Unit 4: Clinical Manifestation and Treat

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HIV/AID’S Training for the Dental Health WorkerUnit Four : 

HIV/AID’S Training for the Dental Health WorkerUnit Four Developed by Theresa Allyn Based on the Washington State HIV Aids Curriculum Sponsored by WSDA 1 Copyright 2/2008

HIV/AIDS Manifestations Unit Four : 

HIV/AIDS Manifestations Unit Four Developed by Theresa Allyn Based on the Washington State HIV Aids Curriculum Sponsored by WSDA 2 Copyright 2/2008

A Note from your Instructor : 

A Note from your Instructor This next unit is very informative. You will learn what HIV/AIDS looks like in the body, where researchers think HIV came from, and how HBV and HCV affect the HIV infected individual. If you are a sensitive person some of the following slides might cause a bit of an emotional reaction. These slides not only will educate you on how HIV/AIDS ravages the body but will also build in you a sense of compassion and mercy for the HIV/AIDS survivor. To fully enjoy all this presentation has to offer don’t hesitate to try the links for more information as well as for videos that will enrich your learning experience. Remember to view them you must be in full screen view and then simply click on the link. When you are done looking at the link just click the X in the top right corner and you will return to the presentation. Also remember that you can pause the audio component of this unit as you search the web sites and then press play when you return to the presentation to continue where you left off at. This material is based on the AIDS What you Must Know Washington State Curriculum. You can download the electronic version of the training manual for free by visiting: http://www.doh.wa.gov/CFH/HIV_AIDS/Prev_Edu/training_curriculum/KNOW_2007.pdf 3 Copyright 2/2008

Unit Four Overview : 

Unit Four Overview What is the natural history of HIV infection? How is an AIDS case defined? What are AIDS indicator conditions? How does HIV work in the body? What new drug therapies exist? How are HIV/AID’s cases managed and what resources are available? What connection does Tuberculosis and HIV have? What about other sexually transmitted diseases and HIV? What about Hepatitis B and HIV? What about Hepatitis C and HIV? 4 Copyright 2/2008

The Natural Process of HIV Infection : 

The Natural Process of HIV Infection 5 Copyright 2/2008

Viral Transmission : 

Viral Transmission This is the initial infection with HIV. When a person is infected with HIV, they will probably have virus circulating in their bloodstream, and may become infectious to others within five days. The person may be infectious before the onset of any symptoms. They will remain infectious for the rest of their lives. 6 Copyright 2/2008

Primary HIV Infection : 

Primary HIV Infection 7 Copyright 2/2008

Seroconversion : 

Seroconversion Seroconversion is the time period that it takes from infection to the production of antibodies, which would show positive on an HIV test. This may vary from person to person. HIV antibodies are detectable sometime within the first six weeks to six months of infection, and in most cases will be detectable for life. 8 Copyright 2/2008

Asymptomatic HIV Infection : 

Asymptomatic HIV Infection During this time period an HIV-infected person has no noticeable signs or symptoms. The person may look and feel healthy, but can still pass the virus to others. It is not unusual for an HIV infected person to live 10 years or longer without any outward physical signs of progression to AIDS. Meanwhile, the person's blood and other systems are affected by HIV. This would be reflected in laboratory tests. Unless a person in this stage has been tested for HIV, they will probably not be aware they are infected. 9 Copyright 2/2008

Symptomatic HIV Infection : 

Symptomatic HIV Infection During the symptomatic stage of HIV infection, a person begins to have noticeable physical symptoms that are related to HIV infection. Anyone who has symptoms like these and has engaged in behaviors that transmit HIV should seek medical advice. The only way to know for sure if you are infected with HIV is to take an HIV antibody test. 10 Common Systems Include: Copyright 2/2008

AIDS : 

AIDS 11 Copyright 2/2008

Cofactors : 

Cofactors A cofactor is a separate condition that can change or "speed up“ the course of disease. There are several cofactors that can increase the rate of progression to AIDS. They include a person's age, certain genetic factors and possibly drug use, smoking, nutrition and HCV. 12 Copyright 2/2008

Time from Infection to Death : 

Time from Infection to Death Currently, if the infection is untreated, the average time from HIV infection to death is 10-12 years. Early detection and medical treatment may mean that the person will live longer. 13 Copyright 2/2008

