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Spectrum of HIV Disease

Spectrum of HIV Disease. ACUTE STAGE Flu like symptoms – 1 to 2 weeks ASYMPTOMATIC PERIOD No physical symptoms – 8 to 11 years HIV ILLNESS Night sweats, fatigue, diarrhea, fever, yeast infections, swollen lymph nodes AIDS Opportunistic Infections, CD4<200. 1. HIV TEST.

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Spectrum of HIV Disease

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  1. Spectrum of HIV Disease ACUTE STAGE Flu like symptoms – 1 to 2 weeks ASYMPTOMATIC PERIOD No physical symptoms – 8 to 11 years HIV ILLNESS Night sweats, fatigue, diarrhea, fever, yeast infections, swollen lymph nodes AIDS Opportunistic Infections, CD4<200 1

  2. HIV TEST HIV Antibody test Looks for antibodies Accuracy of the test 99.9% Types of tests Standard test – results will be known in 1 week Rapid test – results will be known in 20 minutes Test settings Anonymous Confidential 2

  3. HIV Diagnosis (Testing) Antibody tests EIA (or ELISA) Western Blot Rapid Tests OraQuick Advance * Unigold * Clearview Stat Pak & Stat Pak Complete * * These tests are “waived” under CLIA

  4. HIV Diagnosis (Testing) Other tests p24 antigen test Viral load tests Proviral DNA PCR RNA Home kits

  5. HIV TEST Informed Consent 12 yrs of age or older Benefits of Testing…….. Where to test? Private medical doctor County clinic Community-based organizations www.hivla.org 5

  6. California’s “Willful Exposure” Law (1998)/aka “Recalcitrant Behavior”: Willfully exposing another to HIV through unprotected sex • 8 years of imprisonment • Intention to infect others with HIV through sex To be prosecuted under the law, one would have to do ALL of the following: • Have anal or vaginal sex • Know that they are HIV + • Fail to disclose their HIV status • Fail to use a condom • Have a specific intent to infect another person Actual knowledge of HIV infection without more evidence of “specific intent” is insufficient for prosecution. 6

  7. CONFIDENTIALITY LAWS • Disclosing a person’s HIV+ status to a third party without the individual’s specific signed consent, is illegal; • Penalties and damages for unauthorized disclosure of HIV status is a $5,000-$10,000 fine and/or jail sentence. 7

  8. FEDERAL ANTI-DISCRIMINATION LAWS Rehabilitation Act of 1973 and American with Disabilities Act (ADA) 1990 Prohibits discrimination against a person with a disability, including HIV disease or AIDS. infection. infection. This prohibits discrimination with regards to employment, public services, public accommodations, and medical care. Housing Discrimination Care Discrimination A doctor or dentist cannot refuse to treat an HIV+ person California Anti-Discrimination Laws Fair Employment and Housing Act (FEHA) and Unruh Civil Rights Act 8

  9. PREVENTION “It is not who we are but what we do that puts us at risk for HIV infection” • Abstinence • Safer Sex Male Condom (Activity) Female Condom Dental Dams • Needle use Not Sharing Needles Cleaning Needles (3x3x3 Method) Needle Exchange • Harm reduction 9

  10. PREVENTION Universal Precautions “Infection control measures that reduce the risk of transmission of blood-born germs from patients to health care workers” • Wash hands thoroughly • Wear latex gloves • Use masks and eye protection • Wear a gown • Carefully handling and disposing of sharp instruments during and after use. 10

  11. PREVENTION POST–EXPOSURE PROPHYLAXIS (PEP) Exposure to HIV within the prior 72 hours Approve for 13 yrs of age or older For more information call 213-351-7699 PRE-EXPOSURE PROPHYLAXIS (PREP) It refers to anti-HIV medication used daily or before sexual encounters Start prior to potential exposure Prep should never be seen as the first line of defense against HIV BREAST FEEDING It is recommended that HIV+ women do not breastfeed Infants. 11

  12. TREATMENT Goals of HIV/AIDS treatment; • Reduce HIV-related morbidity and prolong survival, • Improve quality of life, • Restore the immune system, • Suppress the viral load, and • Prevent vertical HIV transmission (mother to child). 12

  13. TREATMENT • What are Anti-retrovirals (ARVs) ? Drugs that interrupt HIV replication & preserve immune system. • When to start ARVs?: • There are severe symptoms of HIV infection or diagnosis of AIDS with a CD4 count of < 350 cells/mm3 • Patient has CD4 count less than 500 /mm3 • Recommended for pregnant women who otherwise do not meet criteria to halt vertical transmission • Regardless of CD4 count, treatment is recommended for all pregnant patients, and patients with HIV-associated nephropathy (a kidney disorder) or those who need treatment for hepatitis B. • Treatment is considered optional for patients with CD4 counts over 500. 13

  14. Current classes of Anti-HIV medications • Nucleoside Reverse Transcriptase Inhibitors (NRTIs) • Non-Nucleoside Reverse Transcriptase Inhibitors (NRTIs) • Protease Inhibitors • Entry inhibitors • Fusion inhibitors • Integrase inhibitors 14

  15. Who Pays For Treatment? • HMO insurance • Medi-Cal • Medicare Part D • ADAP • Shared cost 15

  16. Recent Advancements • Immune based therapies • Maturation inhibitors • Multi-class Combination Products • Gene Therapy • Vaccine 16

  17. Treatment as Prevention • Science Magazine named 'HIV Treatment as Prevention' as the breakthrough of 2011 • The HIV Prevention Trials Network (HPTN) 052 study of 1,700 sero-discordant couples reported that ARVs reduced the risk of heterosexual transmission by 96%. 17

  18. Complementary Therapy • General Health Maintenance • Psychological Well-Being • Spiritual Well-Being • Social Well-Being 18

  19. For More Information Contact • Jason Dawson, MPH jdawson@ph.lacounty.gov 213-351-8043

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