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Wednesday, October 10, 2007

Nursing Reference: HIV-AIDS

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Nursing Reference: HIV-AIDS Slide Transcript
Slide 1: HIV/AIDS North Dakota Department of Health HIV/AIDS Program

Slide 2: H Human I Immunodeficiency V Virus

Slide 3: A Acquired I Immuno D Deficiency S Syndrome

Slide 4: HIV Transmission HIV enters the bloodstream through: Open Cuts  Breaks in the skin  Mucous membranes  Direct injection 

Slide 5: HIV Transmission Common fluids that are a means of transmission: Blood  Semen  Vaginal Secretions  Breast Milk 

Slide 6: HIV in Body Fluids Blood Semen 18,000 Vaginal 11,000 Fluid Amniotic 7,000 Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids

Slide 7: Routes of Transmission of HIV Sexual Contact: Male-to-male Male-to-female or vice versa Female-to-female Blood Exposure: Injecting drug use/needle sharing Occupational exposure Transfusion of blood products Perinatal: Transmission from mom to baby Breastfeeding

Slide 8: HIV-Infected T-Cell New HIV HIV Infected HIV T-Cell Virus T-Cell Virus

Slide 9: 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

Slide 10: HIV Infection and Antibody Response ---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage--- Flu-like Symptoms Or Symptom-free AIDS Symptoms No Symptoms ---- Virus Infection Occurs Antibody ---- < 6 month ~ Years ~ Years ~ Years ~ Years

Slide 11: 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

Slide 12: HIV Testing Requires a blood or oral fluid sample HIV test detects the body’s antibody response to HIV infection The test does NOT detect the HIV virus

Slide 13: HIV Testing in North Dakota Confidential vs. anonymous testing Testing offered free-of-charge at state- funded HIV test sites for those at risk Test results are available within a week For a list of HIV test sites in North Dakota call 1.800.70.ndhiv or visit www.ndhiv.com

Slide 14: 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

Slide 15: HIV Testing EIA/ELISA Test Positive Negative No HIV Exposure HIV Exposure Repeat Low Risk High Risk Positive Repeat ELISA Negative Run IFA Positive Every 3 months Confirmation for 1 year Repeat every 6 months for continued Indeterminate Negative Positive High risk behavior Repeat at Repeat at End Testing Negative 3 weeks 2-4 months HIV +

Slide 16: North Dakota 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)

Slide 17: North Dakota 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

Slide 18: 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

Slide 19: 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

Slide 20: HIV Risk Reduction Avoid drug and alcohol use to maintain good judgment Don’t share needles used by others for: Drugs Tattoos Body piercing • Avoid exposure to blood products

Slide 21: Condoms Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV Condoms = Safer sex Condoms ≠ Safe sex

Slide 22: 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

Slide 23: 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

Slide 24: HIV Exposure and Infection Some people have had multiple exposures without becoming infected Some people have been exposed one time and become infected

Slide 25: “When you have sex with someone, you are having sex with everyone they have had sex with for the last ten years.” Former Surgeon General C. Everett Koop

Slide 26: HIV and Sexually Transmitted Diseases

Slide 27: HIV and Sexually Transmitted Diseases STDs increase infectivity of HIV A person co-infected with an STD 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

Slide 28: 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

Slide 29: 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

Slide 30: HIV Post Exposure Prophylaxis

Slide 31: 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

Slide 32: 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 low-risk transmissions or exposures occurring more than 72 hours after exposure

Slide 33: 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 





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