The 1993 Revised AIDS Surveillance Case Definition : 

The 1993 Revised AIDS Surveillance Case Definition 14 Copyright 2/2008

Adult AIDS Indicator ConditionsA positive HIV test plus one or more of the following: : 

Adult AIDS Indicator ConditionsA positive HIV test plus one or more of the following: 15 Copyright 2/2008

Adult AIDS Indicator Conditions Cont…A positive HIV test plus one or more of the following: : 

Adult AIDS Indicator Conditions Cont…A positive HIV test plus one or more of the following: 16 Copyright 2/2008

Adult AIDS Indicator Conditions Cont…A positive HIV test plus one or more of the following: : 

Adult AIDS Indicator Conditions Cont…A positive HIV test plus one or more of the following: 17 Copyright 2/2008

Candidiasis : 

Candidiasis 18 Copyright 2/2008 www.aids-mages.ch

Cervical Cancer : 

Cervical Cancer 19 Aids-image.ch Copyright 2/2008

Cryptococcosis : 

Cryptococcosis 20 Copyright 2/2008

Herpes Simplex Virus : 

Herpes Simplex Virus 21 Copyright 2/2008

Kaposi’s Sarcoma : 

Kaposi’s Sarcoma 22 Copyright 2/2008

Elevated KS Lesion : 

Elevated KS Lesion 23 Copyright 2/2008

Wasting : 

Wasting 24 Copyright 2/2008

Tuberculosis : 

Tuberculosis 25 Copyright 2/2008

Toxoplasmosis of internal organs : 

Toxoplasmosis of internal organs 26 Copyright 2/2008

Pneumonia : 

Pneumonia 27 Copyright 2/2008

The Difference between Clinical Manifestations and Opportunistic Infections : 

The Difference between Clinical Manifestations and Opportunistic Infections When a person's immune system is suppressed, they have weaker defenses against the wide variety of bacteria, viruses, fungi and other pathogens that are present almost everywhere. A "clinical manifestation" is the physical result of some type of illness or infection. The "opportunistic" diseases and infections associated with HIV infection are any of the infections that are part of an AIDS defining classification. For example: the opportunistic infection cytomegalovirus often causes the clinical manifestation of blindness in people with AIDS. 28 To see original pictures and an article on opportunistic disease click on or visit www.mayoclinicproceedings.com/inside.asp?AID=... Copyright 2/2008

Retinitis can Lead to Blindness : 

Retinitis can Lead to Blindness 29 Copyright 2/2008

How HIV Works in the Body : 

How HIV Works in the Body 30 Copyright 2/2008

HIV Infection can cause many Painful or Uncomfortable Conditions, Including: : 

HIV Infection can cause many Painful or Uncomfortable Conditions, Including: 31 Copyright 2/2008

More HIV Uncomfortable Conditions: : 

More HIV Uncomfortable Conditions: 32 Copyright 2/2008

HIV in Children : 

HIV in Children Children show significant differences in their HIV disease progression and their virologic and immunologic responses, compared to adults. Without drug treatment, children may have developmental delay, pneumocystis carinii pneumonia, failure to thrive, recurrent bacterial infections and other conditions related to HIV. The antiretroviral treatments that are available for HIV infection may not be available in pediatric formulations. The medications may have different side effects in children than they do in adults. 33 Copyright 2/2008

HIV in Children Cont… : 

HIV in Children Cont… It is vital that women know their HIV status before or during pregnancy. Antiretroviral treatment significantly reduces the chance that their child will become infected with HIV. Prior to the development of antiretroviral therapies, most HIV-infected children were very sick by seven years of age. In 1994, scientists discovered that a short treatment course of the medication AZT for pregnant women dramatically reduced the number, and rate, of children who became infected perinatally. C-sections for delivery in certain cases may be warranted to reduce HIV transmission. As a result, perinatal HIV infections have substantially declined in the developed world. 34 Copyright 2/2008

HIV in Children Cont… : 

HIV in Children Cont… Early diagnosis of HIV infection in newborns is now possible. Antiretroviral therapy for infants is now the standard of care, and should be started as soon as the child is determined by testing to be HIV-infected. Current recommendations are to treat apparently uninfected children whose mothers are HIV-positive with antiretroviral medicines for six weeks, to reduce any possibility of HIV transmission. 35 Copyright 2/2008

