HIV/AIDS North Dakota Department of Health HIV/AIDS Program
<ul><li>H Human </li></ul><ul><li>I Immunodeficiency </li></ul><ul><li>V Virus </li></ul>
<ul><li>A   Acquired </li></ul><ul><li>  I Immuno </li></ul><ul><li>D   Deficiency </li></ul><ul><li>  S  Syndrome </li></ul>
HIV Transmission <ul><li>HIV enters the bloodstream through: </li></ul><ul><ul><li>Open Cuts </li></ul></ul><ul><ul><li>Br...
HIV Transmission <ul><li>Common fluids that are a means of transmission: </li></ul><ul><ul><li>Blood </li></ul></ul><ul><u...
HIV in Body Fluids Semen 11,000 Vaginal  Fluid 7,000 Blood 18,000 Amniotic  Fluid 4,000 Saliva 1 Average number of HIV par...
Routes of Transmission of HIV <ul><li>Sexual Contact: Male-to-male </li></ul><ul><li>Male-to-female or vice versa </li></u...
HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus
Window Period <ul><li>This is the period of time after becoming infected when an HIV test is negative </li></ul><ul><li>90...
HIV Infection and Antibody Response Infection Occurs AIDS Symptoms ---Initial Stage---- ---------------Intermediate or Lat...
Importance of Early Testing  and Diagnosis <ul><li>Allows for early treatment to maintain and stabilize the immune system ...
HIV Testing   <ul><li>Requires a blood or oral fluid sample </li></ul><ul><li>HIV test detects the body’s antibody respons...
HIV Testing in North Dakota <ul><li>Confidential vs. anonymous testing </li></ul><ul><li>Testing offered free-of-charge at...
HIV Testing <ul><li>Those recently exposed should be retested at least six months after their last exposure </li></ul><ul>...
EIA/ELISA Test Positive Negative Run IFA Confirmation Repeat Positive Positive End Testing Repeat ELISA Every 3 months for...
North Dakota Law  for HIV Testing <ul><li>Requires informed consent </li></ul><ul><li>No premarital testing requirement </...
North Dakota Law  for HIV Testing (cont.) <ul><li>Allows testing of individuals: </li></ul><ul><ul><li>14 years of age or ...
  <ul><li>Once a person is infected they are always infected </li></ul><ul><li>Medications are available to prolong life b...
HIV Risk Reduction <ul><li>Avoid unprotected sexual contact   </li></ul><ul><li>Use barriers such as condoms and dental da...
HIV Risk Reduction <ul><li>Avoid drug and alcohol use to maintain good judgment </li></ul><ul><li>Don’t share needles used...
Condoms <ul><li>Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections i...
Condom Use <ul><li>Should be used consistently and correctly </li></ul><ul><li>Should be either latex or polyurethane </li...
People Infected with HIV <ul><li>Can look healthy </li></ul><ul><li>Can be unaware of their infection </li></ul><ul><li>Ca...
HIV Exposure and Infection <ul><li>Some people have had multiple exposures without becoming infected </li></ul><ul><li>Som...
<ul><li>“ When you have sex with someone, you are having sex with everyone they have had sex with for the last ten years.”...
HIV and Sexually Transmitted Diseases
HIV and Sexually  Transmitted Diseases <ul><li>STDs increase infectivity of HIV </li></ul><ul><ul><li>A person co-infected...
HIV and Sexually  Transmitted Diseases <ul><li>STDs increase the susceptibility to HIV </li></ul><ul><ul><li>Ulcerative an...
HIV and Sexually  Transmitted Diseases <ul><li>The effect of HIV infection on the immune system increases the the risk of ...
HIV Post Exposure Prophylaxis
HIV Occupational Exposure <ul><li>Review facility policy and report the incident </li></ul><ul><li>Medical follow-up is ne...
HIV Non-Occupational Exposure   <ul><li>No data exists on the efficacy of antiretroviral medication after non-occupational...
HIV Non-Occupational Exposure <ul><li>Provider Considerations: </li></ul><ul><ul><li>Evaluate HIV status of patient and ri...
