HIV & AIDS GN PDF

HIV, AIDS and immunodeficiency Mr B Tighe Biomed GDC Learning Outcomes 1.1.2 1.1.3 1.1.4 1.2.1 1.2.4 1.7.1 1.7.7 7.3 Intended learning outcomes Develop a broad knowledge base in the area of HIV Describe terms HIV, AIDS, Immunodeficiency Identify the stages of HIV Recognize the signs and...

HIV, AIDS and immunodeficiency Mr B Tighe Biomed GDC Learning Outcomes 1.1.2 1.1.3 1.1.4 1.2.1 1.2.4 1.7.1 1.7.7 7.3 Intended learning outcomes Develop a broad knowledge base in the area of HIV Describe terms HIV, AIDS, Immunodeficiency Identify the stages of HIV Recognize the signs and symptoms of HIV and how they manifest  HIV = human immunodeficiency virus What is immunodeficiency? Result in full or partial impairment of immune system Immunodeficiency Primary = genetic Secondary = environmental (HIV, AIDS, malnutrition) Immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off.  Lots of different conditions - huge range IMMUNODEFICIENCY Ataxia-telangiectasia AIDs Complement deficiencies Chediak-Higashi syndrome DiGeorge syndrome Hypogammaglobulinemia HIV Job syndrome Leukocyte adhesion defects Combined immunodeficiency disease The history The history The history In 1983 Luc Montagnier suspected it was caused by a virus. He teamed up with Francoise Barre-Sinoussi and found retrovirus within cells taken from AIDS patients.  One of the hypothesis The cut hunter hypothesis’ Originated from chimpanzee’s The chimpanzee version of the virus is called simian immunodeficiency virus, or SIV. Scientists think it was probably passed to humans when humans hunted these chimpanzees for meat and came in contact with their infected blood. This mutated version is then transmitted from human to human Another theory…  Different to HIV What is AIDS? HIV causes AIDS You cannot catch AIDS AIDS (acquired immune deficiency syndrome) is the term used to describe a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus. HIV infection https://vimeo.com/260291607#embed–detailed https://www.youtube.com/watch?v=5g1ijpBI6Dk https://www.youtube.com/watch?v=BADDj82oces–slidevideo HIV STAGE 1 - Seroconversion illness Short illness soon after they contract HIV (up to 6 weeks). Seroconversion illness or primary or acute HIV infection. Can be asymptomatic or an influenza-like illness Fever, rash, sore throat, headaches etc. Seroconversion is the period when someone with HIV is at their most infectious. Most likely to pass on Or might not know what they have is HIV HIV STAGE 2 - The asymptomatic stage of HIV Once seroconversion is over, most people feel fine and don’t experience any symptoms. This is often called the asymptomatic stage and it can last for several years. Though you might feel well at this stage, the virus is active, infecting new cells, making copies of itself and damaging your immune system’s ability to fight illness. HIV STAGE 3 - Symptomatic HIV The longer you live with HIV without treatment, the greater your risk of developing infections that your weakened immune system can’t fight: certain cancers, as well as the direct effects of HIV. Swollen lymph nodes, weight loss, fever, diarrhoea, cough — when the immune system is compromised Getting ill in one of these ways means that you now have symptomatic HIV. HIV STAGE 4 - Late-stage HIV If HIV has a chance to cause a lot of damage to your immune system, you may become ill from certain serious opportunistic infections and cancers. These illnesses are also known as AIDS-defining. Severe infections = Tuberculosis, meningitis, severe bacterial infections, invasive cancer, non Hodgkin’s lymphoma  When you develop AIDS, you’re potentially going to develop Aids-defining illnesses a whole collection of these illnesses — a collection of these make up AIDS Candidiasis of the oesophagus, bronchi, trachea, or lungs [but NOT oral] Cervical cancer, invasive Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal (greater than one month's duration) Cytomegalovirus disease or CMV (other than liver, spleen, or nodes) Cytomegalovirus retinitis (with loss of vision) Encephalopathy, HIV related Herpes simplex: chronic ulcer(s) (more than 1 month in duration); or bronchitis, pneumonitis, or esophagitis Histoplasmosis, disseminated or extrapulmonary Isosporiasis, chronic intestinal (more than 1 month in duration) Kaposi sarcoma Lymphoma, Burkitt's (or equivalent term) Lymphoma, immunoblastic (or equivalent term) Lymphoma, primary, of brain