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Hiv aids part 1[6]
- 1. HIV/AIDS Elaine Kauschinger PhD, MS, ARNP, FNP-BC Assistant Professor of Clinical Lead Faculty, Family Nurse Practitioner Program University of Miami School of Nursing & Health Studies
- 2. 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
- 3. 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
- 4. HIV/AIDS: Part I Epidemiology & Transmission
- 5. HIV/AIDS: Basic Definitions Human Immune Deficiency Virus Acquired Immune Deficiency Virus Opportunistic Infections (OIs) CD4 count & viral load
- 6. 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 Count HIV in plasma HIV in plasma (“viral load”) (cells/mL) (copies/mL) CD4 (T Cell) count Source: HRSA HIV/AIDS Bureau
- 7. 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
- 8. 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
- 9. 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
- 10. 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.
- 21. 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 million 21
- 22. Modes of Transmission Sexual • Anal>vaginal>oral Perinatal • Intrapartum • Labor & Delivery • Breastfeeding Blood • IVDU • Occupational exposure • Transfusion & blood products
- 23. Prevention of Transmission Avoidance of direct contact with sexual fluids Abstinence Safer sex & condom use Infection control practices Safer blood supply Mother-to-child (MTC) IVDU
- 24. Please continue to part 2
Notas del editor
- Epidemiology of HIV Infection through 2009
- From 2006 through 2009 the number of diagnoses of HIV infection among adults and adolescents remained stable in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006. In 2009, an estimated 42,793 adults and adolescents were diagnosed with HIV infection; of these, 76% of diagnoses were among males and 24% were among females. The estimated number of diagnoses of HIV infection among males increased 5% from 2006-2009. The estimated number among female adults and adolescents decreased 9% from 2006-2009. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting.
- This slide presents the distribution of diagnoses of HIV infection among adults and adolescents diagnosed from 2006 through 2009, by transmission category, for 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006. The percentage of diagnoses of HIV infection among adults and adolescents exposed through male-to-male sexual contact increased from 50% in 2006 to 56% in 2009. The percentages of diagnosed HIV infections among adults and adolescents exposed through injection drug use, male-to-male sexual contact and injection drug use, and heterosexual contact remained relatively stable from 2006-2009. The remaining diagnoses of HIV infection were those attributed to hemophilia or the receipt of blood or blood products, and those in persons without an identified risk factor. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Heterosexual contact is with a person known to have or to be at high risk for HIV infection.
- In 2009, among adult and adolescent males diagnosed with HIV infection in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006, an estimated 74% of infections were attributed to male-to-male sexual contact and 8% were attributed to injection drug use. Approximately 14% of diagnosed infections were attributed to heterosexual contact and 4% attributed to male-to-male sexual contact and injection drug use. Most (85%) diagnosed HIV infections among adult and adolescent females were attributed to heterosexual contact, and 15% were attributed to injection drug use. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Heterosexual contact is with a person known to have or to be at high risk for HIV infection.
- In 2009, among the 32,538 adult and adolescent males diagnosed with HIV infection in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006, 46% were black/African American, 31% were white and 20% were Hispanic/Latino. Approximately 1% of diagnoses among males were Asian and males reporting multiple races, and less than 1% each was American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. Among the 10,255 adult and adolescent females diagnosed with HIV infection in 2009, 65% were black/African American, 17% were white and 16% were Hispanic/Latino. Approximately 1% of diagnoses were among Asians and females reporting multiple races, and less than 1% each was among American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Hispanics/Latinos can be of any race.
- This slide presents the distribution of adults and adolescents* living with a diagnosis of HIV infection by sex and transmission category at the end of 2008 in the 40 states and 5 U.S dependent areas with confidential name-based HIV infection reporting since at least January 2006. Among male adults and adolescents living with a diagnosis of HIV infection at the end of 2008, 63% of infections were attributed to male-to-male sexual contact. An estimated 17% of infections were attributed to injection drug use, and 12% to heterosexual contact. Approximately 7% of infections were attributed to male-to-male sexual contact and injection drug use. Among female adults and adolescents living with a diagnosis of HIV infection at the end of 2008, 73% of infections were attributed to heterosexual contact and 26% to injection drug use. The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Heterosexual contact is with a person known to have or to be at high risk for HIV infection. *Persons living with a diagnosis of HIV infection by transmission category are classified as adult or adolescent based on age and transmission at diagnosis.
- The distribution of AIDS diagnoses by transmission category has shifted since the beginning of the epidemic. In 1985, male-to-male sexual contact accounted for an estimated 65% of all AIDS diagnoses; this proportion reached its lowest point in 1999 at 40% of diagnoses. Since then, the percentage of AIDS diagnoses attributed to male-to-male sexual contact has increased and in 2009 this transmission category accounted for 49% of all AIDS diagnoses. The estimated percentage of AIDS diagnoses attributed to injection drug use increased from 20% to 32% during 1985–1993 and decreased since that time accounting for 15% of diagnoses in 2009. The estimated percentage of AIDS diagnoses attributed to male-to-male sexual contact and injection drug use decreased from 9% in 1985 to 5% in 2009. The estimated percentage of AIDS diagnoses attributed to heterosexual contact increased from 3% in 1985 to 31% in 2009. The remaining AIDS diagnoses were those attributed to hemophilia or the receipt of blood or blood products and those in persons without an identified risk factor. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing risk-factor information, but not for incomplete reporting. Heterosexual contact is with a person known to have, or to be at high risk for, HIV infection.
- In the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006, the estimated rate of diagnoses of HIV infection among adults and adolescents was 21.1 per 100,000 population in 2009. The rate for adults and adolescents diagnosed with HIV infection ranged from zero per 100,000 in American Samoa and the Northern Mariana Islands to 40.6 per 100,000 in Georgia.The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting.
- Estimated rates (per 100,000 population) of children living with a diagnosis of HIV infection at the end of 2008 in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006 are shown in this slide. Areas with the highest estimated rates of children living with a diagnosis of HIV infection at the end of 2008 were New York (22.4), the U.S. Virgin Islands (21.8), Florida (14.8), New Jersey (13.4), and Louisiana (12.3). The following 40 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2006: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Persons living with a diagnosis of HIV infection are classified as children based on age at end of 2008.
- The estimated rates (per 100,000 population) of AIDS diagnoses in 2009 are shown for each state, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. Areas with the highest rates of AIDS diagnoses in 2009 were the District of Columbia (119.8), New York (24.6) and Florida (23.7). The District of Columbia is a metropolitan area; use caution when comparing the AIDS diagnosis rate in D.C. to state AIDS rates. All displayed data have been estimated. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting.
- ABCs of prevention: A = abstinence, B = be faithful, C = use condoms (correctly & cosistently)