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HIV-AIDS

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HIV-AIDS

  1. 1. HIV/AIDS North Dakota Department of Health HIV/AIDS Program
  2. 2. <ul><li>H Human </li></ul><ul><li>I Immunodeficiency </li></ul><ul><li>V Virus </li></ul>
  3. 3. <ul><li>A Acquired </li></ul><ul><li> I Immuno </li></ul><ul><li>D Deficiency </li></ul><ul><li> S Syndrome </li></ul>
  4. 4. HIV Transmission <ul><li>HIV enters the bloodstream through: </li></ul><ul><ul><li>Open Cuts </li></ul></ul><ul><ul><li>Breaks in the skin </li></ul></ul><ul><ul><li>Mucous membranes </li></ul></ul><ul><ul><li>Direct injection </li></ul></ul>
  5. 5. HIV Transmission <ul><li>Common fluids that are a means of transmission: </li></ul><ul><ul><li>Blood </li></ul></ul><ul><ul><li>Semen </li></ul></ul><ul><ul><li>Vaginal Secretions </li></ul></ul><ul><ul><li>Breast Milk </li></ul></ul>
  6. 6. HIV in Body Fluids Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids
  7. 7. Routes of Transmission of HIV <ul><li>Sexual Contact: Male-to-male </li></ul><ul><li>Male-to-female or vice versa </li></ul><ul><li>Female-to-female </li></ul><ul><li>Blood Exposure: Injecting drug use/needle sharing </li></ul><ul><li> Occupational exposure </li></ul><ul><li> Transfusion of blood products </li></ul><ul><li>Perinatal: Transmission from mom to baby </li></ul><ul><li>Breastfeeding </li></ul>
  8. 8. HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus
  9. 9. Window Period <ul><li>This is the period of time after becoming infected when an HIV test is negative </li></ul><ul><li>90 percent of cases test positive within three months of exposure </li></ul><ul><li>10 percent of cases test positive within three to six months of exposure </li></ul>
  10. 10. HIV Infection and Antibody Response Infection Occurs AIDS Symptoms ---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage--- Flu-like Symptoms Or No Symptoms Symptom-free < ---- ----
  11. 11. Importance of Early Testing and Diagnosis <ul><li>Allows for early treatment to maintain and stabilize the immune system response </li></ul><ul><li>Decreases risk of HIV transmission from mother to newborn baby </li></ul><ul><li>Allows for risk reduction education to reduce or eliminate high-risk behavior </li></ul>
  12. 12. HIV Testing <ul><li>Requires a blood or oral fluid sample </li></ul><ul><li>HIV test detects the body’s antibody response to HIV infection </li></ul><ul><li>The test does NOT detect the HIV virus </li></ul>
  13. 13. HIV Testing in North Dakota <ul><li>Confidential vs. anonymous testing </li></ul><ul><li>Testing offered free-of-charge at state-funded HIV test sites for those at risk </li></ul><ul><li>Test results are available within a week </li></ul><ul><li>For a list of HIV test sites in North Dakota call 1.800.70.ndhiv or visit www.ndhiv.com </li></ul>
  14. 14. HIV Testing <ul><li>Those recently exposed should be retested at least six months after their last exposure </li></ul><ul><li>Screening test (EIA/ELISA) vs. confirmatory test (IFA) </li></ul><ul><li> EIA/ELISA (Reactive) </li></ul><ul><ul><li>Repeat EIA/ELISA (Reactive) </li></ul></ul><ul><ul><li>IFA (Reactive) </li></ul></ul><ul><ul><li>Positive for HIV </li></ul></ul>
  15. 15. EIA/ELISA Test Positive Negative Run IFA Confirmation Repeat Positive Positive End Testing Repeat ELISA Every 3 months for 1 year Negative Positive Negative Indeterminate Repeat at 2-4 months Repeat at 3 weeks HIV Testing No HIV Exposure Low Risk HIV Exposure High Risk Negative HIV + Repeat every 6 months for continued High risk behavior
  16. 16. North Dakota Law for HIV Testing <ul><li>Requires informed consent </li></ul><ul><li>No premarital testing requirement </li></ul><ul><li>Prenatal testing not required but recommended </li></ul><ul><li>School notification not required for positive staff or students (universal precautions) </li></ul>
  17. 17. North Dakota Law for HIV Testing (cont.) <ul><li>Allows testing of individuals: </li></ul><ul><ul><li>14 years of age or older without parental consent </li></ul></ul><ul><ul><li>Mandatory testing for prison inmates in grade 1, grade 2, regional facilities, and the state penitentiary as defined in NDCC:23-07-07.5 </li></ul></ul><ul><ul><li>Court ordered testing for defendants charged with a sex offense as defined in NDCC: 23-07.7-01 </li></ul></ul>
  18. 18. <ul><li>Once a person is infected they are always infected </li></ul><ul><li>Medications are available to prolong life but they do not cure the disease </li></ul><ul><li>Those who are infected are capable of infecting others without having symptoms or knowing of the infection </li></ul>HIV AIDS
