HIV, AIDS and Immunodeficiency - 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 What is immunodeficiency? Immunodeficiency Immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off. Primary immunodeficiency- genetic defect Secondary immunodeficiency- environmental factors such as hiv, aids , malnutrition  Lots of different conditions 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. 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… What is 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 causes aids. 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. -D Can be asymptomatic or an influenza-like illness Seroconversion is the period when someone with HIV is at their most infectious. 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. Getting ill in one of these ways means that you now have symptomatic HIV. *swollen lymph node *weight loss *fever *cough 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. Next page - > Aids-defining illnesses 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 Non-Hodgkin lymphoma. 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. 5th most common cancer in the uk not everyone with hiv. Lymphatic system Part of the body’s immune system, helping to protect us from infection and disease The lymphatic system includes: lymph vessels lymph nodes lymphocytes lymphatic organs other lymphatic tissue. Common aids-defining illnesses Tuberculosis (TB) Caused by a bacterium called Mycobacterium tuberculosis. HIV increases risk of being infected with TB Infection with both HIV and TB is called HIV/TB coinfection. Globally PLHIV were 19 times more likely to fall ill with TB 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) 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 Kaposi’s sarcoma (KS) 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 Common aids-defining illnesses Kaposi’s sarcoma (KS) in the mouth Common aids-defining illnesses Candidiasis 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 A patient with oesophageal candidiasis complains of dysphagia and/or odynophagia. Difficulty 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? Factors that can be avoided '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. 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 The chance of getting HIV through oral sex is very low HIV cannot be transmitted through sweat, urine or saliva 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 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. 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: 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 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. 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. 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 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 HIV preventative drug - dosent mean they have hiv Post-Exposure Prophylaxis (PEP) Needs to be taken within 72 hours 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. 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 Patients living with HIV For patients living with HIV, we should encourage them to: take regular exercise 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 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