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Hepatitis & HIV/AIDS

Hepatitis & HIV/AIDS. Hepatitis. CDC, 2012. HIV. Human Immunodeficiency Virus = The cause of AIDS AIDS = the end-stage of HIV disease. In what year were the first cases of AIDS reported? A: 1971 B: 1981 C: 1991 D: 2001. HIV. About 30-40 million people worldwide are living with HIV

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Hepatitis & HIV/AIDS

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  1. Hepatitis & HIV/AIDS

  2. Hepatitis CDC, 2012

  3. HIV • Human Immunodeficiency Virus = The cause of AIDS • AIDS = the end-stage of HIV disease

  4. In what year were the first cases of AIDS reported? • A: 1971 • B: 1981 • C: 1991 • D: 2001

  5. HIV • About 30-40 million people worldwide are living with HIV • How many of those live in the US? • Approximately 1 million • Approximately 1 in 5 of them don’t know they have HIV

  6. More HIV • About 40,000 Americans become HIV-infected every year. • About 10% of new cases are already drug-resistant in US. • ½ of all new HIV infections in the US occur in people under 25 years of age. • 6th leading cause of death for ages 25-44 • Potential years of life lost

  7. HIV in Oregon

  8. HIV infection involves 2 elements: • 1: A virus • 2: Humans • Monkeys have SIV, not HIV

  9. Which of the following is NOT a way that a person can become infected with HIV? • A: Sharing a drinking glass • B: Unprotected sex • C: Injecting drug use • D: None of the above – they are all ways that a person could become infected with HIV.

  10. How is HIV most commonly spread? • Sexual Transmission = most common • Are all sexual behaviors equally risky? • What is meant by “having sex”? • Need to define: • Ex: President Clinton “I did not have sexual relations with that woman.” • Ex: “Sexually active”

  11. #2 reason for HIV spread • Sharing needles and syringes • Direct blood-to-blood transmission • Most efficient transmission • The drugs themselves do not transmit HIV • Ex: sharing steroid needles, tattoo, ear piercing

  12. Which drug is MOST involved in HIV transmission? • Alcohol • Sexual risks, sexual assaults and other risks while under the influence.

  13. Exposure to how many viruses are necessary to become infected with HIV? • Exposure to at least 1,000 HIVs are necessary for infection. • Immune system responds to HIV • Overexposure necessary • Ex: Ejaculate contains about 100 million sperm • “Low sperm count” = 20 million sperm

  14. Where are the most HIVs in a person infected with HIV? • Lymph nodes

  15. However, we are concerned with body fluids • Body fluids with the most risk have a high viral load • Not all body fluids have the same viral loads.

  16. What body fluid has the most HIV? • Blood, including menstrual blood • Ex: 2 billion HIVs in 1 pint of blood in person with end-stage AIDS • Viral load varies with disease stage • Note: “Non-detectable HIV” does not mean the person is disease free.

  17. What body fluid has the 2nd most HIV? • Semen • Including pre-seminal fluid (pre-cum) • High HIV levels in semen still possible even though “non-detectable” in blood

  18. What body fluid has the 3rd most HIV? • Vaginal fluid • Vaginal fluid can help prevent micro-tears in the vagina. • Micro-tears are portals on entry for HIV.

  19. What body fluid has the 4th most HIV? • Breast milk • 10-20% risk of HIV transmission to infant from breastfeeding IF mom not being treated. • Note: some areas of the world have such poor water quality that the death risk to the infant is greater with exposure to the water than to breast milk with HIV.

  20. Any other body fluids that carry HIV? • Saliva • Extremely small amounts of HIV in saliva • More HIV when blood is in the saliva • Blood-free saliva is a “theoretical risk” • Ex: At least 1 quart of saliva to get 1,000 HIVs • NO documented case from exposure to saliva only. • Tears • Would require approximately 2 quarts (64 oz) of tears directly into a body to get 1,000 HIVs • Theoretical risk only • No known HIV case ever acquired through tears.

  21. Is the skin an effective barrier? • YES • Skin-to-skin contact is NOT a risk for HIV. • No risk: handshake, hugs, kissing • Blood on outer skin does not seep in • What is the exception? • A fresh opening in the skin = portal of entry for HIV

  22. Portals of entry for viruses • Mucosal surfaces • (inner skin) • HIV may seep through: • Mouth, penis, vagina, anus, urethra, etc.

  23. General rule: No one else’s body fluids touches your mucosal surfaces unless you know her/his HIV status

  24. What mucosal surface can HIV enter the easist? • Anal Canal • Epithelium of the rectum is fragile and only 1-cell layer thick • Easily torn with penetration • Microtears are additional portals of entry for HIV • Irritated areas, hemorrhoids, HPV are all portals of entry for HIV

  25. Vagina is portal of entry for HIV • Epithelium of vagina is 7-cell layers thick

  26. Who is at higher risk to become infected with HIV during vaginal intercourse – the male or the female?

  27. Why? • 1) Vagina has larger mucosal area than penis • 2) Micro-tears during intercourse = portals of entry • 3) More HIV in semen than in vaginal fluids • 4) More semen exposure • 5) Women more likely to have unknown vaginal infection leading to irritated tissues, more T cells fighting infection • 6) Semen contains immuno-suppressant

  28. That said… Worldwide, most males who have HIV got it from vaginal intercourse

  29. #3 portal of entry • Penis • Urethra mucosal surface is portal of entry

  30. Mouth • A few cases of HIV transmission documented through oral sex – both performing and receiving • Ex: blood in the saliva or cuts/sores around mouth • Micro-abrasions increase risk: floss, brush, biting lips • Ex: monkeys transmit SIV through oral sex • Recommend condoms/barriers for oral and anal sex

  31. Given “dangerous” body fluids and “dangerous” mucosal skins, what is the MOST risky sexual behavior? • Anal intercourse • Which is more risky – penetrator or recipient? • Answer: Recipient of anal sex is MOST risky behavior for HIV

  32. There is a continuum for safer sex • “Unprotected sex is group sex” • “Safe sex” = outer skin-to-skin contact • One person must be HIV-infected before it can be transmitted through sex • Know the HIV-status of your partner • You can’t tell by looking • Be an agent of your own care

  33. Why don’t mosquitoes transmit HIV? • HIV is treated like food and digested along with the blood meal. • Even if it did, too few HIV to initiate an infection. • No documented HIV transmission after years of study • Mosquitoes bite more infants & old people • HIV rates are lowest in infants & old people

  34. “Yes, you can get HIV from mosquitoes if you have unprotected anal sex with a mosquito.” • Randy Shilts, “And the Band Played On”

  35. HIV Testing • According to the CDC, which of the following groups should get routinely tested for HIV during health/medical visits? • A: Anyone between 18 and 44 • B: Anyone between 13 and 64 • C: Just young people, between 15 and 24 • D: Only those at high risk regardless of age

  36. HIV testing • ELISA, confirmed with Western Blot • Positive P24 antigen test • Home tests • Recently approved

  37. Anything new? • The Affordable Care Act of 2010 • Reduce number of new infections • Increase access to care • Reduce HIV-related disparities • 2013 Budget • Estimated $28.4 billion for domestic and global HIV/AIDS activities

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