  19. 19. HIV Risk Reduction <ul><li>Avoid unprotected sexual contact </li></ul><ul><li>Use barriers such as condoms and dental dams </li></ul><ul><li>Limit multiple partners by maintaining a long-term relationship with one person </li></ul><ul><li>Talk to your partner about being tested before you begin a sexual relationship </li></ul>
  20. 20. HIV Risk Reduction <ul><li>Avoid drug and alcohol use to maintain good judgment </li></ul><ul><li>Don’t share needles used by others for: </li></ul><ul><ul><ul><li>Drugs </li></ul></ul></ul><ul><ul><li>Tattoos </li></ul></ul><ul><ul><li>Body piercing </li></ul></ul><ul><li>Avoid exposure to blood products </li></ul>
  21. 21. Condoms <ul><li>Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV </li></ul><ul><li>Condoms = Safer sex </li></ul><ul><li>Condoms ≠ Safe sex </li></ul>
  22. 22. Condom Use <ul><li>Should be used consistently and correctly </li></ul><ul><li>Should be either latex or polyurethane </li></ul><ul><li>Should be discussed with your partner before the sexual act begins </li></ul><ul><li>Should be the responsibility of both partners for the protection of both partners </li></ul><ul><li>Male and female condoms are available </li></ul>
  23. 23. People Infected with HIV <ul><li>Can look healthy </li></ul><ul><li>Can be unaware of their infection </li></ul><ul><li>Can live long productive lives when their HIV infection is managed </li></ul><ul><li>Can infect people when they engage in high-risk behavior </li></ul>
  24. 24. HIV Exposure and Infection <ul><li>Some people have had multiple exposures without becoming infected </li></ul><ul><li>Some people have been exposed one time and become infected </li></ul>
  25. 25. <ul><li>“ When you have sex with someone, you are having sex with everyone they have had sex with for the last ten years.” </li></ul><ul><ul><ul><li>Former Surgeon General </li></ul></ul></ul><ul><li>C. Everett Koop </li></ul>
  26. 26. HIV and Sexually Transmitted Diseases
  27. 27. HIV and Sexually Transmitted Diseases <ul><li>STDs increase infectivity of HIV </li></ul><ul><ul><li>A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding </li></ul></ul><ul><ul><li>More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection </li></ul></ul>
  28. 28. HIV and Sexually Transmitted Diseases <ul><li>STDs increase the susceptibility to HIV </li></ul><ul><ul><li>Ulcerative and inflammatory STDs compromise the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV </li></ul></ul><ul><ul><li>Ulcerative STDs include: syphilis, chancroid, and genital herpes </li></ul></ul><ul><ul><li>Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis </li></ul></ul>
  29. 29. HIV and Sexually Transmitted Diseases <ul><li>The effect of HIV infection on the immune system increases the the risk of STDs </li></ul><ul><ul><li>A suppressed immune response due to HIV can: </li></ul></ul><ul><ul><ul><li>I ncrease the reactivation of genital ulcers </li></ul></ul></ul><ul><ul><ul><li>Increase the rate of abnormal cell growth </li></ul></ul></ul><ul><ul><ul><li>Increase the difficulty in curing reactivated or newly acquired genital ulcers </li></ul></ul></ul><ul><ul><ul><li>Increase the risk of becoming infected with additional STDs </li></ul></ul></ul>
  30. 30. HIV Post Exposure Prophylaxis
  31. 31. HIV Occupational Exposure <ul><li>Review facility policy and report the incident </li></ul><ul><li>Medical follow-up is necessary to determine the exposure risk and course of treatment </li></ul><ul><li>Baseline and follow-up HIV testing </li></ul><ul><li>Four week course of medication initiated one to two hours after exposure </li></ul><ul><li>Liver function tests to monitor medication tolerance </li></ul><ul><li>Exposure precautions practiced </li></ul>
  32. 32. HIV Non-Occupational Exposure <ul><li>No data exists on the efficacy of antiretroviral medication after non-occupational exposures </li></ul><ul><li>The health care provider and patient may decide to use antiretroviral therapy after weighing the risks and benefits </li></ul><ul><li>Antiretrovirals should not be used for those with low-risk transmissions or exposures occurring more than 72 hours after exposure </li></ul>PREVENTION --- FIRST
  33. 33. HIV Non-Occupational Exposure <ul><li>Provider Considerations: </li></ul><ul><ul><li>Evaluate HIV status of patient and risk history of source patient </li></ul></ul><ul><ul><li>Provide necessary medical care and counseling </li></ul></ul><ul><ul><li>Evaluate risk event and factors for exposure </li></ul></ul><ul><ul><li>Determine elapsed time from exposure </li></ul></ul><ul><ul><li>Evaluate potential for continuous HIV exposure </li></ul></ul><ul><ul><li>Obtain informed consent for testing and treatment </li></ul></ul><ul><ul><li>Evaluate pregnancy status of females </li></ul></ul><ul><ul><li>Monitor for drug toxicity and acute infection </li></ul></ul>

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