View a Short Movie on AIDS and Children…Click on the Link Below: : 

View a Short Movie on AIDS and Children…Click on the Link Below: 36 http://www.youtube.com/watch?v=zyx-0TUkafU Copyright 2/2008

HIV in Women : 

HIV in Women Certain strains of HIV may infect women more easily. The strain of HIV present in Thailand seems to transmit more easily to women through sexual intercourse. Scientists believe that women and receptive partners are more easily infected with HIV, compared to the insertive partner. Receptive partners are at greater risk for transmission of any sexually transmitted disease, including HIV. Women infected with HIV are at increased risk for a number of gynecological problems, including pelvic inflammatory disease, abscesses of the fallopian tubes and ovaries, and recurrent yeast infections. 37 www.blackvoices.com/.../ To view original artwork and article on black women and HIV click or visit the following link: Copyright 2/2008

Slide 38: 

Some studies have found that HIV-infected women have a higher prevalence of infection with the human papilloma virus (HPV). Cervical dysplasia is a precancerous condition of the cervix cause by certain strains of HPV. Cervical dysplasia in HIV-infected women often becomes more aggressive as the woman's immune system declines. This may lead to invasive cervical carcinoma, which is an AIDS-indicator condition. It is important for women with HIV to have more frequent Pap tests. 38 To view article on HPV click or visit the following link: http://www.healthline.com/blogs/health_observances/2007/01/some-cervical-disorders-and-their.html HPV and HIV in Women Aids-images.ch Copyright 2/2008

HIV in Women : 

HIV in Women Several studies have shown that women with HIV in the U.S. receive less health care services and HIV medications, compared to men. This may be because women aren't diagnosed or tested as frequently as men. 39 Copyright 2/2008

Access to Good Medical Care is Important for all HIV/AIDS Infected Individuals : 

Access to Good Medical Care is Important for all HIV/AIDS Infected Individuals As the medications that are available to treat HIV infection have become more numerous and complex, HIV care has become a medical specialty. If possible, people who have HIV infection should seek out a physician who is skilled in the treatment of HIV and AIDS. People in Washington State may begin to access an HIV specialist through the assistance of the case manager(s) in their county. Call your local health department or health district for information on case management programs. 40 Copyright 2/2008

History of HIV Drug Therapies : 

History of HIV Drug Therapies 41 Copyright 2/2008

The Improved Drug Therapies for HIV are not always Helpful : 

The Improved Drug Therapies for HIV are not always Helpful Not everyone with HIV infection benefits from the new drug therapies. Some people cannot tolerate the unpleasant or serious side effects from the medications. Others cannot adhere to the complex treatment schedule. If a person does not take their medication every day according to their physician’s instructions, the drugs do not work effectively and viral resistance may develop. 42 Copyright 2/2008

Cost of New Drug Therapies can be Prohibitive : 

Cost of New Drug Therapies can be Prohibitive Insurance programs and government programs for individuals with low income pay for much of the cost of the HIV medicines in Washington State. These medicines may cost upwards of $2,000 per person each month. People who live in other countries where the medication is unaffordable have very limited access to the newer therapies. 43 Copyright 2/2008

New Therapies are not a “Cure" for HIV Infection : 

New Therapies are not a “Cure" for HIV Infection Although the new drug therapies work for many people to keep the amount of virus in their bodies to very low levels, they are not a "cure for HIV.“ Once therapy is discontinued, viral load will increase. Even during treatment, viral replication occurs and the person remains infectious to others. 44 Copyright 2/2008

Resistance to the HIV Medications can Develop : 

Resistance to the HIV Medications can Develop Many people find that after time, the virus becomes resistant to the medication, and they must change medications. This is especially true when the medications are not taken correctly, and it limits the number of possible drug therapies that the person might be able to use. 45 Copyright 2/2008

Side Effects of HIV Medications : 

Side Effects of HIV Medications Patients often have unpleasant side effects when they use prescription medications to treat their HIV infection. nausea diarrhea peripheral neuropathy (numbness and/or pain in feet and hands) changes in body fat distribution called lipodystrophy, which presents with large fat deposits on the back of the neck, on the stomach area and in breast size in women and/or with pronounced thinning of the arms and legs. interference with the metabolism of oral contraceptives osteoporosis diabetes or other changes in glucose metabolism very high cholesterol or triglycerides damage to the nervous system, liver and/or other body organs 46 Copyright 2/2008

