HIV/AIDS

Criteria justify routine screening

HIV infection meets all generally accepted criteria that justify screening: (1) HIV infection is a serious health disorder that can be diagnosed before symptoms develop; (2) HIV can be detected by reliable, and noninvasive screening tests; (3) infected patients have years of life to gain if treatment is initiated

Available HIV diagnostic tests

Again, if the initial HIV test is a rapid test or a home test and it is positive, the individual should go to a health care provider to get follow-up testing. However, if the initial HIV test is a laboratory test and it is positive, the laboratory will usually conduct follow-up testing on the same blood sample as the initial test. Again, the primary tests for diagnosing HIV and AIDs include: ELISA Test, which stands for enzyme-linked immunosorbent assay, is used to detect HIV infection. If an ELISA test is positive, the Western blot test is usually administered to confirm the diagnosis. ELISA can also detect Lyme Disease as an example

Initial & Supplemental HIV Tests

An initial HIV test usually will either be an antigen/antibody test or an antibody test. If the initial HIV test is a rapid test, or a home test and it is positive, the individual should go to a health care provider to get follow-up testing. ***Supplemental follow-up, is optimized for specificity (positive test generates confidence that patient truly has HIV) The primary tests for diagnosing HIV and AIDs include: ELISA Test, which stands for enzyme-linked immunosorbent assay, is used to detect HIV infection. If an ELISA test is positive, the Western blot test is usually administered to confirm the diagnosis.

Communicating Preliminary positive HIV test result

As you know, a positive result on a rapid HIV test (or screen) is considered preliminary and requires confirmation (serum HIV ELISA and Western blot) before the diagnosis of HIV infection is establish hed. Don't want to lose anyone part of process

HIV screening guidelines from U.S. Preventative Service Taskforce (USPSTF)

As you know, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening

AIDS Coalition to Unleash Power (ACT UP): How to Survive a Plague (2:10MIN)

Because of some of the issues with access to drugs and stigma associated with the diseases came the need for the activism! • AIDS Coalition to Unleash Power (ACT UP) is an international, grassroots political group working to end the AIDS pandemic. The group works to improve the lives of people with AIDS through direct action, medical research, treatment and advocacy, and working to change legislation and public policies. Purpose: HIV/AIDS Formation: March 1987 Key people: Larry Kramer Larry Kramer (born June 25, 1935) is an American playwright, author, film producer, public health advocate, and LGBT rights activist. He began his career rewriting scripts while working for Columbia Pictures, which led him to London where he worked with United Artists. There he wrote the screenplay for the 1969 film Women in Love (1969) and earned an Academy Award nomination for his work. Kramer introduced a controversial and confrontational style in his novel ******s (1978), which earned mixed reviews and emphatic denunciations from elements within the gay community for Kramer's one-sided portrayal of shallow, promiscuous gay relationships in the 1970s. Kramer witnessed the spread of the disease later known as Acquired Immune Deficiency Syndrome (AIDS) among his friends in 1980. He co-founded the Gay Men's Health Crisis (GMHC), which has become the world's largest private organization assisting people living with AIDS. Kramer grew frustrated with bureaucratic paralysis and the apathy of gay men to the AIDS crisis, and wished to engage in further action than the social services GMHC provided. He expressed his frustration by writing a play titled The Normal Heart, produced at The Public Theater in New York City in 1985. His political activism continued with the founding of the AIDS Coalition to Unleash Power (ACT UP) in 1987, an influential direct action protest organization with the aim of gaining more public action to fight the AIDS crisis. ACT UP has been widely credited with changing public health policy and the perception of people living with AIDS (PWAs), and with raising awareness of HIV and AIDS-related diseases.[1] Kramer has been a finalist for the Pulitzer Prize for his play The Destiny of Me (1992), and he is a two-time recipient of the Obie Award. Things took a lot of time What brought us here, is the activism Find research and resouces Barriers as the population didn't have momentum

In fact, Eighty-seven percent (7,125) of youth who received an HIV diagnosis were young men and 13% (1,039) were young women.

