HealthStream Regulatory Script

HealthStream Regulatory Script Overview of HIV (CE) Version: [May 2006] Lesson 1: Introduction Lesson 2: HIV & AIDS Lesson 3: Transmission of HIV Lesson 4: HIV Testing Lesson 5: Treatment & Prevention of HIV Infection

Lesson 1: Introduction 1001 Introduction Welcome to the introductory lesson on an overview of HIV. [glossary] IMAGE: 1001.GIF HIV is one of the most important health threats of our time. It has killed millions of people in the United States and worldwide. Therefore, all healthcare professionals need a basic understanding of the virus and the disease it causes: AIDS [glossary]. As your partner, HealthStream strives to provide its customers with excellence in regulatory learning solutions. As new guidelines are continually issued by regulatory agencies, we work to update courses, as needed, in a timely manner. Since responsibility for complying with new guidelines remains with your organization, HealthStream encourages you to routinely check all relevant regulatory agencies directly for the latest updates for clinical/organizational guidelines. Point 1 of 4 2

1002 Course Rationale This course will teach you the basics about HIV and AIDS. NO IMAGE You will learn: o The relationship between HIV and AIDS o How HIV is spread o How HIV infection is diagnosed o How HIV infection can be prevented and treated Point 2 of 4

1003 Course Goals After completing this course, you should be able to: List key features of HIV and AIDS. Recognize how HIV is spread. Identify tests used to diagnose HIV infection. Specify tests and methods used to follow the progress of HIV infection. Cite strategies for preventing the spread of HIV. NO IMAGE Point 3 of 4

1004 Course Outline This introductory lesson gives the course rationale, goals, and outline. FLASH ANIMATION: 1004.SWF/FLA Lesson 2 describes the relationship between HIV and AIDS. Key features of HIV and AIDS are presented. Lesson 3 explains how HIV is spread. Lesson 4 discusses HIV testing. Finally, lesson 5 provides a brief outline of HIV prevention and treatment strategies. Point 4 of 4

Lesson 2: HIV & AIDS 2001 Introduction Welcome to the lesson on HIV and AIDS. FLASH ANIMATION: 2001.SWF/FLA Point 1 of 13

2002 Objectives After completing this lesson, you should be able to: Identify the relationship between HIV and AIDS. Recognize how HIV affects the immune system. List the stages of HIV infection. NO IMAGE Point 2 of 13

2003 Are HIV & AIDS the Same Thing? HIV and AIDS are not the same. IMAGE: 2003.GIF HIV is a virus that affects the human immune system. AIDS is the disease that the virus can cause. Point 3 of 13

2004 How HIV Affects the Immune System The immune system is made up of cells and tissues that: o Protect the body from infection. o Fight disease. IMAGE: 2004.GIF One of the key cells of the immune system is the CD4 cell. HIV infects CD4 cells. This harms the immune system. As a result, the body becomes less and less able to defend itself from disease. Opportunistic diseases can develop. These are diseases that usually affect only people with unhealthy immune systems. Point 4 of 13

2005 How HIV Can Cause AIDS HIV infection develops in four basic stages: 1. Initial infection 2. Infection without symptoms 3. Infection with symptoms 4. AIDS Click on each stage to learn more. CLICK TO REVEAL Initial infection This stage begins the moment HIV enters the body. Sometimes, there is a brief flu-like illness. In many cases, there are no symptoms at all. During this stage, HIV test results are usually negative. However, the infected person can spread HIV to others. Infection without symptoms This stage of HIV infection can last for years. The patient has no symptoms. CD4 counts do not drop significantly. However, the virus is actively copying itself within CD4 cells. This begins the damage to the immune system. The infected person tests positive on an HIV test. The person can spread HIV to others. Infection with symptoms This stage of HIV infection also can last for years. The patient s CD4 count begins to decrease. Symptoms begin to develop. Symptoms are often non-specific. They may include tiredness, fever, loss of appetite, and swollen lymph glands [glossary]. Opportunistic diseases such as yeast infection may develop. The infected person tests positive on an HIV test. The person can spread HIV to others. AIDS AIDS is the final and most severe stage of HIV infection. AIDS is diagnosed when the patient has two signs of the disease. First, the patient must test positive for HIV. Second, the patient has either a CD4 count of fewer than 200 cells/ml of blood or at least one opportunistic disease. Examples of opportunistic diseases in patients with AIDS include pneumocytis carinii pneumonia, Kaposi s sarcoma, cryptosporidiosis, CMV disease, thrush, and active tuberculosis [glossary]. The person can spread HIV to others. Point 5 of 13