Mycobacterium avium complex or M kansasii, disseminated or extrapulmonary Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary) Mycobacterium, other species or unidentified species, disseminated or extrapulmonary Pneumocystis pneumonia (PCP) Pneumonia, recurrent Progressive multifocal leukoencephalopathy Salmonella septicemia, recurrent Toxoplasmosis of brain Wasting syndrome due to HIV  Common aids-defining illnesses 5th most common cancer in UK Many types - some grow slow, some grow fast Non-Hodgkin lymphoma. Develops in white blood cells called lymphocytes Cancer of the lymphatic system The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. HIV increases risk of developing non-Hodgkin lymphoma but so does Epstein Barr virus  Lymphatic system Part of the body’s immune system, helping to protect us from infection and disease Also drains fluid from body’s tissue back into the blood The lymphatic system includes: lymph vessels lymph nodes lymphocytes lymphatic organs other lymphatic tissue. Clear fluid called lymph moves through vessels and nodes and eventually return to blood stream. As the lymph fluid passes through nodes it filters out bacteria and viruses. Contain infection fighting white blood cells called lymphocytes. Lymph nodes often swell when fighting infection Common aids-defining illnesses Tuberculosis (TB) Usually attacks lungs but can attack any part of body; kidneys, spine, brain. Not everyone infected with TB becomes sick Caused by a bacterium called Mycobacterium tuberculosis. HIV increases risk of being infected with TB Due to weakened immune system Infection with both HIV and TB is called HIV/TB coinfection. People living with HIV Globally PLHIV were 19 times more likely to fall ill with TB Untreated lateness TB infection is more likely to advance to TB disease in people with HIV  Can be spread through pigeon droppings or fruit Common aids-defining illnesses Cryptococcal meningitis Caused by a fungus named cryptococcus neoformans Most people likely breathe in this microscopic fungus at some point in their lives but never get sick from it. In people with HIV, Cryptococcus can stay hidden in the body and later cause a serious (but not contagious) brain infection called cryptococcal meningitis. Common aids-defining illnesses Cachexia (Wasting syndrome/ Anorexia cachexia syndrome) Not limited to HIV Complex process Sudden loss of mass (weight) Not just associated with cancer Also common in advance stages of other illnesses (HIV, kidney disease etc) Still unsure of what happens Complex process — involves several organs and system within body Cells within muscles, fat and liver might not respond well to insulin — insulin resistance (insulin helps to take glucose from blood so your body can’t use glucose from blood for energy if insulin resistant) Cytokines contributes to loss of fat and muscle on body. Common aids-defining illnesses Kaposi’s sarcoma (KS) Caused by Herpes virus type 8 (HHV-8) HHV-8 is a relatively common virus, and most people who have it will not develop Kaposi's sarcoma. The virus is thought to be spread during sex, through blood or saliva, or perinatal transmission. Can cause cancer in people with a weakened immune system, and people who have a genetic vulnerability to the virus. Common aids-defining illnesses Bluey, purpley, pink lesions on the skin Kaposi’s sarcoma (KS) Increasing chances of Kaposi sarcoma A weakened immune system allows the HHV-8 virus to multiply. The virus alters the genetic instructions that control cell growth, causing the endothelial cells reproduce uncontrollably and form tumours. It affects the cells which line the inside surface of blood vessels and lymphatic vessels, called endothelial cells. Can be limited, only affecting the skin, or more extensive with involvement of lymph nodes and internal organs such as the lungs or digestive system Common aids-defining illnesses Kaposi’s sarcoma (KS) on the skin Can get sore and ulcerate or even enlarge Common aids-defining illnesses Kaposi’s sarcoma (KS) in the mouth Common aids-defining illnesses Candidiasis (Thrush) NOT EVERYONE WITH ORAL THRUSH HAS HIV!! Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida Usually affects of bronchi, trachea, lungs or oesophageal Oropharyngeal candidiasis is the most common opportunistic infection to affect individuals with HIV Common aids-defining illnesses Candidiasis Easily removable, curd-like white plaques, underneath which lies raw or bleeding mucosa Predominant symptoms are sore mouth and throat Can be asymptomatic A patient with oesophageal candidiasis complains of dysphagia and/or odynophagia. Difficulty swallowing Painful swallowing Respiratory symptoms include increased phlegm production, chronic cough and hoarseness of voice Common aids-defining illnesses Hairy leukoplakia Oral hairy leukoplakia is a condition triggered by the Epstein-Barr virus. It happens most often in people whose immune systems are very weak. It is most often seen in people with HIV. This condition can be a warning sign of HIV or a severely weakened immune system. Common aids-defining illnesses Hairy leukoplakia The condition causes white patches on the tongue. The patches can cause mild discomfort and taste changes. Treatment is aimed at treating the underlying immune problem, such as HIV. What about mental health? “People living with HIV/AIDS (PLWHA) have higher rates of 'modifiable' cancer risk” What is a modifiable cancer risk? 'Modifiable' cancer risk What is a modifiable cancer risk? Modifiable cancer risks are things that can often be avoided with lifestyle changes, like: - Smoking - Drinking alcohol - Infection with HPV and hepatitis B and C Park et al., 2016 study 54% of HIV positive people included in the study were smokers – around two-and- a-half times higher than the general American population. 5% of HIV positive people were co-infected with hepatitis B compared to 0.3% of the general population with hepatitis B. 26% of the individuals had chronic hepatitis C compared to 0.9% of the general American population. 46% of women had HPV infection that could lead to cancer compared to 29% of the general US population. 68% of men who have sex with men had anal HPV infection with a risk of leading to cancer, although there were no general population figures available.  If a patient has HIV — important to ask them to reduce alcohol and smoke and giving them heathly lifestyle — as any other patient!! Alcohol and risk of cancer Guidelines state consuming more than 14 units of alcohol each week increases risks of cancer. Increased death rate in HIV+ men who drink more than 13 units of alcohol has been found https://www.drinkaware.co.uk/tools/unit-and-calorie-calculator Transmission of HIV infection HIV is found in the body fluids of an infected person (semen, vaginal and anal fluids, blood and breast milk) The most common way of getting HIV in the UK is through having anal or vaginal sex without a condom. Anal sex carries the highest risk – especially for the passive partner Cannot be become infected through kissing, hugging, The chance of getting HIV through oral sex is very low shaking hands, sharing objects, food, water. HIV cannot be transmitted through sweat, urine or saliva People with HIV taking antiretroviral treatment are virally suppressed so do not transmit HIV to sexual partners Risk factors Behaviours and conditions that put individuals at greater risk of contracting HIV include: Having another sexually transmitted infection (STI) Sharing contaminated needles, syringes receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing Needle stick injuries More risk at catching Hep B than HIV through needle stick Diagnosing HIV Seek medical advice as soon as possible if you think you might have been exposed to HIV. If you experience a needle stick then contact occupational health immediately (A&E if out of hours). If the patient is known to have HIV then ask if they would be happy to attend occupational health for blood tests. Have to respect wishes if they refuse — cannot make them Ask for the patients viral load if they know it The only way to find out if you have HIV is to have an HIV test. Coming into contact with HIV It's important to be aware that: Recommended as soon as possible and ideally within 24 hours You have 72 hours to access emergency anti-HIV medicine called post-exposure prophylaxis (PEP) Negative HIV tests may need to be repeated at 6, 12 and 24 weeks after the incident Have to complete full 6 months of test to check If the test becomes positive, you'll be referred to a specialist HIV clinic for some more tests and a discussion about your treatment options. Self testing https://freetesting.hiv/ https://www.test.hiv/ Treatment for HIV Antiretroviral medicines (ART) are used to treat HIV. Allowing immune system to repair itself and prevent further damage They work