The Stigma of HIV and AIDS. A Brief History of HIV/AIDS. A Brief History of HIV/AIDS. Opportunistic Infections and Modes of Transmission

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1 Nurse Caring Concepts 1A The Stigma of HIV and AIDS Opportunistic Infections and Modes of Transmission Week HIV may have spread from monkeys to humans (may have first jumped from chimpanzees to humans in Man died in Congo in what researchers now say was first proven AIDS death 1978 Gay men in the US & Sweden & heterosexuals in Tanzania & Haiti -- begin showing signs of AIDS 1981: Gay men with Pnuemocystitis carinii (PCP) in LA & Kaposi s Sarcoma (KS) in New York PCP in drug addicts Called Gay-Related Immune Deficiency (GRID) 1982: Blood-borne virus suspected as etiology Named AIDS when immune system involvement recognized. First blood transfusion recipient & first babies identified as AIDS + (AIDS in 14 nations)

2 1983: Regional disease patterns noted in US (New Jersey gay men minority of cases & IV drug users half, different in other parts of US Report of 2 separate epidemics in Europe: 1) linked to Africa; 2) gay men who d been in US Recognized AIDS virus transmitted via: pregnancy, birth & blood transfusions AIDS now in 33 countries, 3000 Americans infected; 1283 deaths 1984: AIDS retrovirus isolated; blood testing begun SF gay bathhouses closed Patient zero dies 7000 American have AIDS 1985: First diagnostic kit approved by FDA Rock Hudson dies; Ryan White barred from school 51 countries with AIDS; 1st AIDS conference 1986: Zidovudine (AZT) being used to tx AIDS World Health Organization recommends to give needles & syringes to addicts 1987: Princess Diana opens first AIDS hospital in UK Zambian president s son dies of AIDS First panel for AIDS memory quilt US home burned (sons with AIDS) Infants born HIV+ not always HIV + 100, ,000 cases in 127 countries

3 1988: FDA allows treatment development shortcuts US launches AIDS campaign Needle exchange programs begin 1989: New drugs(antiretrovirals) & AZT available 1990: Ryan White dies; Ryan White CARE Act passed New York needle exchange closed down Breastfeeding risk known WHO reports HIV: 8 million; AIDS: 307, Kimberley Bergalsis with AIDS from dentist asks mandatory testing of HCWs Magic Johnson tests HIV+ Red Ribbon campaign launched New antiretroviral drugs Drug resistance appears 1992: Arthur Ashe announces he is HIV+ First combo drug treatment available 1993: Rudolf Nureyev & Arthur Ashe die of AIDS AZT not useful for asymptomatic HIV+ 1994: Tom Hanks wins Oscar for Philadelphia Story AZT shows benefit to infants of HIV+ moms AIDS is leading cause US death age : Combo treatment becomes standard FDA approves first protease inhibitor WHO program replaced by UNAIDS

4 1996 Magic returns to pro basketball Triple drug treatment introduced New HIV infections Decline in ; SF AIDS hospice closes 1997 Concerns re protease inhibitor side effects & resistance UNAIDS reports HIV epidemic much worse than previous estimates (30 million HIV+) 1998 Canada: outbreak of HIV+ drug addicts AZT price cut; still too costly More new drugs; AIDS vaccine trials begun; 1999 US MD sentenced to 50 yrs after injecting HIV+ blood into former lover; Chimp claimed to be source of HIV South Africa forces drug co. price cut World: 33 million living with HIV/AIDS 2001 HIV/AIDs Statistics North America 900,000 living with HIV 45,000 new infections each year # HIV infections increasing among women, teens, people of color, those who live in rural areas are poor or have violence in their lives Globally Most devastating epidemic in history, still in early stages; 42 million living with HIV Major mode of transmission is heterosexual sex Young, productive people lost to disease; vicious circle as poverty increases vulnerability

5 Modes of Transmission Fragile virus transmitted in body fluids (blood, semen, vaginal secretions, amniotic fluid, breastmilk) containing HIV or infected T- lymphocytes Any behavior resulting in break in skin or mucosa increases risk of exposure Blood & blood products can transmit HIV but risk minimal with current donor & blood screening practices (window between infection & development of antibodies) Modes of Transmission Direct contact with blood or body secretions, usually through break in skin or across mucous membranes (sexually, injection, transfusion) Not spread via hugging, shaking hands, sharing eating utensils HCWs not at increased risk for HIV AIDS if standard precautions observed. Stages of HIV Disease Usually years between HIV infection & AIDS dx CDC categorizes progression of HIV infection & AIDS in adults & adolescents on basis of: CD4+ T-cell counts Clinical conditions associated with AIDS CDC Classifications of HIV/AIDS Primary (acute) infection HIV asymptomatic (Category A) HIV symptomatic (Category B) AIDS(Category C)

6 Primary (Acute HIV) Infection Period from infection with HIV to development of antibodies Intense viral replication occurring & dissemination of HIV throughout body Symptoms range from none to severe flu-like Antibodies in typically can be detected in serum 2 to 3 weeks after infection; when antibodies appear, HIV firmly established in host CD4+ T lymphocyte levels fall then return to baseline resulting in infection steady state HIV Asymptomatic (CDC Category A) After reaching viral set point, chronic, asymptomatic state begins CD4+ T lymphocyte cell count > 500/mm 3 On average, 8 to 10 years in this phase Patients feel well, and show few, if any symptoms Apparent good health continues because CD4 levels high enough to preserve immune response HIV Symptomatic (CDC Category B) CD4+ T lymphocyte levels fall- 200 to 499/mm 3 Symptomatic condition(s) appears considered to have clinical course or require management complicated by HIV infection Includes oropharyngeal candidiasis (thrush), vaginal candidiasis (yeast infection), shingles, oral hairy leukoplasia, cervical dysplasia, fever or diarrhea > 1 month duration

7 AIDS (CDC Category C) CD4+ T lymphocyte levels fall below 200/mm 3 One of the following develops: Opportunistic infection: fungal: pneumocystis carinii pneumonia, viral: cytomagalovirus disease, protozoal: disseminated coccidiomycosis, bacterial: mycobacterium avium complex Opportunistic cancer: Kaposi s Sarcoma (KS) Wasting syndrome: loss of 10% body mass Dementia Pneumocystis carinii (PCP) Most common infection in AIDS clients Causes disease only in immunocompromised hosts Without prophylactic therapy, will develop in 80% of all HIV-infected individuals S/sx: fever, fatigue, non-productive cough, progressive SOB and hypoxemia Kaposis s Sarcoma Most common neoplasm in AIDS clients; especially in homosexual & bisexual men S/sx: Skin: Painless, nodular, reddish lesions varying in size from cm. Lesions grow & may ulcerate, painful Respiratory: dyspnea, respiratory failure GI: diarrhea, oral & esophageal lesions

8 Cytomegalovirus (CMV) Infection with CMV major cause of disease and death in immunocompromised patients S/Sx: Eye: lesions on retina, blurred vision, blindness GI: stomatitis, esophagitis, gastritis, colitis, bloody diarrhea, pain, weight loss Respiratory: pneumonia Mycobacterium Avium Complex (MAC) In disseminated form, is most commonly reported bacterial infection in AIDS patients Poor prognosis; survival 3 to 7 months after infection Only body tissues not frequently infected are the brain, bone & muscle. S/Sx: GI: abdominal pain, diarrhea, debility & wasting. Other: fever, night sweats, fatigue, anorexia, malaise & anemia