2006 HIV Infection Without AIDS Many anti-hiv drugs have been developed over the past 20 years. NO IMAGE As a result, HIV-infected patients are able to live longer and longer without developing AIDS. Point 6 of 13

2007 Review FLASH INTERACTION: 2007.SWF/FLA Drag and drop terms from the word bank to complete the following sentences. 1. HIV is a. [virus] 2. HIV infects cells of the. [immune system] 3. The final and most severe stage of HIV infection is. [AIDS] Word bank: Virus Bacterium Fungus Cancer Immune system Nervous system Reproductive system Urinary system Symptomatic infection AIDS Point 7 of 13

2008 Summary You have completed the lesson on HIV and AIDS. NO IMAGE Remember: o o o o HIV is the virus that causes AIDS. HIV infects CD4 cells. This damages the immune system. HIV infection occurs in stages. A stage without symptoms can last for years. AIDS is the final and most severe stage of HIV infection. With proper treatment, HIV-infected patients are living longer and longer without developing AIDS. Point 8 of 13

Lesson 3: Transmission of HIV 3001 Introduction Welcome to the lesson on the spread of HIV. FLASH ANIMATION: 3001.SWF/FLA Point 1 of 13

3002 Objectives After completing this lesson, you should be able to: NO IMAGE - List body fluids known to contain infectious HIV. o Identify ways in which these body fluids can spread HIV from person to person. o Identify body fluids that do not contain HIV. o Recognize forms of casual contact that do not carry a risk for HIV transmission. Point 2 of 13

3003 HIV in Body Fluids When a person is infected with HIV, he or she can spread the virus to others through certain body fluids. IMAGE: 3003.JPG These fluids are: o Blood o Semen (men) o Vaginal secretions (women) o Breast milk (lactating women) These body fluids are known to spread HIV. See the table to the right for a list of body fluids that may contain HIV. Point 3 of 13

3004 HIV Transmission Spread of HIV can happen if an infectious body fluid comes into contact with certain areas of an uninfected person s body. IMAGE: 3004.GIF These areas, in general, are: o Non-intact skin [glossary] o Mucous membranes [glossary] o The bloodstream Contact can happen as a result of: o High-risk behaviors [glossary] o Mother-to-child exposure o Accidental exposure in the healthcare setting On the following screens, let s take a closer look at each way of spreading HIV. Point 4 of 13

3005 High-Risk Behaviors HIV is most often spread through these high-risk behaviors: o Unprotected sex with an HIV-infected partner o Sharing needles/syringes for injection drugs with an HIVinfected person FLASH ANIMATION: 3005.SWF/FLA Point 5 of 13

3006 High-Risk Behaviors: Unprotected Sex Unprotected vaginal, anal, or oral* sex can spread infected semen or vaginal secretions: o From an infected partner o To an uninfected partner s mucous membranes (lining the vagina, penis, anus/rectum, or mouth) IMAGE: 3006.GIF If the infected person has cuts or sores in the area of contact, contaminated blood also could be spread. If the uninfected person has cuts or sores in the area of contact, infected fluids also could make contact with that non-intact skin. *Note: Oral sex is included in the list of high-risk behaviors. Despite popular opinion, oral sex is not a safe substitute for intercourse. HIV and other STD s can be spread through oral sex. Point 6 of 13

3007 High-Risk Behaviors: Sharing IV Drugs Sharing injection-drug equipment spreads contaminated blood: o From the infected person o To the uninfected person s bloodstream IMAGE: 3007.GIF Point 7 of 13

3008 Mother-to-Child HIV may spread from an infected mother to her child during: o Pregnancy o Labor/delivery o Breastfeeding FLASH ANIMATION: 3008.SWF/FLA During these activities, the mother s contaminated body fluids (blood, vaginal secretions, breast milk) can come into contact with the child s bloodstream and/or mucous membranes. Point 8 of 13

