behaviors and
sexually transmitted infections
(STI’s) as a part of routine medical
care for patients ages >13-65
• Prevention counseling not required
• Patient can opt-out of test
 Patients need to sign a form stating that
they do not want to have an HIV test

25. HIV Testing
 All pregnancies in the first & last
trimester
• In Florida, all pregnant patients need to
be offered an HIV test
 Once in a patient’s lifetime
 Repeat all high risk patients with
exposure with initial negative tests
within 3 months then at 6 months.
 Persistent high risk behavior

26. Counseling & testing
 Mandatory informed consent (Florida
Section 381.004)
• Positive results reports to health
department
 Name is reported to county health
department but anonymous testing is
available
 Super confidentiality
• Patients can receive results over phone
as well as during return office visit.

27. Part 3: Clinical Management of
HIV Infection

28. Life cycle of the HIV virus

29. Highly Active Antiretroviral Therapy
(HAART)
6 classes of HIV medications:
•All patients need to take a “cocktail” of 3
drugs.
1. Nucleoside/nucleotide analogs (“nukes”)
2. Nonnucleoside reverse transcriptase inhibitors
(NNRTI’s) (“non-nukes”)
3. Protease inhibitors (“PI’s”)
4. Fusion entry inhibitors
5. CCR5 Inhibitors

31. Treatment of HIV Patients
 The treatment of (HIV) infection has
improved steadily since the advent of
potent combination therapy in 1996
 As of 2012, the Panel on Antiretroviral
Guidelines for Adults and Adolescent
updated its recommendations on initiation
of medication in treatment-naive (never
received prior medication for HIV) patients.
• The Panel’s recommends ART is for all HIV-
infected individuals
• Effective treatment includes daily medication
that includes 3 classes of HIV medication

32. Treatment of HIV Patients
 In addition, initiation of ART is strongly
recommended for pregnant individuals,
HIV-associated nephropathy, hepatitis
B virus (HBV) co-infection and those
patients with a history of an AIDS-
defining illness
 The changes are primarily based on
increasing evidence showing the
harmful impact of ongoing HIV
replication on AIDS and non-AIDS
disease progression.

34. Part 4:Prevention &
Infection Control

35. Infection control practices
 Standard precautions
• Standard precautions are the basic level
of infection control that should be used
in the care of all patients all of the time.
• This includes the use of:
 Hand hygiene
 Gloves, gowns, masks, face shield, & eye
protection
 Patient care equipment
 1:10 bleach solution for accidental infectious
fluid/blood spills

36. Post Exposure Prophylaxis
 A bloodborne pathogen is a pathogenic
microorganisms that are transmitted via
human blood and cause disease in
humans.
 They include, but are not limited to, hepatitis B
virus, and human immunodeficiency virus.

37. What is the Occupational Safety
and Health Administration
(OSHA)?
 Created in 1970 to ensure a safe and
healthy workplace.
 In 1991 the Bloodborne Pathogen
standard was created.
 In 2001 the Needlestick Prevention Act
required employers to select safer
devices.
 All institutions are required to develop
and implement a bloodborne pathogen
exposure control plan.

38. Types of Bloodborne Pathogen
Exposures
 Needle stick
 injuries are wounds caused
by needles that accidentally
puncture the skin
 Sharps Injury
 scalpels
 Splash
 Cutaneous Exposure

39. Occupational Exposure
 Internationally, the number of HIV
infections among health care workers
due to needlestick & sharps injuries has
been estimated to be 1,000 cases
(range: 200–5,000) per year.
 The average risk for HIV transmission
after a percutaneous exposure to HIV-
infected blood has been estimated to
be approximately 0.3%

40. Exposure
 These situations require consideration of
treatment with HIV antiretroviral therapy:
• Post exposure prophylaxis (PEP)
 Average risk of HIV transmission following
percutaneous exposure to
• Infected blood: 0.3%
• Mucous membrane exposure: 0.09%
• After skin exposure: unknown
• Following exposure to fluids or tissues other
than blood: unknown
 Risk of transmission of hepatitis B virus after a
large bore needle stick is approximately 5% while
to hepatitis C virus is 1.8%

41. Post Exposure Management
 Clean exposed area with
bactericidal soap and water
 Apply first aid
 Supervisor Assistance – follow
instructions located in UM Student
Handbook (located on-line).
 Counseling to determine need for
post exposure prophylaxis (PEP)
 Initiation of PEP, as needed,
within 2 hrs

42. Post Exposure Management
Post Exposure drug
management dependent
upon severity of injury:
– Percutaneous
– Mucous membrane
– Skin

43. Resources
 National Clinicians’ Post-Exposure
Hotline (PEPLine): 888-448-4911
 Post-Exposure Prophylaxis Registry
for Health Care Workers: 888-737-
4448 (888-PEP-4HIV)
 CDC (for reporting HIV
seroconversion in health care
workers who received PEP): 404-
638-6425

44.  National Post-Exposure Prophylaxis
Hotline: 888-HIV-4911
 Florida/Caribbean AIDS Education &
Training Center: www.FCAETC.org