HIV/AIDS Information Sheet ‘The HIV Test, In the US 80 million HIV Antibody tests are performed each yoar. The basic teat sevens for HIV antibodies rather than for the virus itself. ‘The two most common test ueed are the Elisa and the Western Blot. ‘The Blise test is inexpensive to perform and only proves wrong 3 out of every 4,000 tests. If 8 patient tests positive after two Blisa tests then another test muet be performed to confirm the results. The Western Blot specifically identifies the molecular weight of the HIV antibody. A false positive or negative reading is extremely rare: only one out of every 2 million tests. All fifty states have Inws that require physicians to report caes of AIDS as defined by the CDC to their Iocal health departments. Florida physicians are required to report cases of AIDS and all patients with positive HIV tosts to the local county health department. Confidentiality Once a test result has been obtained, the identity of the person tested, as well as the test result, whether positive or negative ie confidential. Only the following entities are entitled to the information: ‘The test subject ‘Licensed professionals involved in the diagnosis, treatment, and disposition, including physicians, nurses, or health eare providers who participate in the administration of caze, For statistical purposes positive results are reported to local health departments or the CDC. Confidentiality and all state and federal laws still apply. By law all medical records are confidential; however the Omnibus Act imposes super confidentiality on all information about HIV testing of any identifiable patient. Universal Precautions ‘Tho torm universal precautions refers to a method of infection control in whieh all human blood and other potentially infectious materials are treated as if known to be infectious for ‘HIV and HBV. ‘Though proper gloving is an important part of universal precautions, medical professionals ‘must remember that latex gloves will not prevent the largest threat of HIV transmission in ‘modical settings (needlestick injuries) Common sense must be used, Never recap a needle unless it is a multi-dose syringe, and only use the one-handed scope method for recapping the device to prevent needlestick injury. Masks and protective eyewear chould be used to prevent mucus membrane contact. Remember you should always wash your hands thoroughly before and after any patient contact. Use univereal precautions with all patients. Page tofMedications Currently, we have an arsenal of medications to use in the war against HIV. The standard drugs Nucleoside analogs (AZT, 3TC, D4T, and di). The new weapons against HIV are the protease inhibitors (Crixivan, Ritonavir, or Saquinavir). We now use a new cacktail of ‘metiications consisting of two parts standard drugs (AZT and 8TC) and one part new drug (Grixivan). The new combination of medications used, typically reduee the viral levels by 60% to 70%, until the drugs wear off about every other year. Switching to a new combination can renew the battle, ‘What about a cure? HIV io a tricky virus that hides out in sanctuary sites and mutates on us. Our best success was e patient who was Lreated with an intensive five-drug combination within months of his, infection. Researchers were unable to detect any of the virusas in his blood or his lymph node cultures for a full 87 weeks. Then the virus rebounded to full levels. What the future holds Researchers don’t see a cure anytime soon. However, many possibilities do exiet for the future. Rare cases of natural immunity may provide a new direction, In some people (les than 1%), a T-cell co-receptor (CKR-5) mutation blocks the HIV infection even after repeated exposure, Researchers are learning how this works. In the future, it may be possible to ‘safely mutate other people's CKR-5 receptors to craato a vaceine effect. Pathogenesis ‘The most accepted theory first proposed by Robert Gallo MD, chief of the laboratory of tumor cell biology at the National Cancer Institute in Bethesda, MD, states that FTV (Human Immunodeficiency Virus), the virus that causes AIDS eeems likely to have originated in Africa, where serum samples from the early 1970's have been found to show a high incidence of seropositivity. No serum samples stored in the US, prior to 1978 have been found to be seropositive, Immunology Immunological examinations of patients with AIDS reveal a defect in cell mediated immunity suggesting a pattern of opportunistic infections, Three particular abnormali ‘immune function were found to be occurring in an unusual and distinetive combination known aa the AIDS triad: 1, Decreased number of helper T lymphocytes 2. Hypergammaglobulina-emia 8. Tmpaired response to recall antigens on skin testing Virology In 1983, Barre-Sinoussi isolated a retrovirue named lymphadenopathy-associated virus (LAV), In 1984, Dr. Gallo isolated a retrovirus called human T-cell lymphotropic virus type 111 GHTLY 111), These two isolates have subsequently been found to be identical, and are now recognized to be the cause of AIDS. The virus is now termed 111/LAV or Human Immunodeficiency Virus (HIV). Page oFWhat's a Retrovirus? Retroviruses are RNA viruses, this name refers to the fact that RNA transcription proceeds in a reverse direction (RNA to DNA) before the virus can be inco:porated into a host cell and replicate. This retrograde is dependent on the presence of a viral enzyme called reverse transcriptase. This enzyme is currently being explored as a method of controlling HIV. US Statistics ‘+ From 1981 to 1996 a total of 630,418 AIDS cases were reported and confirmed by the coc © The CDC estimates that nation wide, there may be up to 1,000,000 HIV positive patients. (The majority is unaware of their atatus) * Current US population is about 266,000,000 that are 1 in 256 individuals that may be infected Epidemiology Acquired immunodeficiency syndrome (AIDS) was fret recognized in the US in 1981 with an outbreak of pneumocystis carinii pneumonia and kaposi's sarcoma in previously healthy ‘men. Before 1981 both conditions had been very rare. These new easee were found to be occurring in special risk groups, suggesting that an infection with a blood or semen borne virus was responsible, ‘Transmission ‘The HIV virus may be transmitted through contact with most bodily fluids provided the virus has a means of entry from the reservoir to the new host, Fluids that have been rrecognizod by the Centers for Disease Control and prevention (CDC) as directly linked to the transmission of HIV are: Blood, blood products, semen, vaginal secretions, and possibly ‘synovial, cerebrospinal fluid, pleural uid, peritoneal, pericardial, and amniotic uid. What about Saliva? Saliva has a built in barrier against HIV tranamission. An enzyme called (SLIP) which traps IV in the saliva where as the virus can't break out to infeet your white blood cells, However, when there is blood in the saliva there is a possibility of HIV transmission. Oral sex is low risk Oral foreplay (ie. not to climax) almost never sproads HIV unless there are open cuts, sores, lesions, or wounds in the mouth. However, this low risk only applies to HIV. You can easily contract Herpes, Hepatitis, or Syphilis from oral acx. ‘Mother to fetus transmission ‘The number of HIV positive women who give birth each year ia 7,000, Approximately 25- 80% of babies born to HIV infected women will themselves be HIV infected. (An estimated 4,000-2,000 infants born each year are infected). However, with the help of medications (Gidovadine), the rate of transmission can be redueed to 8.8%. Physicians are also required to offer pregnant pationts an HIV test. Florida law currently requires pregnant women to receive a blood test for eyphilie.Incubation Period From the time you are exposed it will take your system 2 weeks to 9 months until the HIV Antibodies can be doteeted. The virus can then remain in a person's body for years before symptoms of disease develop. This phenomenon which Researchers still don’t understand is {known aa the incubation period. It is estimated that half of the people infected with HIV will develop AIDS within 9.8 years. Informed Consent Tn many states, no medical professional can perform an HIV test without first obtaining informed consent. Consent includes an explanation of the purpose and limitations of the test, meaning of test results, measures for the prevention of exposure to and transmission of HIV, the benefits of partner notification, the availability of health care eervices, and confidentiality of test results. ‘The patient should be pre-test counseled and post-test counseled by a Certified HIV Counselor or licensed physician. When a person ie incompetent or under the age of majority, informed consent must be obtained from a legal guardian or other authorized person, ‘The following minors should be treated as adults: * Any minor whom requests to be examined, tested, or treated for a sexually transmitted disease and is mature enough to make an informed judgment. Any minor who has reached the age of 17 and who has given consent to blood donation. ¢ Any married minor or unwed pregnant minor. Exceptions to HIV Informed Consent + When testing for sexually transmitted diseases, including testing of prostitutes or persons soliciting prostitutes. * Blood and tissue donation specimens Inemergencies, for diagnostic purposes in ordar to provide appropriate eare when the patient is unable to consent. As part of an autopsy for which consent was obtained. Inmates in correctional facilities. Persons convicted of an offense involving the transmission of body Aid. Defendants prosecuted for sexual battery, assault, or rape. Court orders.