3009 Occupational Exposure Healthcare personnel are at risk for HIV infection from: o Needle-stick or other sharps injury [glossary] o Splashes, sprays, or other sources of patient bodily fluids FLASH ANIMATION: 3009.SWF/FLA Sharps injury can give HIV direct access to the worker s bloodstream. Splashes and sprays can put infected fluids in contact with exposed mucous membranes or non-intact skin. This is especially likely if the healthcare worker is not using proper Standard Precautions. Point 9 of 13

3010 Noninfectious Bodily Fluids As a healthcare provider, you must be careful to protect yourself from body fluids. IMAGE: 3010.JPG However, certain fluids and secretions are not infectious. HIV is not present in an infected person s o Feces o Nasal secretions o Saliva o Sputum o Sweat o Tears o Urine o Vomit Point 10 of 13

3011 Transmission Myths and Misconceptions A person cannot get (or give) HIV infection from: IMAGE: 3011.JPG Casual contact Sweat, saliva, or tears Clothing Public drinking fountains, phones, or toilets Sharing a meal Insect bites or stings Donating blood Kissing with a closed mouth Note: Kissing with an open mouth carries a small risk of HIV transmission. Blood contact may occur if cuts or sores are present. Point 11 of 13

3012 Review is (are) at increased risk for HIV infection. a. An IV drug user b. The unborn child of an HIV-positive mother c. A healthcare worker who does not follow Standard Precautions d. A, B, and C e. None of the above MULTIPLE CHOICE INTERACTION Correct: D Feedback for A: Not quite. The correct answer is D. All of these people are at increased risk for HIV. Feedback for B: Not quite. The correct answer is D. All of these people are at increased risk for HIV. Feedback for C: Not quite. The correct answer is D. All of these people are at increased risk for HIV. Feedback for D: Correct. All of these people are at increased risk for HIV. Feedback for E: Incorrect. The correct answer is D. All of these people are at increased risk for HIV. Point 12 of 13

3013 Summary You have completed the lesson on HIV transmission. NO IMAGE Remember: o HIV is present in blood, semen, vaginal secretions, and breast milk. o HIV is spread when an infectious body fluid comes into contact with non-intact skin, mucous membranes, or the bloodstream. o HIV can be spread through high-risk behaviors. This includes unprotected sex and sharing IV-drug equipment. o An HIV-positive mother can spread the virus to her child during pregnancy, labor and delivery, or breastfeeding. o Healthcare workers are at risk for occupational exposure to HIV. o Many body fluids do not contain HIV. o HIV cannot be spread through casual contact. Point 13 of 13

Lesson 4: HIV Testing 4001 Introduction Welcome to the lesson on testing for HIV. FLASH ANIMATION: 4001.SWF/FLA Point 1 of 10

4002 Objectives After completing this lesson, you should be able to: o Identify lab tests used to diagnose HIV infection. o List key steps in the HIV testing procedure. o Cite three reasons for the importance of HIV testing. o Recognize groups at increased risk for HIV infection. NO IMAGE Point 2 of 10

4003 Antibody Testing In most cases, HIV infection is diagnosed by looking for antibodies [glossary] against the virus. IMAGE: 4003.GIF One problem with antibody testing is that an infected person may not test positive until three to six months after being infected. Before this time, an HIV antibody test on an infected person may come back negative. This is a false negative. The infected person does carry the virus and can infect others. Point 3 of 10

4004 ELISA HIV antibody testing uses a series of lab procedures. The first procedure used is the ELISA. ELISA stands for enzymelinked immunosorbent assay. IMAGE: 4004.GIF This test also may be called an enzyme immunoassay (EIA). ELISA can detect HIV antibodies in: o Blood drawn from a vein o Finger-prick blood o Oral fluid o Urine Point 4 of 10

4005 Confirmatory Testing If the first ELISA test result is positive, more tests are done. This is to verify the positive result. IMAGE: 4005.GIF First, two repeat ELISAs are performed. If either or both of these are positive, the sample is tested by Western blot. This is a different lab method of looking for antibodies. If the Western blot is positive, the sample is HIV-positive. If the results of the Western are negative or unclear, the patient should come back in a month to repeat the testing. Point 5 of 10