Breakdown is... •Less than 1% (25) of youth who received an HIV diagnosis were aged 13 to 14, •21% (1,723) were aged 15 to 19, •and 79% (6,416) were aged 20 to 24. • • •Affecting young, out and about, more at risk •Risk reduces as you age , life style choices or maybe underdiagnosis

However, CDC Revised recommendations for HIV testing

CDC Advancing HIV Prevention: New Strategies for a Changing Epidemic, is aimed at reducing barriers to early diagnosis of HIV infection and increasing access to quality medical care, treatment, and ongoing prevention services. •CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. For those with specific risk factors, CDC recommends getting tested at least once a year. CDC has reduced the USPSTF recommendations from sscreening task force Reduced it. Adversitstemsnt is encouraging testing

False Positive

Common causes include... §Other viral diseases §Hematologic disorders §Liver diseases §Immunizations §Autoimmune disorders Common causes of a false positive ELISA include...administration of flu vaccine, presence of (HLA-DR) antibodies in multigravada women, presence of rheumatoid factor, positive RPR test (syphilis), hypergammaglobulinemia (e.g. multiple myeloma) and autoimmune hepatitis. FYI: You will still test positive for HIV if you are undetectable (due to antivirals). HIV tests usually detect antibodies, which are part of your immune system's response to HIV. People living with HIV who are undetectable still have antibodies to HIV which means you will test positive for HIV even if you have an undetectable viral load. Blood disorder Need to move to more confirmaitry tests to see what is happening

"AIDS Free Generation"Possibilities....and the role of CHN

Crisis linking people to care If not ID who has HIV , and make sure the person who has it getaccess to care, then we wont see improvesmtns More accurately more frequently make sure people get tested and get the antivirals they need

Most new HIV infections occur among men who have sex with men (MSM) of all races and ethnicities

Demography by transmission category, again, most new HIV infections occur among men who have sex with men (MSM) of all races and ethnicities, followed by African American heterosexual women. By race/ethnicity overall, African Americans are the most heavily affected population, followed by Latinos. Contagious diseae, the trend, following gay, ethnicity

HIV

HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome or AIDS if not treated. Essentially, HIV attacks the body's immune system, making it difficult for the immune system fight off infections.

Testing HIV and AIDS

HIV tests, look for antibodies to HIV in your blood or oral fluid. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid. •Today, we can obtain a rapid antibody screening test, results in 30 minutes or less.

CDC HIV Screening Specific recommendations (Links on Sakai)

In April 2013, the U.S. Preventive Services Task Force issued similar recommendations. That matched the CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. For those with specific risk factors, CDC recommends getting tested at least once a year. Eudcation Health histories Patient know about them and getting care they desriver Ask questions Do they match trends Yesat infections Opportunistic infections

*How long after a possible exposure should a person wait to get tested?

Important to educate patients on the possible change of misdiagnosis. •3% chance it can take up to 6 months to develop antibodies to HIV. • •8 weeks, 3 months , 6 months test. Since it takes a while maybe to get antiboidis

History HIV/AIDS

It is widely believed that HIV originated in the Democratic Republic of Congo around 1920 when HIV crossed species from chimpanzees to humans. Up until the 1980s, we do not know how many people were infected with HIV or developed AIDS. •To complicate things, human need protein, and just like we eat farm animals, some parts of the world eat "bush meat". Contamination can occur with an animal bit or in the preparation of eating "bush meat". • • •Crossing species

Understanding HIV & AIDS

Late stage HIV instead of AIDS title. Same thing though. Made in thymus gland. CD4. type of wbc that is important in fighting infections It causes destruction of cd 4 cells, leads to other complciations Opportunistic infection + low TB4 cells.

