HIV/AIDS Training for Health Facility Employees

1. HIV/AIDS Training for Health Facility Employees Based on KNOW Curriculum from the Washington State Department of Health Edition 7- December 2014 revised and edited by Janee Moore MPH, Luke Syphard MPH, and David Heal MSW

2. Clinical Manifestations and Treatment Section Four

3. Stages of Untreated HIV Infection • Viral Transmission • Primary HIV Infection • Seroconversion • Asymptomatic HIV Infection • Symptomatic HIV Infection • AIDS

4. The Natural History of HIV Infection Stages • Viral Transmission • Initial infection of an HIV-positive person infecting another person • No symptoms • Primary HIV infection • First few weeks of HIV infection • High HIV viral load • Most common symptoms: fever, swollen glands in neck, armpits and/or groin, rash, fatigue, and sore throat

5. The Natural History of HIV Infection Stages • Seroconversion • Time period from infection to production of sufficient HIV antibodies for testing • Asymptomatic HIV infection • No signs or symptoms of HIV

6. The Natural History of HIV Infection Stages • Symptomatic HIV Infection • Person begins to have noticeable physical signs of HIV. Common symptoms include: • Persistent low grade fever • Pronounced weight loss not due to dieting • Persistent headaches • Diarrhea that lasts more than one month • Difficulty recovering from colds and the flu • Becoming sicker than normally would with other illnesses • Woman may have recurrent vaginal yeast infections • Thrush (a yeast infection) coating the mouth of tongue

7. The Natural History of HIV Infection Stages • AIDS • Diagnosis by HIV-specific blood tests, and/or physical condition • May appear healthy, but continue to be infectious without treatment • Over time, white blood count decreases and health worsens

8. How HIV Works in the Body • HIV affects: • The kind and number of blood cells • The amount of fat and muscle definition in the body • The structure and functioning of the brain • The normal functioning of the immune system • The body’s basic metabolism

9. How HIV Works in the Body • HIV infection can cause painful or uncomfortable conditions including: • Confusion or dementia • Diarrhea • Fatigue • Fever • Nausea or vomiting • Painful joints, muscles, or nerve pain • Difficulty with breathing • Urinary or fetal incontinence • Vision or hearing loss • Thrush (yeast infections in the mouth) • Chronic pneumonias, sinusitis, or bronchitis • Loss of muscle tissue and body weight

10. HIV in Children • Without drug treatment, children are susceptible to: • Developmental delay • Pneumocystis Carinii Pneumonia • Failure to thrive • Recurrent bacterial infections • Antiretroviral treatment reduces the chance of transmission from mother to child Source: https://www.cdc.gov/hiv/pdf/group/gender/pregnantwomen/cdc-hiv-pregnant-women.pdf. Accessed: July 16, 2018

11. HIV in Women • Research shows that receptive sex partners (including women) have a greater risk of getting HIV • HIV-positive women are at risk for gynecological problems including: • Pelvic inflammatory disease • Abscesses of the fallopian tubes and ovaries • Recurrent yeast infections Source: https://www.cdc.gov/hiv/pdf/group/gender/women/cdc-hiv-women.pdf. Accessed: July 15, 2018

12. Impact of New Drug Therapies on HIV Clinical Progression • History of HIV drug therapies • Limited HIV medications before 1996 • Today, highly active antiviral medications are highly effective, easier, and have less side effects • Reduction of death by AIDS in the U.S.

13. HIV Drug Therapy Use and Costs • Highly Active Antiviral Therapy • Works well for people by controlling viral load • Treatment expenses • HIV medicines can cost more than $1300 / month • Alternative therapy options • Vitamins • Massage • Herbs • Naturopathic remedies

14. Tuberculosis (TB) • Transmitted by airborne droplets with active TB bacteria through coughing, sneezing, or talking • Epidemiology of TB • Globally, 2 billion people infected • One of the leading killers of HIV-positive people Source: https://www.anokacounty.us/2935/Tuberculosis-TB. Accessed on July 14, 2018

15. Tuberculosis (TB) Symptoms and Treatment • Symptoms • No symptoms for the first 4-12 weeks • Cough, weight loss, and fever usually occurs within first two years • Treatment • Multidrug regimen lasting 6-12 months

16. Sexually Transmitted Disease / Infection • More than 25 infectious organisms transmitted through sexual activity • Bacterial, viral and other causes of STI: • Scabies: caused by mites • “Crabs”: pubic lice • Trichomoniasis: protozoa (tiny organisms) • Yeast infections: fungi • Pelvic inflammatory disease: gonorrhea or chlamydia

17. HIV and STI’s • STI’s increases the risk of HIV transmission because: • Breaks in skin can provide direct entry for HIV • Inflammation makes it easier for HIV to enter the body • HIV is often detected in discharge from genital ulcers • Sores can bleed easily and come in contact with tissues during sex • Inflammation increases HIV viral shedding/load in genital secretions

18. Prevention of STI’s • Get tested with your partner(s) • Avoid douching • Use condoms correctly • Get examined and treated if STI occurs • Notify sex partner whendiagnosed • Abstain from sex • Monogamous relationship • Discuss risk factors with partner(s) • Understand birth control doesn’t prevent infections Source: https://www.cdc.gov/nchhstp/newsroom/2013/sam-infographic-2013.html. Accessed on July 16, 2018

19. Hepatitis and HBV • What is Hepatitis? • Inflammation of liver caused many things, including viruses • What is Hepatitis B (HBV)? • Virus transmitted by blood and body fluids of infected person Source: https://www.lahey.org/departments_and_locations/departments/cancer_center/liver_cancer_center/ebsco_content/hepatitis_b.aspx. Accessed on July 13, 2018.

20. Prevention of HBV A comprehensive strategy to eliminate HBV transmission in the United States includes four components:

21. Risk Factors for HBV Infection • Sharing injection needles/syringes • Sexual intercourse with infected or multiple partners • Being a man and having sex with a man • Working where you may come in contact with blood / body fluids • Share personal care items (razors, toothbrushes) with infected person • Kidney dialysis • Born in a part of the world with high rate of HBV • Receive tattoo with improperly sanitized equipment

22. Symptoms of HBV • Loss of appetite • Fatigue • Abdominal pain • Jaundice (yellowing of the eyes and skin) • Joint pain • Malaise • Dark urine • Nausea or vomiting • Skin rashes

23. Hepatitis C (HCV) and HIV • What is Hepatitis C? • Liver disease caused by the hepatitis C virus (HCV) found in the blood of infected persons • Transmission of HCV • Sharing needles to inject drugs • Sex with multiple partners

24. Symptoms of HCV • Sometimes, few or no symptoms for decades • Symptoms appearing is a sign of advanced liver disease. Symptoms include: • Loss of appetite • Nausea • Vomiting • Abdominal pain • Fever • Muscle and joint pain • Jaundice • Dark-colored urine Source: http://www.hep-c-alert.org/tag/global-statistics. Accessed July 16, 2018

25. Prevention of HCV • Follow Universal/Standard precautions • Only get tattoos at legitimate businesses • Refrain from non-prescription drug use / sharing drug equipment • Do not share toothbrushes, razors, nail clippers, etc. • Cover sores/cuts on skin • Practice safe sex (condoms) • Women who want kids should discuss choices with a medical specialist • People with HCV should not donate blood, semen or body organs