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HIV/AIDS Elaine Kauschinger PhD, MS, ARNP, FNP-BC Assistant Professor of ClinicalLead Faculty, Family Nurse Practitioner Program University of Miami School of Nursing & Health Studies
Objectives Discuss the epidemiology of HIV/AIDS at the international, national and state level Describe HIV-infected patients in terms of age, gender, ethnicity, and sexual orientation Discuss modes of transmission of HIV Identify clinical management and treatment Discuss counseling and testing Describe prevention & infection control Identify risk factors associated with occupational exposure 2
License Requirements FS381.004.5 1 hour on HIV/AIDS CE requirement to be completed prior to the first renewal Part 1: Epidemiology & transmission Part 2: Counseling & Testing Part 3: Clinical management & treatment Part 4: Prevention & infection control
10,000,000 Average progression without 800 treatment: 10 years from infection 1,000,000 to AIDS diagnosis 100,000 500 10,000 1,000 200 100 100 50 10 Months Years 0 CD4 CountHIV in plasma HIV in plasma (“viral load”) (cells/mL) (copies/mL) CD4 (T Cell) count Source: HRSA HIV/AIDS Bureau
HIV vs AIDS AIDS definition: • Mycobacterium • Candida TB Pulmonary MAC Esophageal • PML Not thrush • Recurrent pneumonia • PCP • Toxoplasmosis • Coccidiodomycosis – extrapulmonary • Wasting syndrome • Cervical cancer • CD4 < 200 or < 14% • CMV lymph • HIV encephalopathy • Cryptosporidium • Chronic HSV infections • Isospora • Kaposi’s sarcoma • Recurrent bacterial • Lymphoma infection • Recurrent pneumonia
History of HIV/AIDS History of HIV/AIDS epidemic in the U.S. is very recent. June 1981: the first description of what would soon be referred to as AIDS appeared in the Center for Disease Control’s (CDC) Morbidity and Mortality Weekly Report. • Florida reported its first AIDS case in 1981
Initial Reports June 5, 1981: 5 cases of PCP in gay men from UCLA (MMWR) July 3, 1981: 26 additional cases Dec 10, 1981: 3 NEJM papers describe cases 9 Gottlieb MS NEJM 2001;344:1788-91
Introduction CDC (2009) estimates 1.2 million people in the United States (US) are living with HIV infection. • About 33 million people living with HIV worldwide One in five (20%) of those people are unaware of their infection. Despite increases in the total number of people in the US living with HIV infection in recent years, the annual number of new HIV infections has remained relatively stable. • New infections continue at far too high of a level, with approximately 50,000 Americans becoming infected with HIV each year.
E. W. Europe Europe/C. N. America E. Asia/Pacific 570,000 Asia 1.2 ~1 million 1.2 million million Caribbean N. Africa & 440,000 Middle SE Asia East 500,000 6.0 million Latin/South Sub-Saharan America Africa Australia 1.5 million 15,000 29.5 million Total: >40 million21