4006 Significance of Testing HIV testing is important for three main reasons: o Patients who test positive can get the care they need. o Patients who find out they are HIV-positive are more likely to stop high-risk behaviors. o Testing allows public health agencies to track HIV infection trends. IMAGE: 4006.GIF The next lesson takes a closer look at follow-up care and decreasing high-risk behaviors. The rest of this lesson takes a brief look at using HIV test results to track HIV trends. Point 6 of 10

4007 HIV Surveillance & Epidemiology As of January 2004, 49 of the 50 United States had laws requiring providers to report positive HIV test results. IMAGE: 4007.GIF These laws help state and federal health agencies follow trends related to HIV infection. Following trends can help: Identify groups at risk. Guide prevention efforts. These efforts include the distribution of money and other resources. Point 7 of 10

4008 Groups at Risk Surveillance data have consistently shown that two groups in the United States are at highest risk for HIV infection. These groups are: o Men who have sex with men o Injection-drug users IMAGE: 4008.GIF However, the face of HIV/AIDS in the U.S. is starting to change. Groups at increasing risk for HIV/AIDS include: o Women o Young people o People of color Point 8 of 10

4009 Review FLASH INTERACTION: 4009.SWF/FLA Drag and drop terms from the word bank to complete the following paragraph. A patient requests HIV testing. A sample is drawn. The first test is the [ELISA]. The test results are positive. The next step is to perform [two repeat ELISAs]. The results are positive. Confirmatory testing is performed by [Western blot]. The test results are unclear. The patient should be told [to return in one month for repeat testing]. Word bank: ELISA Viral load test p24 antigen assay Two repeat ELISAs Western blot That he or she is HIV-positive That he or she is HIV-negative To return in one month for repeat testing Point 9 of 10

4010 Summary You have completed the lesson on HIV testing. NO IMAGE Remember: o Antibody testing is the most common test used to diagnose HIV infection. o Antibody testing within three to six months of HIV infection may give a false negative result. o Antibody testing starts with the ELISA test. This test can be done on blood drawn from a vein, finger-prick blood, oral fluid, or urine. o If the first ELISA test is positive, the ELISA is repeated twice. If either or both of these tests are positive, a Western blot is done. If the Western is positive, the patient is HIV-positive. o HIV testing is important for planning treatment, decreasing high-risk behaviors, and surveillance. o HIV surveillance shows that men-who-have-sex-with-men and injection-drug users are at highest risk for HIV in the United States. HIV risk is increasing among women, young people, and people of color. Point 10 of 10

Lesson 5: Treatment & Prevention of HIV Infection 5001 Introduction Welcome to the lesson on treatment and prevention of HIV infection. FLASH ANIMATION: 5001.SWF/FLA Point 1 of 15

5002 Objectives After completing this lesson, you should be able to: o List tests used to establish a baseline [glossary] and monitor the health of an HIV-infected patient. o Identify the role of drugs in treating HIV infection. o Cite strategies for reducing the risk of HIV transmission. NO IMAGE Point 2 of 15

5003 CD4 Count & Viral Load Remember: HIV infection can progress very slowly. Patients can have a long period without symptoms. Some patients may not have testing until years after they are infected. Therefore, when a patient tests positive for HIV, it is important to find out exactly how far the infection has progressed. This is done by taking baseline measurements. Important baseline measurements are: CD4 count Viral load CLICK TO REVEAL CD4 count Remember: HIV attacks the immune system by infecting CD4 cells. As HIV infection progresses, CD4 count falls. Therefore, CD4 count gives a measure of how far the infection has progressed. It also indicates how much damage has been done to the immune system. Viral load Viral load is a measure of how much virus is present in the body. As HIV infection progresses, viral load increases. Click on each measurement to learn more. Point 3 of 15

5004 Medical History & Physical Exam Other basic lab tests may be used to check the baseline health of an HIV-positive patient. IMAGE: 5004.GIF The patient also should have a: Full physical exam Detailed medical history Point 4 of 15