Alternative Therapies for HIV Infection : 

Alternative Therapies for HIV Infection People have used and relied on "alternative" (sometimes called complimentary) therapies to treat HIV infection for as long as HIV has been known. Many people use these treatments along with therapies from their medical provider. Other people choose to only use alternative therapies. These therapies include a wide range of treatments, from vitamins, massage, herbs, naturopathic remedies, and many more. While there is no evidence of harm from these treatments, there is also very little evidence of benefit. Many of these remedies have not been studied to see if they help. 47 Copyright 2/2008

Interactions with other Medications/Drugs : 

Interactions with other Medications/Drugs It is important for people who are taking alternative therapies to tell their medical provider. There may be drug reactions or other harmful side effects from the interactions of the "natural“ medicine and antiretrovirals. For example, St. John’s Wort is an herbal remedy that has major interactions with the HIV medications. Other drugs, including over the counter medications, prescription medications and "street drugs," may have serious interaction with antiretroviral medications. It is extremely important that people on HIV medications tell their doctor, pharmacist and social workers about all other drugs they take. 48 Copyright 2/2008

When will a Vaccine be Available? : 

When will a Vaccine be Available? Scientists have worked for years to develop a vaccine to prevent, or alleviate the severity of HIV infection. No one knows when a vaccine will be ready for distribution. Many promising developments have been made and it is possible that a vaccine will be available within this decade. Currently, prevention is still the only way to avoid HIV infection. 49 Copyright 2/2008

Finding Case Management : 

Finding Case Management People living with HIV often seek the assistance of an HIV case manager who can help explain the different types of services available. Washington state has several systems in place to provide prescription and medical assistance to people living with HIV and AIDS. Contact your local health department or district to find case management in your community. You can also call the Washington State Department of Health Client Services toll-free at 1-877-376-9316. 50 Copyright 2/2008

Children’s HIV Programs : 

Children’s HIV Programs Children with HIV may also benefit from the "Children with Special Health Care Needs" program. Care coordinators for this program are located at every county health department/district. Local community-based organizations like the Northwest Family Center in Seattle, and specialty hospitals like Children's Medical Center in Seattle and Mary Bridge Children's Hospital in Tacoma may also provide additional support to children and families. 51 Copyright 2/2008

Tuberculosis, Other Sexually Transmitted Diseases and Hepatitis B and C : 

Tuberculosis, Other Sexually Transmitted Diseases and Hepatitis B and C Tuberculosis and HIV Definition of Tuberculosis (TB) Mycobacterium tuberculosis (hereafter referred to as M. Tuberculosis, or TB) is transmitted by airborne droplets from people with active pulmonary or laryngeal TB during coughing, sneezing, or talking. Although the TB bacteria can live anywhere in the body, infectious pulmonary or laryngeal TB poses the greatest threat to public health. 52 Copyright 2/2008

Cause of TB : 

Cause of TB Latent infection, which is asymptomatic and not infectious, can last for a lifetime. A presumptive diagnosis of active TB is made when there are positive test results or acid-fast bacilli (AFB) in sputum or other bodily fluids. The diagnosis is confirmed by identification of M. tuberculosis on culture, which should be followed by drug sensitivity testing of the bacteria. 53 aids-image.ch Copyright 2/2008

Epidemiology of TB : 

Epidemiology of TB Globally, there are probably 2 billion people (1/3 of the world's population) infected with TB, and 8 million active cases of TB each year. Tuberculosis is one of the leading causes of death in the world. A total of 256 new cases of tuberculosis were diagnosed among Washington residents in 2005. Twenty-three of 39 counties had at least one new case of TB. There were ten counties with five or more cases of TB. Among these, the five highest county specific incidence rates were King (7.0), Yakima (5.6), Yakima (5.6), Skagit (5.4), Snohomish (3.6), and Pierce (3.5). 54 Copyright 2/2008

TB Transmission & Progression : 

TB Transmission & Progression 55 Copyright 2/2008

Symptoms of TB : 

