In the history of the United States, there has never been a healthcare issue that has attracted more attention, struck more fear, nor caused more individuals to become isolated than HIV and AIDS. Since 1984, more than 120 movies and 48 documentaries have been made that focus on HIV and AIDS. Is it any wonder that so much emphasis has been placed on HIV/AIDS over the last 3 decades, when 78 million people have contracted HIV and close to 39 million have died of AIDS-related causes since the beginning of the pandemic…..
Education concerning HIV/AIDS for healthcare professionals is of vital importance. Knowing the modes of transmission of HIV will help keep the professionals interacting with the patients safe and provide the therapists the opportunity to assist the HIV/AIDS patients in maintaining a higher quality of life. Throughout this course we will discuss the origins of HIV and AIDS, how it can be contracted, opportunistic infections, U.S. and global statistics, testing methods for HIV, treatment and disease management, prevention techniques and procedures for accidental exposure for healthcare workers, the role of therapists in HIV/AIDS treatment, and the impact of the Affordable Care Act.
What is HIV/AIDs?
HIV stands for Human Immunodeficiency Virus…
H – human (Only humans can be infected by this virus)
I – immunodeficiency (HIV weakens the immune system)
V- virus (A virus can only reproduce itself by taking over a cell in the body of its host)
HIV is a virus that invades the human body just like those that include the common cold, except that HIV cannot be cured and eradicated from the body like other viruses. Unfortunately, once you have HIV, you always have HIV.
Symptoms of HIV infection can include:
Swollen Lymph Nodes
Cough or Shortness of Breath
The HIV virus can reside in the body for years and present no symptoms. AVERT (an international HIV and AIDS charity) reports that due to the lack of symptoms, 60% of young people infected with HIV are unaware they are infected and continue to spread the virus. These young people account for a majority of the new HIV infections. Over time the HIV virus attacks a key component of the immune system known as T-cells or CD4 cells. T-cells/CD4 cells are used by HIV to reproduce its own cells and then destroys these infection fighting organisms. At a point when the T-cells and CD4 cells can no longer fight off infections, the HIV virus has become AIDS. AIDS typically develops within 10 years if the HIV positive individual does not receive treatment. Symptoms of AIDS include:
White Spots/Lesions on Tongue or in Mouth
Cognitive Changes (including forgetfulness or confusion)
Once HIV has progressed to AIDS, the virus becomes life threatening due to the advanced interference with the immune system. AIDS completely devastates the immune system and the body can no longer fight off infections. These life threatening infections are known as “opportunistic infections” and we will discuss these in detail later in the course.
In the mid-90s before treatments were developed, a person could progress from HIV infection to full blown AIDS in just a matter of a few years. The AIDS.GOV website now reports that with treatment, HIV does not always progress to AIDS and most people in 2015 with proper treatment can have a full (normal) life expectancy.
Medical professionals define that a person is considered to have progressed to full blown AIDS when that person shows the following:
- One or more “Opportunistic Infections”
- A very low CD4 cell count, or
- Certain cancers
Where did HIV/AIDS Come From?
Through extensive research, scientists have identified a type of chimpanzee which resides in West Africa as the original mode of transmission to humans. The virus in the chimpanzee was named simian immunodeficiency or SIV. SIV mutated in humans after hunters killed the infected chimpanzees for food and came into contact with the infected blood.
After spreading across Africa and other parts of the world, we know that HIV existed in the US in at least the mid to late 1970s due to the illnesses that New York and Los Angeles physicians reported among men having sex with other men.
According to the AIDS Institute, AIDS or acquired immunodeficiency syndrome was the name that was given to describe the number of opportunistic infections by public health officials beginning in 1982. Surveillance or formal tracking of AIDS cases also began in the US in 1982. Then in 1983, the virus that causes AIDS was discovered and was first named by an international scientific committee. The virus was named HTLV-III/LAV which stood for human T-cell lymphotropic virus-type III/lymphadenopathy-associated virus. At a later time the name was changed to HIV or human immunodeficiency virus.
How is HIV Contracted?
HIV can be contracted through several different modes which include sexual relations with another person who is infected with HIV, intravenous drug use, exposure to contaminated blood, from mother to child during pregnancy, childbirth or breastfeeding. According to the Centers for Disease Control, in the US, HIV is mainly spread by having sex or sharing intravenous drug equipment with an HIV infected person.
Only specific fluids from a person infected with HIV can transmit the HIV virus including:
- Pre-seminal Fluid
- Rectal Fluids
- Vaginal Fluids
- Breast Milk
It is important to know that these fluids must come in contact with damaged tissue, sores, or a mucous membrane for contamination to occur. Mucous membranes are found in the vagina, the opening of the penis, the rectum and the mouth.
