community health lecture notes | Lecture notes Community Health

HIV 101 N4415: Community Health Nursing

Objectives

After attending this lecture, students will be able to discuss:

1. Epidemiology of HIV/AIDS.

Every 9 Minutes someone in the US is infected with HIV

HIV transmission in U.S.

-MSM-Men who have sex with men is a term used in CDC because iindicates behaviors that transmits HIV, rather than

self sexual identity.

-IDU-Injection Drug Users

Retrovirus-RNA. Goes into healthy cells changing RNA to DNA.

Sneaky. Not a death sentence.

Global pandemic driven by travel/migration, sex practices, drug use, war, economics. Pandemic related to economics

(prostitution)

Chronic infectious disease which can be controlled with effective treatment

Estimated Per-Act Risk for Acquisition of HIV by Exposure Route

- Estimates of per-act risk of acquisition of HIV are approximate and vary widely depending on the viral load of the source contact, the presence of

sexually transmitted diseases, and other factors.

-Blood transfusion-9,000

2. How HIV is and is not transmitted.

How do you get it?

Transmission of HIV: Sources

Blood (IV drug users )

Semen (unprotected sex)

Pre-seminal fluid

Vaginal fluid (pregnancy)

Breast milk

Transmission of HIV: Modes

Blood transfusion

Sexual contact

Injection drug use

Perinatal (vertical transmission): Mother-to-child

Occupational exposure

- Six common transmission categories are:

male-to-male sexual contact,

injection drug use,

heterosexual contact,

mother-to-child (perinatal) transmission,

and other (includes blood transfusions and unknown cause).

How HIV is NOT transmitted

Sharing food

Bed linen, door knobs, telephones, towels, combs, toilet seats

Swimming pools

Touching, shaking hands, living and working with an infected person

Kidding, hugging

Mosquitoes, flies, other insects



3. HIV symptoms and disease progression.

Disease progression

What happens to your body if you are infected with HIV?

Disease progression

1. Primary infection

2. Window period

3. Asymptomatic chronic HIV infection

4. Symptomatic HIV infection

5. Advanced HIV infection

6. AIDS

a. 7-10 years

Acute HIV infection S/S

•Fatigue

•Headache

•Pain

•Peripheral neuropathy

•Nausea/vomiting

•Wasting

•Diarrhea

•Skin rashes/itching

•Candidiasis

•Seems like the flu

Primary infection

Acute Retroviral Syndrome: Signs & Symptoms

Fever 96%

Lymphadenopathy 74%

Pharyngitis 70%

Rash 70%

Myalgia or arthalgia 54%

Diarrhea 32%

Person is highly infectious but has not seroconverted-will not show up on labs in bloodstream yet

4. Complications and opportunistic infections associated with HIV.

Like to start treating between early & intermediate

Partial preview of the text

Download community health lecture notes and more Lecture notes Community Health in PDF only on Docsity!

HIV 101 N4415: Community Health Nursing Objectives After attending this lecture, students will be able to discuss:

1. Epidemiology of HIV/AIDS.  Every 9 Minutes someone in the US is infected with HIV  HIV transmission in U.S. -MSM-Men who have sex with men is a term used in CDC because iindicates behaviors that transmits HIV, rather than self sexual identity. -IDU-Injection Drug Users Retrovirus-RNA. Goes into healthy cells changing RNA to DNA. Sneaky. Not a death sentence. Global pandemic driven by travel/migration, sex practices, drug use, war, economics. Pandemic related to economics (prostitution) Chronic infectious disease which can be controlled with effective treatment Estimated Per-Act Risk for Acquisition of HIV by Exposure Route

Estimates of per-act risk of acquisition of HIV are approximate and vary widely depending on the viral load of the source contact, the presence of sexually transmitted diseases, and other factors. **-Blood transfusion-9,

How HIV is and is not transmitted.** How do you get it? Transmission of HIV: Sources  Blood (IV drug users )  Semen (unprotected sex)  Pre-seminal fluid  Vaginal fluid (pregnancy)  Breast milk Transmission of HIV: Modes Blood transfusion Sexual contact Injection drug use Perinatal (vertical transmission): Mother-to-child Occupational exposure