Symptoms of TB The period from initial exposure to conversion of the tuberculin skin test is four to 12 weeks. During this period, the patient shows no symptoms. The progression to active disease and symptoms (such as cough, weight loss, and fever) usually occurs within the first two years after infection, but may occur at any time. 56 http://embryology.med.unsw.edu.au/Defect/bacteria.htm For original photo of T.B. Bacterium and article on TB and pregnancy click or visit the following link: Copyright 2/2008

Prevention of TB : 

Prevention of TB It is important to recognize the behavioral barriers to TB management, which include deficiencies in treatment regimens, poor client adherence to TB medications, and lack of public awareness. Primary health care providers need adequate training in screening, diagnosis, treatment, counseling, and contact tracing for TB through continuing education programs and expert consultation. Promoting patient adherence to the sometimes complicated medication schedule also requires consideration of the patient’s cultural and ethnic perceptions of his/her health condition. Providing strategies and services that address the multiple health problems associated with TB (such as alcohol and drug abuse, homelessness, and mental illness) also builds trust and promotes adherence to treatment plans. 57 Copyright 2/2008

TB Treatment : 

TB Treatment Isoniazid daily regimen for 9 months is recommended because prospective, randomized trials in HIV-negative persons indicate that 12 months of treatment is more effective than 6 months of treatment. Although a 9-month regimen of isoniazid is the preferred regimen for the treatment of LTBI, a 6-month regimen also provides substantial protection. In some situations, treatment for 6 months rather than 9 months may provide a more favorable outcome from a cost-effectiveness standpoint. Thus, based on local conditions, health departments or providers may conclude that a 6-mnth rather than a 9-month course of isoniazid is preferred. Clinical trials have shown that daily preventive therapy for 12 months reduces the risk for TB disease by more than 90% in patients with latent TB infection who complete a full course of therapy. There is evidence that six months of preventive therapy with Isoniazid may also prevent disease in approximately 69% of patients who complete the regimen. Every effort should be made to ensure that patients adhere to this therapy for at least six months. Children should receive at least nine months of preventive therapy. 58 Copyright 2/2008

HIV and TB : 

HIV and TB 59 Copyright 2/2008

Treatment of TB and Multidrug Resistant-TB : 

Treatment of TB and Multidrug Resistant-TB In order to prevent drug resistance and cure TB, the CDC recommends that TB be treated with a multidrug regimen, which may last six to 12 months. Current recommendations can be found in the Washington State Department of Health's Guidelines for the Prevention, Treatment and Control of TB. A copy may be obtained by calling the Washington State Department of Health TB Program at (360) 236-3447. Treatment of multidrug-resistant TB (MDR-TB) is much more difficult and must be individualized. The patient with MDR-TB requires treatment for two years or more. 60 Drug resistant TB To view original artwork and article on drug resistant TB a click or visit the following link: http://embryology.med.unsw.edu.au/Defect/bacteria.htm Copyright 2/2008

Drug Resistant TB : 

Drug Resistant TB HIV/TB co-infected persons are at considerably greater risk of developing TB disease than those who only have TB. Studies suggest that the risk of developing TB disease is 7% to 10% each year for persons who are infected with both M.tuberculosis and HIV, whereas it is 10% over a lifetime for a person infected only with M.tuberculsosis. In an HIV-infected person, TB disease can develop in either of two ways. A person who already has latent TB infection can become infected with HIV, and then TB disease can develop as the immune system is weakened. Or, a person who has HIV infection can become infected with M. tuberculosis, and TB disease can then rapidly develop because their immune system is not functioning. Pulmonary TB and extra pulmonary TB are among the conditions included in the 1993 AIDS surveillance case definition. Any HIV-infected person with a diagnosis of TB disease should be reported as having TB and AIDS. 61 Drug resistant TB Patient To view original artwork and other pictures of individuals suffering from resistant TB a click or visit the following link: http://embryology.med.unsw.edu.au/Defect/bacteria.htm Copyright 2/2008

For More Information on TB Contact: : 

For More Information on TB Contact: The communicable disease staff in each county health department/district The Washington State Department of Health TB program, (360) 236-3447 The Centers for Disease Control and Prevention Division of TB Elimination Web site: http://www.cdc.gov/nchstp/tb WA State Department of Health web site: www.doh.wa.gov/cfh/TB 62 Copyright 2/2008

