HIV Infection and AIDS: Etiology, Epidemiology, Transmission and TestingWhere did HIV come from? Present in US, Europe and Africa for many decades (1960s) Mutation First identified in 1984 Difficult to trace to one personDefinitions HIV prevalence: The number of people living with HIV—with or without a diagnosis of AIDS—at a point in time. HIV incidence: The number of people who become newly infected with HIV ina given period. HIV diagnoses: The number of HIV diagnoses during a given period, regardless of when the persons became infected. AIDS diagnoses: The number of AIDS diagnoses during a given period. AIDS isdiagnosed when an HIV-infected person’s immune system becomes severely compromised (measured by CD4 cell count) and/or the person becomes ill with an opportunistic infection. DEFINITION: HIV/AIDS HIV- stands for human immunodeficiency virus. This is the virus that causes AIDS. HIV is diff from other viruses because it attacks the immune system. AIDS-stands for acquired immunodeficiency syndrome. AIDS is the final stage of HIV infection. It can take years for a person infected with HIV, even withouttreatment, to reach this stage. HIV PREVALANCE  1.1 million adults and adolescents were living with diagnosed or undiagnosed HIV infection in the United States at the end of 2006 (CDC, 2008). The majority of those living with HIV were nonwhite (65.4%), and nearly half(48.1%) were men who have sex with men (MSM). The HIV prevalence rates for blacks (1,715.1 per 100,000) and Hispanics (585.3 per 100,000) were, respectively, 7.6 and 2.6 times the rate for whites (CDC, 2008)THE PROBLEM diagnosed to late for treatment to be effective 20% people infected with HIV don’t know it (including women) 1/3 are diagnosed so late that they develop AIDS within one year The states with the biggest epidemic and the greatest number of late diagnosis = Fla., NY, Texas, GA., NJHIV overviewHuman Immunosuppressive virus (HIV) “This is the retro-virus that causes AIDS” HIV – 1 and HIV – 2 (mostly in West Africa) 1983 and 1984 (virus identified) Gallo, NCI (HTLV-111), Montagnier, Pasteur Institute (Lymphadenopathy Associated Virus), Levy et.al, (AIDS Associated Virus)  Attacks and weakens the immune system Destroys “helper ‘T’ cells” (lymphocytes)  Attaches to the CD4 (<200)VIRAL LOAD Measures the amount of HIV in the blood system An undetectable viral load does not mean you are cured. You can still infect others! Reservoirs  Window period/sero-conversion During this phase, the infection is established and a proviral reservoir is created. This reservoir consists of persistently infected cells, typically macrophages, and appears to steadily release virus. Some of the viral release replenishes the reservoir, and some goes on to produce more active infection.  Most convert by 3-6 monthsTRANSMISSION (body fluids, cells and tissue) Peripheral blood Lymph nodes Brain tissue Cerebral spinal fluid Tears Bone marrow Plasma Saliva Retina  Cornea Ear secretions Bronchial fluid Semen Breast milk Mucous membranes Vaginal fluidHow is HIV transmittedHIV is not transmitted through casual contact! Blood transfusion  Sharing contaminated needles Unprotected sex (receptive anal) Needle sticks Receptive penile/vaginal Insertive (anal) Insertive (penile vaginal) Oral sex (male to male less) Bite injury (rare) Drug apparatus  products, tissues, or organs Mother to child Female to female (0) Transmission (made easier?) Genital ulcers STI Trauma Presence of inflammation or exudates Menstruation  Menopause (dryness) First sexual experience Lack of circumcision TREATMENT (MTCT) (stopped) Antiretroviral therapy- given to pregnant HIV-infected women reduced this type of HIV transmission  Without (AT) 25% of pregnant HIV infected women will transmit the virus reduce the rate of HIV transmission to 2% or less!!!!MTCT Most perinatal transmission: occurs at the time of birth Post delivery breast feeding Other factors Younger maternal agree  Increased maternal RNA viral load Increased maternal RNA viral load in breast milk Breast clinical condition (cracked nipples) Sub-optimal nutritional status Increased duration of breastfeeding The epidemic at a Glance How many people are infected worldwide? 33 million people live with HIV worldwide in low- and middle-income countries. An estimated 2.7 million people were newly infected with the virus in 2010.Facts HIV/AIDS is the world’s leading infectious disease killer 30 million people died to date.  1.8 million people die every year from HIV/AIDS. About 6.65 million HIV-positive people had access to ART in low- and middle-income countries at the end of 2010 Overall, the coverage of ART continued to increase and was 47% of the 14.2 million people eligible for treatment at the end of 2010. How many children are living with HIV/AIDS?—3.4 million!! According to 2010 figures most of the children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding.  Almost 1100 children become newly infected with HIV each day.  The number of children receiving ART increased from about 75, 000 in 2005 to 456, 000 in 2010.  HIV is the strongest risk factor for developing active TB disease In 2010, more than 350 000 deaths from tuberculosis occurred among people living with HIV. The majority of people living with both HIV and TB reside in sub-Saharan Africa (about 82% of cases worldwide).Living with HIVConfidentiality 0 HIV information must be considered confidential0 Faxing medical record information with HIV test results is prohibited in some states. Right to Know!0 Healthcare workers have the right to know when they are caring for patients with highly contagious diseases0 The duty to disclose and protect the rights of the caregiver outweighs the patient confidentiality issue0 OSHA helps protect healthcare workers in this area and mandates employee training in the areas of epidemiology, modes of transmission, prevention, and universal precautions.The Person• The experience of living with HIV is extremely individualistic • Individuals should be looked at in terms of each individual’s personal, social,