Six common transmission categories are: male-to-male sexual contact, injection drug use, heterosexual contact, mother-to-child (perinatal) transmission, and other (includes blood transfusions and unknown cause). How HIV is NOT transmitted  Sharing food  Bed linen, door knobs, telephones, towels, combs, toilet seats  Swimming pools  Touching, shaking hands, living and working with an infected person  Kidding, hugging  Mosquitoes, flies, other insects  3. HIV symptoms and disease progression. Disease progression What happens to your body if you are infected with HIV? Disease progression

Primary infection
Window period
Asymptomatic chronic HIV infection
Symptomatic HIV infection
Advanced HIV infection
AIDS a. 7-10 years Acute HIV infection S/S

Fatigue
Headache
Pain
Peripheral neuropathy
Nausea/vomiting
Wasting
Diarrhea
Skin rashes/itching
Candidiasis
Seems like the flu Primary infection Acute Retroviral Syndrome: Signs & Symptoms Fever 96% Lymphadenopathy 74% Pharyngitis 70% Rash 70% Myalgia or arthalgia 54% Diarrhea 32% Person is highly infectious but has not seroconverted-will not show up on labs in bloodstream yet 4. Complications and opportunistic infections associated with HIV. Like to start treating between early & intermediate

Common HIV/AIDS-related complications  Diabetes  Lipodystrophy-odd distribution of fat (is a problem with the way the body produces, uses, and stores fat. It is also called fat redistribution.)  Lactic acidosis-Increased lactic acid in blood (condition caused by the buildup of lactic acid in the blood. The condition is a rare but serious side effect of some HIV medicines. fatigue, loss of appetite, nausea and vomiting, stomach pain, and weight loss)  Opportunistic infections & malignancies  Pneumocystis -Fungus  Tuberculosis  Cryptococcal meningitis Kaposi’s sarcoma - type of cancer that mainly affects the skin, mouth, and lymph nodes -- infection-fighting glands. Spots on neck, face

5. Recommended treatment for HIV Treatment Several different kinds of antiretroviral drugs are currently used to treat HIV infection.• These medicines do not cure HIV infection or AIDS• These medicines do not eliminate the risk of passing HIV to others• Treatment of HIV infection requires a combination of HIV medicines• Not all medicines are right for all people, and treatments may be different for each person; talk with your doctor or other health care provider if you have questions about your treatment When to start treatment

You have severe symptoms
Your CD4 count is under 500
You're pregnant
You have HIV-related kidney disease
You're being treated for hepatitis B
Transmitted by blood, semen, IV drug use Side effects of antiretroviral drugs Nausea, vomiting or diarrhea Abnormal heartbeats Shortness of breath Liver damage Elevated blood sugar levels Skin rash Weakened bones Bone death, particularly in the hip joints Treatment issues Adherence to medication regimen Drug Resistance Side effects Cost-skyrocketed price for drugs. Guy is in jail. We need those meds.
Requires lifetime commitment to taking meds as prescribed.
Every missed dose increases the chance of the virus developing resistance to the drugs
Drugs are expensive
Limited access to drugs and HIV providers
Side effects
If do not adhere to routine may develop resistance to drugs and must start new drugs PEP: postexposure prophylaxis Drug Risk assessment Treatment -Goal is to begin treatment within 2 hours -Gotta request blood draw from patient if needlestick, but they might not show up positive so you still have to go through treatment and follow-up -Several weeks can pass and you’re not seroconverted so don’t think you have it. Must re-test in a few weeks and make sure because it might not show up positive til then. Follow-up
Optimal PEP treatment when initiated within 2 hrs of exposure has been shown to reduce the incidence of HIV seroconversion by up to 81% (CDC, 2001 6. Evidence-based HIV prevention strategies. HIV occupational exposure
As of 2010, 57 documented transmissions and 143 possible transmissions had been reported in the United States.
Health care workers who are exposed to HIV-infected blood at work have a 0.3% risk of becoming infected.
Gotta get tested. Small window to check.
In other words, 3 of every 1,000 such injuries, if untreated, will result in infection.
We’ve done well with prevention
Underreporting of cases to CDC is possible, however, because case reporting is voluntary.
Occupational exposures should be considered urgent medical concerns, and PEP should be started within 72 hours—the sooner the better; every hour counts. HIV tests A positive antibody test means you are infected with HIV. Your body is producing the antibodies to HIV Why testing is important 20% of persons infected with HIV in U.S. do not know they have it