Other STDs and HIV : 

Other STDs and HIV Definition of STDs The term STD (sexually transmitted disease) refers to more than 25 infectious organisms transmitted through sexual activity and dozens of clinical syndromes that they cause. STDs affect men and women and can be transmitted from mothers to babies during pregnancy and childbirth. They are also called sexually transmitted infections (STIs). Genital Warts 63 Aids-images.ch Copyright 2/2008

What Causes STD? : 

What Causes STD? Different bacteria cause STDs such as chlamydia, gonorrhea and syphilis. Herpes, genital warts, hepatitis B and HIV have different viral causes. Scabies are caused by mites, and pubic lice cause “crabs.” Trichomoniasis is caused by tiny organisms called protozoa; “yeast” infections are caused by fungi. STDs such as pelvic inflammatory disease can have more than one cause – a woman may have both gonorrhea and chlamydia causing this condition. A man may have more than one cause for epididymitis, usually gonorrhea and/or chlamydia. Non gonococcal urethritis (NGU) is usually caused by bacteria. 64 To view original artwork and statistics regarding STD’s click or visit the following link: http://www.cdc.gov/std/stats01/ Copyright 2/2008

STD’S Nationally and Internationally : 

STD’S Nationally and Internationally 65 Copyright 2/2008

HIV and STDs : 

HIV and STDs The presence of infection with other STDs increases the risk of HIV transmission because: STDs like syphilis and symptomatic herpes can cause breaks in the skin, which provide direct entry for HIV Inflammation from STDs, such as chlamydia, makes it easier for HIV to enter and infect the body HIV is often detected in the pus or other discharge from genital ulcers from HIV-infected men and women Sores can bleed easily and come into contact with vaginal, cervical, oral, urethral and rectal tissues during sex Inflammation appears to increase HIV viral shedding and the viral load in genital secretions 66 Copyright 2/2008

STD Transmission : 

STD Transmission STDs are transmitted in the same way that HIV is transmitted: By anal, vaginal and oral sex. In addition, skin-to-skin contact is important for the transmission of herpes, genital warts and HPV infection, syphilis, scabies and pubic lice. 67 To view original artwork and information on pubic hair lice click or visit the following link http://www.cdc.gov/std/stats01/ Copyright 2/2008

Symptoms of STD : 

In the past there was a great emphasis on symptoms as indicators of STD infection. Research has changed this. We now know that 80% of those with chlamydia, 70% of those with herpes and a great percentage of those with other STDs have no symptoms, but can still spread the infections. Along with prompt testing and treatment for those who do have symptoms, the emphasis in the U.S. is screening for infection based on behavioral risk. Patients cannot assume that their health care providers do STD testing. In other words, women who are getting a pap test or yearly exam should not just assume that they are also being tested for chlamydia or any other STDs. 68 To view original picture of bacteria and information on chlamydia click or visit the following link http://www.abc.net.au/science/news/stories/2004/1098471.htm Symptoms of STD Copyright 2/2008

Prevention of STDs : 

Prevention of STDs Abstain or be in a mutually monogamous relationship with an uninfected partner Know that many STDs have no symptoms Know that birth control pills and shots do not prevent infections – you must use condoms along with other birth control methods Go with your sex partner(s) for tests Avoid douching Learn the right way to use condoms and then use them correctly and consistently every time you have sex Be sure all sex partners are examined and treated if an STD occurs Change the ways you have sex so that there is no risk of infection Learn how to talk about correct use of condoms with all sex partners Practice the prevention you have learned for HIV and hepatitis 69 Copyright 2/2008

STD Tests : 

STD Tests At most sites, new urine LCR (urinate in a cup) tests for some STDs are available. Western Blot (blood tests) for herpes and hybrid capture tests for genital warts may also be available. In most places, however, cultures, wet preps and blood draws for syphilis remain the standard testing method. It is vital that women get pap tests, and that both men and women disclose a history of STD during medical workups. 70 Western Blot Test To view original art work and an article on testing for STD’s Click on the following link: http://www.bioasset.com/microbiological-evaluations-testing.html Copyright 2/2008

Hepatitis B and HIV : 