5005 Co-infections and Opportunistic Infections Finally, certain other infections are often present with HIV. For example, patients often have other STDs. IMAGE: 5005.GIF Tests should be performed to identify whether these infections are present. Any opportunistic infections also should be identified and addressed. Point 5 of 15

5006 Monitoring HIV Infection Once a baseline has been established, the HIV-infected patient should continue to have regular medical checkups. IMAGE: 5006.GIF Regular checkups are needed to: Track the progress of the infection. Plan treatment. The infection is tracked by monitoring: o CD4 count (every three to six months) o Viral load (every three to four months) Overall health of the patient also gives an indication of how HIV infection is progressing. Point 6 of 15

5007 Treatment of HIV It is important to monitor the progress of HIV infection. IMAGE: 5007.GIF This can help the patient decide when to start drug treatment. The HIV drugs available today do not cure the infection. They do slow the infection down. This can help the patient stay healthy longer. The CDC [glossary] is currently involved in phase 2 clinical trials for an HIV vaccine. Point 7 of 15

5008 HIV Prevention Remember: Common ways of spreading HIV are: High-risk behaviors Mother-to-child transmission IMAGE: 5008.GIF Patients who engage in high-risk behaviors should be given information about risk prevention. HIV-positive mothers should be given information about how to reduce the risk of spreading HIV to their children. Let s take a closer look on the following screens. Point 8 of 15

5009 High-Risk Behaviors: Unprotected Sex To prevent sexual transmission of HIV, only two methods are 100% effective: o Sexual abstinence [glossary] o Sexual activity only in a long-term, mutually monogamous [glossary] relationship with an HIV-negative partner IMAGE: 5009.GIF For some of your patients, these may be realistic goals. For other patients, you will need to provide information on how to make unsafe sexual relationships safer. For example, help patients come up with specific strategies for: o Using latex condoms correctly and consistently o Reducing the number of sexual partners o Reducing the number of risky sexual partners Point 9 of 15

5010 High-Risk Behaviors: IV Drug Use For IV-drug users, the safest practice is to stop using injection drugs. IMAGE: 5010.GIF In many cases, however, this may not be a realistic goal. In these cases, help the patient come up with specific strategies for: o Entering a drug treatment program o Using clean needles for drug injection Point 10 of 15

5011 Mother-to-Child Transmission The CDC recommends that HIV testing should be offered to all pregnant women. IMAGE: 5011.GIF If a pregnant woman tests positive, she has a treatment option. This treatment uses the drug AZT (Retrovir). The treatment plan uses: 1. Oral AZT, starting at 14 to 34 weeks of pregnancy 2. Intravenous AZT (IV) during labor and delivery 3. Liquid AZT, given to the baby every six hours, for the first six weeks of life This three-part AZT treatment lowers the risk that HIV will be spread to the child by almost 70%. Remember: HIV also can be spread through breast milk. Therefore, HIV-positive mothers should not breastfeed. Point 11 of 15

5012 Occupational Exposure You now know the basics for helping to protect patients from HIV exposure and infection. IMAGE: 5012.GIF Let s take a look at reducing your risk. To help protect workers from HIV and other bloodborne infections, OSHA issued the Bloodborne Pathogens Standard (BPS) in 1992. The BPS mandates the use of Universal Precautions (now Standard Precautions). Point 12 of 15

5013 Standard Precautions According to Standard Precautions, healthcare workers should: o Assume that all blood and other bodily fluids are infectious. o Use barrier protection (gloves, face shield, protective clothing, etc.) as needed to protect skin and mucous membrane from contact with blood and other bodily fluids. o Wash hands and other skin surfaces immediately and thoroughly after contact with patient blood or other bodily fluids. o Wash hands immediately after glove removal. o Avoid accidental injury from needles, scalpel blades [glossary], and other sharps. IMAGE: 5013.GIF Point 13 of 15