by stopping the virus replicating in the body Combination of different medicines taken every day The goal of HIV treatment is to have an undetectable viral load. Level of HIV virus in body is low enough not to be detected Viral load Viral load is the amount of HIV in the blood. A viral load test shows how much of the virus is in the body by measuring how many particles of HIV are in a blood sample. The results are given as the number of copies of HIV per millilitre of blood – for example 200 copies/ml. U=U - 100,000 copies/ml Over 90% of people with HIV have effective treatment and are undetectable Undetectable = untransmittable U=U HIGH C D4 COUN T VIRAL LOAD 20 CO BELO PIES/ W ML. Unmedicated HIV / AIDS 1000 AD > AL LO ML. VIR OPIES/ C UNT O C D4 C LOW  Pre-Exposure Prophylaxis (PrEP) Blocks the acquisition of HIV. PrEP as a prevention choice. Taken regularly (one tablet per day) or 2+1+1 option (event based dosing) Truvada Anti retrovirals by HIV negative people to block acquisition of HIV Recommends as prevention choice for people at substantial risk of HIV (if someone’s partner has HIV etc) Post-Exposure Prophylaxis (PEP) Needs to be taken within 72 hours To prevent infection 28-day course of ARV drugs WHO recommends PEP use for both occupational and non-occupational exposures, and for adults and children. A single tablet called Truvada and two tablets of raltegravir End the stigma Statistics In 2019, it was estimated that there are 105 200 people living with HIV in the UK. End the stigma Statistics In 2019, it was estimated that there are 105 200 people living with HIV in the UK. 94% of these people are diagnosed, therefore 6% do not know they have it. End the stigma Statistics In 2019, it was estimated that there are 105 200 people living with HIV in the UK. 94% of these people are diagnosed, therefore 6% do not know they have it. This means that around 1 in 16 people living with HIV in the UK do not know that they have the virus. End the stigma Statistics In 2019, it was estimated that there are 105 200 people living with HIV in the UK. 94% of these people are diagnosed, therefore 6% do not know they have it. This means that around 1 in 16 people living with HIV in the UK do not know that they have the virus. 98% of people diagnosed with HIV in the UK are on treatment, and 97% of those on treatment are virally suppressed which means they can’t pass the virus on. Lets break it down… Gender Ethnicity Age UK distribution Mode of transmission In the surgery You should not… Book the patient at the end of the day Place used items in a separate bag Double glove / excessive PPE Refuse to see the patient Ridicule, insult or be derogatory about the patient to team members Make assumptions You should… Universal precautions / standard infection control precautions (SICPs) Possess a positive welcoming attitude Treat the patient with respect and dignity Carry out treatment as you would a non HIV positive patient normally. Patients living with HIV For patients living with HIV, we should encourage them to: take regular exercise No different to patients without HIV eat a well balanced healthy diet stop smoking have yearly flu jabs to minimise the risk of getting serious illnesses Reduce alcohol intake Ensure optimal oral hygiene 3 - 2 – 1 on HIV, AIDS and immunodeficiency 3 things you have learned ?Discussion forum? 2 things I found interesting 1 question I still have Useful videos https://www.youtube.com/watch?v=kkVW8lH3eIg https://www.youtube.com/watch?v=s0Jn8Ln96Y0 https://www.youtube.com/watch?v=3idMpvv0pmc https://www.youtube.com/watch?v=EDpFXxGdAXE https://www.youtube.com/watch?v=eETWIzHZWEY References https://www.aidsmap.com/news/jan-2016/high-rates-modifiable-cancer-risk-factors-present-western-hiv-positive-patients Park, L., Hernández-Ramírez, R., Silverberg, M., Crothers, K. and Dubrow, R., 2016. Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS. AIDS, 30(2), pp.273-291. www.tht.org.uk https://www.nat.org.uk/about-hiv/hiv-statistics www.ght.org.uk https://www.sandyford.scot/media/3149/3-increase-in-hiv-testing-s-allstaff.pdf https://www.thewellproject.org/hiv-information/aids-defining-conditions https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html https://www.youtube.com/watch?v=Ly1pPNoKGZU http://scienceofhiv.org/downloads/HIV_narrated.mov https://www.youtube.com/watch?v=U52g6ZlR1W0 https://www.gov.uk/government/statistics/hiv-annual-data-tables