Hepatitis B and HIV What is Hepatitis? What is Hepatitis B? Hepatitis B (HBV) is a virus that is transmitted by the blood and body fluids of an infected person. Click here to see movie on Hepatitis and how the body fights it 71 Hepatitis is the inflammation of the liver that may be caused by many things, including viruses. Current viruses include Hepatitis A fecal/oral transmission) B, C, D and others. Copyright 2/2008

Prevention of HBV by Immunization : 

Prevention of HBV by Immunization A vaccine to prevent HBV is available. Hepatitis B vaccine is administered intramuscularly as a three dose series over 6 months. More than 90% of people who take the 3 injections become immune to HBV. 72 HBV virus Copyright 2/2008

HBV Epidemiology : 

HBV Epidemiology Each year in the U.S. an estimated 60,000 people become infected with HBV. Of these, about 2-6% of adults will become chronically infectious carriers of the virus. There are 1,250,000 carriers of HBV in the U.S. Each year, over 11,000 people will be hospitalized and about 4,000-5,000 people will die in the U.S. from chronic liver disease or liver cancer caused by HBV. 73 Copyright 2/2008

Symptoms of HBV could include: : 

Symptoms of HBV could include: 74 Copyright 2/2008

Slide 75: 

High Moderate Low/Not Detectable blood semen urine serum vaginal fluid feces wound exudates saliva sweat tears breastmilk Concentration of Hepatitis B Virus in Various Body Fluids 75 Copyright 2/2008

How HBV is not Transmitted by: : 

How HBV is not Transmitted by: • Breastfeeding • Sneezing • Hugging • Coughing • Sharing eating utensils or drinking glasses • Food or water • Casual contact 76 Copyright 2/2008

Risk Factors for HBV if individuals: : 

Risk Factors for HBV if individuals: 77 Copyright 2/2008

Risk Factors for HBV Continued… : 

Risk Factors for HBV Continued… Infants born to mothers who are HBV carriers have a greater than 90% reduction in their chance of becoming infected with HBV, if they receive a shot of hepatitis B immune globulin and hepatitis B vaccine shortly after birth plus two additional vaccine doses by age six months. It is vital that the women and their medical providers are aware that the woman is a HBV carrier. People with HBV should not donate blood, semen or body organs. 78 Copyright 2/2008

Slide 79: 

79 Copyright 2/2008

Prevention and Treatment of HBV : 

Prevention and Treatment of HBV Abstain from sexual intercourse and/or injecting drug use Maintain a monogamous relationship with a partner who is uninfected or vaccinated against HBV Use safer sex practices Never share needles/syringes or other injection equipment There are no medications available for recently acquired (acute)HBV infection. There are antiviral drugs available for the treatment of chronic HBV infection, however treatment success varies by individual. The vaccine is not used to treat HBV infection once a person is infected. 80 Copyright 2/2008

Transmission of HCV : 

Transmission of HCV HCV is transmitted primarily by blood and blood products. Blood transfusions before 1992 and the use of shared or unsterilized needles and syringes have been the main causes of the spread of HCV in the U.S. The primary way that HCV is transmitted now is through injection drug use. (Since 1992, all blood for donation in the U.S. is tested for HCV.) Sexual transmission of HCV is considered low, but accounts for 10 - 20% of infections. If a pregnant woman is infected with HCV, she may pass the virus to her baby. However, this occurs in only about 5-6% of those pregnancies. Household transmission is possible if people share personal care items such as razors, nail clippers, toothbrushes, etc. HCV is not transmitted by: Breastfeeding(unless blood is present) Sneezing Hugging Kissing Coughing Sharing eating utensils or drinking glasses Food or water Casual contact 81 Copyright 2/2008

The Severity of HCV : 

The Severity of HCV The CDC states that, for every 100 people who are infected with HCV: 15% will fully recover and have no liver damage 85% may develop long-term chronic infection 70% may develop chronic liver disease 20% may develop cirrhosis over a period of 20-30 years 1-5% may die from chronic liver disease 82 Copyright 2/2008

Slide 83: 

Risk Factors Associated with Transmission of HCV 83 Copyright 2/2008

Prevention of Hepatitis C : 