5014 Review HIV drugs available today: a. Cure HIV infection. b. Slow the progress of HIV infection. c. Prevent HIV infection from developing into AIDS. d. Prevent the development of all opportunistic infections. MULTIPLE CHOICE INTERACTION Correct: B Feedback for A: Incorrect. There are no drugs available today to cure HIV infection. The correct answer is B. Available drugs slow the progress of HIV infection and help the patient stay healthy. Feedback for B: Correct. Available drugs slow the progress of HIV infection and help the patient stay healthy. Feedback for C: Incorrect. Available drugs slow the progress of HIV infection and help the patient stay healthy. However, they cannot ensure that HIV infection does not progress to AIDS. The correct answer is B. Feedback for D: Incorrect. Available drugs slow the progress of HIV infection and help the patient stay healthy. However, they cannot ensure the prevention of all opportunistic infections. The correct answer is B. Point 14 of 15

5015 Summary You have completed the lesson on HIV treatment and prevention. NO IMAGE Remember: o CD4 count and viral load are used to establish a baseline and monitor the health of an HIV-infected patient. o HIV-infected patients also should be assessed for overall health. o Careful monitoring can help an HIV-infected patient decide when to start drug treatment. Drugs do not cure HIV infection. However, they can help the patient stay healthy for longer. o All patients should be encouraged to decrease high-risk behaviors. o HIV-positive pregnant women should be informed of drug treatment available to reduce the risk of spreading HIV to their baby. They also should be informed of the risk of HIV spread with breastfeeding. o Healthcare workers must use Standard Precautions with all patients to guard against exposure to HIV. Point 15 of 15

Course Glossary # Term Definition abstinence refraining from monogamous having only one sexual partner HIV human immunodeficiency virus AIDS acquired immunodeficiency syndrome lymph glands a small collection of tissue along the lymphatic system that acts as a filter pneumocytis carinii pneumonia inflammation of the lungs caused by the fungus pneumocytis carinii Kaposi s sarcoma a type of cancer characterized by the development of skin lesions and most frequently seen in men with AIDS cryptosporidiosis a diarrheal disease caused by the Cryptosporidium parasite CMV disease disease caused by the virus CMV (cytomegalovirus), which is generally harmless to people in otherwise good health, but is a major cause of disease and death in immunocompromised people, including AIDS patients thrush yeast infection of the mouth tuberculosis opportunistic infections non-intact skin mucous membrane high-risk behaviors sharps injury antibodies baseline CDC scalpel blade disease caused by the bacterium Mycobacterium tuberculosis, which can infect any part of the body but usually infects the lungs infections caused by organisms that usually do not cause illness in healthy people, but are more likely to cause infections in people with weak immune systems skin with cuts, scratches, sores, or other breaks the lining of certain cavities, such as the nose, mouth, vagina, and anus/rectum, that produces a protective layer of mucus activities that increase the likelihood that a person will get HIV accidental piercing of the skin by a sharp instrument such as a needle or scalpel proteins formed by the body s immune system to protect against disease-causing organisms starting point Centers for Disease Prevention and Control blade used in a certain type of surgical instrument

Final Exam Question Title: Question 1 Question: AIDS is: Answer 1: A virus Answer 2: A syndrome Answer 3: A bacterium Answer 4: An immune cell Correct Answer: A syndrome Answer Rationale: AIDS is a syndrome: acquired immune deficiency syndrome. This syndrome is caused by a virus (HIV). Question Title: Question 2 Question: HIV harms the body s by infecting CD4 cells. Answer 1: Urinary system Answer 2: Immune system Answer 3: Nervous system Answer 4: Reproductive system Correct Answer: Immune system Answer Rationale: CD4 cells are important cells of the immune system. HIV infects CD4 cells. This harms the immune system. Question Title: Question 3 Question: HIV produces symptoms in all infected people shortly after the virus enters the body. Answer 1: True Answer 2: False Correct Answer: False Answer Rationale: Some patients have a flu-like illness shortly after infection with HIV. But there are often no symptoms at all at this time. Question Title: Question 4 Question: An HIV-positive patient can spread HIV when the patient is in the stage of:

Answer 1: AIDS Answer 2: Infection with symptoms Answer 3: Infection without symptoms Answer 4: All of the above Answer 5: None of the above Correct Answer: All of the above Answer Rationale: An HIV-positive individual can transmit HIV at any stage of infection. Symptoms do not have to be present. Question Title: Question 5 Question: Mother-to-child transmission is the most common way that HIV is spread. Answer 1: True Answer 2: False Correct Answer: False Answer Rationale: The two most common ways of spreading HIV are sexual contact and sharing IV-drug equipment. Question Title: Question 6 Question: A sexually active person is at increased risk for HIV infection if that person has: Answer 1: A single sexual partner Answer 2: Only HIV-negative sexual partners Answer 3: Sexual partners of unknown HIV status Answer 4: All of the above Answer 5: None of the above Correct Answer: Sexual partners of unknown HIV status Answer Rationale: Risk factors for sexual transmission of HIV are: having HIV-positive sexual partners; having sexual partners of unknown HIV status; having multiple sexual partners; having risky sexual partners; having other STDs; and having a sexual partner with other STDs. Question Title: Question 7 Question: A woman is HIV positive. She just had a baby and is producing breast milk. Infectious amounts of HIV can be found in this woman s: Answer 1: (a) Blood Answer 2: (b) Breast milk Answer 3: (c) Vaginal secretions Answer 4: Both A and C Answer 5: All of the above

Correct Answer: All of the above Answer Rationale: In an HIV-positive woman who is producing breast milk, blood, breast milk, and vaginal secretions are all infectious. Question Title: Question 8 Question: HIV can be spread through: Answer 1: Shaking hands Answer 2: Kissing on the cheek Answer 3: Unprotected sexual contact Answer 4: All of the above Answer 5: None of the above Correct Answer: Unprotected sexual contact Answer Rationale: HIV can be spread through sexual contact. It cannot be spread through casual contact. Question Title: Question 9 Question: The ELISA test can detect HIV antibodies in: Answer 1: Urine Answer 2: Oral fluid Answer 3: Finger-prick blood Answer 4: Blood drawn from a vein Answer 5: All of the above Correct Answer: All of the above Answer Rationale: HIV testing by ELISA can be performed on urine, oral fluid, finger-prick blood, or blood drawn from a vein. Question Title: Question 10 Question: In the United States, % of new cases of HIV infection occur in people under the age of 25. % of these cases result from heterosexual contact. Answer 1: 10, 10 Answer 2: 50, 50 Answer 3: 40, 20 Answer 4: 10, 100 Correct Answer: 50, 50 Answer Rationale: In the United States, young people are at increasing risk of HIV infection. A lot of the spread of HIV in this age group is through heterosexual contact.

Question Title: Question 11 Question: The lab values most useful for checking the status of an HIV-positive patient are: Answer 1: CD4 count and viral load Answer 2: Serum albumin and urine microalbumin Answer 3: Blood urea nitrogen and creatinine clearance Answer 4: Complete blood count and liver function tests Correct Answer: CD4 count and viral load Answer Rationale: Viral load tells how many HIV particles are present in the blood. CD4 count gives a measure of how much damage HIV has done to the immune system. Question Title: Question 12 Question: Sexual abstinence and mutually monogamous sexual activity with an HIV-negative partner: Answer 1: Are the only strategies for reducing the risk of sexual spread of HIV Answer 2: Are ineffective strategies for reducing the risk of sexual spread of HIV Answer 3: Are the only strategies 100% effective in preventing the sexual spread of HIV Answer 4: Are realistic strategies to recommend to all patients to reduce the risk of sexual spread of HIV Correct Answer: Are the only strategies 100% effective in preventing the sexual spread of HIV Answer Rationale: Abstinence or monogamy may not be realistic for all patients. Nevertheless, these two strategies are the only ones that will keep a person 100% safe from the sexual spread of HIV. Question Title: Question 13 Question: IV-drug users can reduce their risk of HIV infection by using clean needles. Answer 1: True Answer 2: False Correct Answer: True Answer Rationale: This statement is true. Question Title: Question 14 Question: Standard Precautions should be used: Answer 1: With all patients known to be HIV-positive Answer 2: With all patients, regardless of infection status Answer 3: With all patients known to be HIV-positive, HBV-positive, or HCV-positive Answer 4: With all patients known to be HIV-positive and all patients of unknown HIV status

Correct Answer: With all patients, regardless of infection status Answer Rationale: Standard Precautions should be used with all patients.