HIV/AIDS

1. HIV/AIDS North Dakota Department of Health HIV/AIDS Program

2. H Human I Immunodeficiency V Virus

3. A Acquired I Immuno D Deficiency S Syndrome

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

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

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

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

8. HIV-Infected T-Cell New HIV Virus HIV Infected T-Cell HIV Virus T-Cell

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

10. HIV Infection and Antibody Response ---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage--- Flu-like Symptoms Or No Symptoms Symptom-free AIDS Symptoms ---- Infection Occurs ---- <

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

26. HIV and Sexually Transmitted Diseases

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

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

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

30. HIV Post Exposure Prophylaxis

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

32. HIV Non-Occupational Exposure • 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 PREVENTION --- FIRST

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