Prevention of Hepatitis C There is no vaccine to prevent HCV infection. The following steps can protect against HCV infection: Follow universal and standard precautions to avoid contact with blood or accidental needle-sticks. Refrain from acquiring tattoos or skin piercings outside of a legitimate business that practices universal precautions. Refrain from any type of injection drug use or drug equipment-sharing. Never share toothbrushes, razors, nail clippers or other personal care items. Cover cuts or sores on the skin. Persons who are HCV-infected may lower the small risk of passing HCV to their sex partner by using latex condoms and practicing safer sex. Women who are HCV-infected and wish to have children should discuss their choices beforehand with a medical specialist. People with HCV should not donate blood, semen or body organs. http://www.astbury.leeds.ac.uk/gallery/leedspix.html Hepatitis C Virus To view original art work and see other pictures of the virus click on the link or visit the following: 84 Copyright 2/2008

Treatment of Hepatitis C : 

Treatment of Hepatitis C Currently there are approved antiretroviral treatments for HCV. The cost of the treatments can be high, and the side effects can be significant (fatigue, flu-like symptoms, nausea, depression and anemia). People infected with HCV should abstain from alcohol use, as this can further damage the liver. Click here for Movie about a HCV survivor 85 Copyright 2/2008

People who Should Consider HCV Testing: : 

People who Should Consider HCV Testing: Current or former injection drug users Persons who received blood transfusions or an organ transplant prior to 1992 Hemophiliacs who received clotting factor concentrates produced before 1987 Persons who received chronic hemodialysis Infants born to infected mothers Healthcare workers who have been occupationally exposed to blood or who have had accidental needle-sticks Persons who are sex partners of people with HCV 86 Copyright 2/2008

Unit Four Quiz Directions : 

Unit Four Quiz Directions Directions: Get a piece of paper and pen and write your answers to the following 10 questions. When finished check your answers on the following answer slides. Keep each self quiz as proof that you have completed the unit. 87 Copyright 2/2008

Quiz for Unit Four : 

Quiz for Unit Four True or False: HBV and HCV infections can have serious consequences to someone living with HIV. True or False: It is not important to start babies born to HIV positive mothers on antiviral until they begin showing signs of HIV. True or False: Many sexually transmitted disease can cause serious problems in the HIV infected individual including making it more likely they could infect someone during intercourse and having serious effects from what normally would be a simple to treat STD. True or False: Opportunistic infections could result in death for the HIV infected patient. True or False: T.B. virus can be spread through the air. True or False: A presumptive diagnosis of active TB is made when there are positive test results or acid-fast bacilli (AFB) in sputum or other bodily fluids. 88 Copyright 2/2008

Quiz for Unit Four Continued… : 

Quiz for Unit Four Continued… True or False: A vaccine is currently available to stop the spread of HIV infection in the body. True or False: Many people find that after time, the virus becomes resistant to the medication, and they must change medications. True or False: Once therapy is discontinued, viral load will increase again for the HIV patient. True or False: Anyone in the state of Washington having HIV has access to free medication and treatment. 89 Copyright 2/2008

Answers Guide for Quiz Four : 

Answers Guide for Quiz Four True or False: HBV and HCV are not a concern for someone living with HIV. True or False: It is not important to start babies born to HIV positive mothers on antiviral until they begin showing signs of HIV. True or False: Many sexually transmitted disease can cause serious problems in the HIV infected individual including making it more likely they could infect someone during intercourse and having serious effects from what normally would be a simple to treat STD. True or False: Opportunistic infections could result in death for the HIV infected patient. True or False: T.B. virus can be spread through the air. True or False: A presumptive diagnosis of active TB is made when there are positive test results or acid-fast bacilli (AFB) in sputum or other bodily fluids. 90 Copyright 2/2008

Answers Guide for Quiz Four : 

Answers Guide for Quiz Four True or False: A vaccine is currently available to stop the spread of HIV infection in the body. True or False: Many people find that after time, the virus becomes resistant to the medication, and they must change medications. True or False: Once therapy is discontinued, viral load will increase again for the HIV patient. True or False: Anyone in the state of Washington having HIV has access to free medication and treatment. 91 Copyright 2/2008

Congratulations : 

Congratulations You have completed Unit Four of HIV/AIDS online learning course. You will now move on to Unit Five HIV/AIDS Manifestation in the mouth and HIV and AIDS ethical Issues. Don’t worry the next two units will be considerably shorter than this corker! 92 Copyright 2/2008

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