HIV cannot be spread through tears, sweat, feces or urine.
HIV that is spread through the blood can occur by:
- Sharing needles when injecting drugs
- Tattoos or body piercing with unsterilized needles
- Accidental needle sticks
- Blood transfusions
- Splashing blood in the eyes
Although HIV can be spread from mother to baby during pregnancy, birth or breastfeeding, it is much less common in recent years due to safety precautions. The same can be said for the transmission of HIV through needle sticks in health care workers. There has not been a case of HIV infection reported via a needle stick since 1999.
HIV and Opportunistic Infections
Opportunistic Infections, OIs, are considered to be those that seek out individuals with weakened immune systems, such as those with HIV/AIDS, and take advantage of that individual’s embattled immune system to cause devastating illnesses. The Centers for Disease Control report that “opportunistic infections” are the most common cause of death for individuals with HIV/AIDS. Individuals with a CD4 count that is below 200 cells/mm3 are at the most risk for developing OIs that are life-threatening. It is extremely important for HIV positive individuals to know the signs and symptoms of opportunistic infections. The AIDS government website maintains an extensive list of these signs, symptom prevention and management at http://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potential-related-health-problems/opportunistic-infections/
Listed below are 20 OIs that the CDC considers “AIDS-defining conditions” (regardless of the CD4 count, if an HIV positive individual has one or more of the opportunistic infections listed below, that person will be diagnosed with AIDS):
- Candidiasis of bronchi, trachea, esophagus, or lungs
- Invasive cervical cancer
- Cryptosporidiosis, chronic intestinal (greater than 1 month’s duration)
- Cytomegalovirus disease (particularly CMV retinitis)
- Encephalopathy, HIV-related
- Herpes simplex: chronic ulcer(s) (greater than 1 month’s duration); or bronchitis, pneumonitis, or esophagitis
- Isosporiasis, chronic intestinal (greater than 1 month’s duration)
- Kaposi’s sarcoma
- Lymphoma, multiple forms
- Mycobacterium avium complex
- Pneumocystis carinii pneumonia
- Pneumonia, recurrent
- Progressive multifocal leukoencephalopathy
- Salmonella septicemia, recurrent
- Toxoplasmosis of brain
- Wasting syndrome due to HIV
General Opportunistic Infection Information
The risk level for developing OIs can be decreased by participating in “antiretroviral therapy” which helps to maintain and increase the CD4 cell count.
Opportunistic infections are considered to be grouped into 2 different categories. One group is considered to be localized and only affect one part/area of the body. The second group of OIs are systemic/disseminated which means that these OIs spread to other parts of the body or bodily systems.
The Centers for Disease Control have issued CD4 levels at which HIV positive individuals may be susceptible to certain opportunistic infections:
CD4 count > 500 cells/mm3 – generally these levels are not at increased risk for OIs, but minor infections such as candida vaginitis or yeast infections may occur
CD4 count 500 to 200 cells/mm3:
- Candidiasis (thrush)
- (KS) Kaposi’s Sarcoma
CD4 count 200 to 100 cells/mm3:
- Pneumocystis Jirovecii
- Progressive Multifocal Leukoencephalopathy (PML)
CD4 count 100 to 50 cells/mm3:
- Cryptococcal Infection
CD4 count < 50 cells/mm3:
- Mycobaterium Aviam Complex (MAC)
*The above list is not all inclusive, but includes most frequently occurring conditions at these CD4 levels.
It is important to understand the far reaching impact of HIV and AIDS and in this section we will share statistics for several categories based on end of 2013 reporting.
The following numbers of infections were reported by region:
Sub-Saharan Africa – 24.7 million
Asia and Pacific – 4.8 million
Caribbean – 250,000
Latin America – 1.6 million
North Africa and Middle East – 230,000
Eastern Europe and Central Asia – 1.1 million
Western and Central Europe and North America – 2.3 million
Everyday more than 5,700 people contract HIV which is nearly 240 infections per hour.
In 2013, 1.5 million people died from HIV related causes.
At the end of 2013, 35 million people were living with HIV.
2.1 million were newly infected with HIV in 2013 and 240,000 were under the age of 15.
Only 12.9 million people living with HIV were receiving antiretroviral therapy in 2013 and only 1 in 4 children had access to antiretroviral therapy in 2013.
At the end of 2013, more than 1 million people were living with HIV in the US.
Of the 1.1 million living with AIDS in the US, 1/5th of those do not know they are infected.
1 in 4 new infections in the US are between the ages of 13 and 24.
African American women account for the majority of new AIDS cases in women – 64%.
The most severely affected group in the US are gay and bisexual men.