In order for viruses to reproduce, they must infect a cell. Viruses are not technically alive: they are sort of like a brain with no body. In order to make new viruses, they must hi-jack a cell, and use it to make new viruses. Just as your body is constantly making new skin cells, or new blood cells, each cell often makes new proteins in order to stay alive and to reproduce itself. Viruses hide their own DNA in the DNA of the cell, and then, when the cell tries to make new proteins, it accidentally makes new viruses as well. HIV mostly infects cells in the immune system.Infection: Several different kinds of cells have proteins on their surface that are called CD4 receptors. HIV searches for cells that have CD4 surface receptors, because this particular protein enables the virus to bind to the cell. Although HIV infects a variety of cells, its main target is the T4-lymphocyte (also called the "T-helper cell"), a kind of white blood cell that has lots of CD4 receptors. The T4-cell is responsible for warning your immune system that there are invaders in the system. Replication: Once HIV binds to a cell, it hides HIV DNA inside the cell's DNA: this turns the cell into a sort of HIV factory. A retrovirus is composed of RNA not DNA. They have an enzyme called reverse transcriptase that gives them the unique property of transcribing their RNA into DNA after entering a cell. The retroviral DNA can then integrate into the chromosal DNA of the host cell to be expressed there. Epidemiology of HIV/AIDS

This slide show that African American males have the highest rates of HIV diagnoses and AA women have the second highest rates. Economic, lack of trust with health care, not using condom
As you can see in this slide, since 1994 the population in the United States most impacted by HIV is African Americans. This burden is even greater among African Americans in the
South. Lack of provider access. Stigma-I’m just a poor person in rural Arkansas why would you give me that med?
Another graph showing percentages of adults and adolescents diagnosed with an AIDS diagnosis by transmission category by year of diagnosis. Infections by IDU have declined while infection via heterosexual contact has increased. Male to male infection decreased for several years but has been increasing. Getting better with IDU. NO DISEASE MECHANISMS ON TEST!! There are a few things you need to know in order to understand HIV infection
DNA: DNA is like the "blueprint" for building living cells.
- Enzymes: Enzymes are like the workers of a cell. They build new proteins, transport materials around the cell, and carry out other important cellular functions.
- RNA: RNA is like the construction boss. Cells use RNA to tell enzymes how to build a specific part of a cell. To make a new protein, enzymes will copy a specific part of the DNA into a piece of RNA. This RNA is then used by other enzymes to build a new protein or enzyme.
- Proteins: The building blocks that are used to make living things.
- Nucleus: A small package inside the cell where the genetic material is kept.
2-10 Billion viral particles every 1-2 days
2 Billion new T cells every day, most destroyed by HIV Antiretoviral drugs NOT ON TEST!!! But know they act differently on CD4 cells so one drug won’t do the work. Need a combination of drugs. Use them for long time=develop resistance, gotta change em. Secondary prevention HIV pregnant women should (NOT ON TEST-PREG) -Should take HIV medications by the second trimester of pregnancy -HIV medications given during labor and delivery; continue after giving birth -newborn should begin receiving HIV medication within 6-12 hours after delivery and continue taking for 6 weeks [ziduvine (ZDV)] Vaginal delivery is safe for women who: -take HIV medications treatment during pregnancy during labor and delivery, and immediately after giving birth, and -mother’s viral load is less than 1,000 copies/ml near time of delivery HIV Pregnant Mothers Should…. Cesarean delivery is indicated for women who: have not received HIV medications during pregnancy; Have a viral load greater than 1,000 copies/ml or an unknown viral load near time of delivery. HIV-positive mothers should not breastfeed their newborns

community health lecture notes, Lecture notes of Community Health

Related documents

Partial preview of the text

Download community health lecture notes and more Lecture notes Community Health in PDF only on Docsity!