What to do?Counseling and Linking to Care

Linkage to care is the first step in engaging in HIV care and is typically defined as the completion of a first medical clinic visit within 30 days after an HIV diagnosis. Important to share results, to not judge , correctly ID who are at risk, having these conversations

Communicating HIV Indeterminate Test Result

NEED TO EDUCATE: An indeterminate result with a positive HIV screen and or negative HIV — be mindful, patients may be in the "window" period before they have developed enough antibody response. ... And that difference may occur exactly when people with acute HIV are most symptomatic Understand sensitivity and specificity Can be very misleading or wrong not being able to explain wthat the specificity and such

U.S. Preventative Service Taskforce (USPSTF)Refresh Your Memory

Slide included to refresh your memory

CDC Rationale for revised HIV testing

Source: (CDC. 2020) (HIV, 2020) According to the Centers for Disease Control and Prevention (CDC) , primary HIV symptoms may show up two to four weeks after initial exposure. Flu like symptoms can continue for up to several weeks. However, some people may exhibit the symptoms only for a few days. •Knowledge of HIV status among HIV-infected persons is associated with a 60% reduction in transmission risk behavior •Diagnosis is a prerequisite to accessing life-extending care and antiretroviral treatment for persons with HIV infection. • •

Screening: Targeted Testing" Diagnostic Testing

Source: Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE; Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1-17. Also pregnant women for their kids

HIV Screening

Source: HIV Tests: Uses, Side Effects, Procedure, Results (verywellhealth.com) We can test at a testing center or use a home kit. These tests can detect antibodies starting a few weeks after you're infected with the virus.

initail testing vs supplemental testing

Take home message Initial = who truly has the disease Supplement = rules out the falses, who doesn't have the disease

Four groups of HIV

The strains of HIV-1 can be classified into four groups. Of these, M is the 'major' group and is responsible for the majority of the global HIV epidemic. The other three groups - N, O and P - are quite uncommon. Group O represents up to 5% of infections in several west and central African countries, and Group N and P have been rarely identified in Cameroon. ***Important to know, All groups can be detected by HIV-1 antibody tests. HIV/AIDS, or Human Immunodeficiency Virus, is considered by some authors a global pandemic. However, the WHO currently uses the term 'global epidemic' to describe HIV. As of 2018, approximately 37.9 million people are infected with HIV globally. More common of two,

HIV Replication Cycle 7 stages

There are seven stages to cell replication. The seven stages of the HIV life cycle are: 1) binding, 2) fusion, 3) reverse transcription, 4) integration, 5) replication, 6) assembly, and 7) budding. To understand each stage in the HIV life cycle, it helps to first imagine what HIV looks like. Each replication cycle only lasts 1 to 2 days. Not responsible to memorize the 7 stages for the exam (just want you to have a general understanding of what happs at the cellular level). Goes after dna and hijacks , kills that cell, pulls out portion of dna, then gotten what it needs, damage, then moves on. Mature viron. Able to replicate from what it steals.. Then it because new viron

The HIV Cell

This is what an HIV cell looks like-can see there is no DNA Of all the body fluids that can transmit HIV, blood contains the highest concentrations of the virus. HIV may survive in blood outside the body for up to 5-6 days at room temperature. It might survive even longer inside blood that is within a syringe, as it does not have exposure to air. However, if it dries out, it does not last long. HIV: A retrovirus virus composed RNA, which has an enzyme called reverse transcriptase (trans-crip-tase), which has the unique property of transcribing their RNA into DNA after entering a cell (the T-Cell in primates). I say primates because, the genetic difference between modern humans and chimpanzees is very small (99%). So, what becomes the retroviral DNA can then integrate into the chromosomal DNA of the host cell, to be expressed there. The problem is, your body's protein-making machinery does not know the difference between its own RNA and viral RNA. ... Retroviruses uses the protein called reverse transcription (trans-crip-tase) which turns their RNA genome into DNA! Therefore, this backwards transcription is why we call them retroviruses. Its an RNA vjrus, it has reverese transciptase, the virus gloms on an denters. Needs to hijack dna of another cell, going always to cd4 cell

Opt out screening

When an Opt-Out approach is implemented, patients should be informed (e.g., through a patient brochure, practice literature/form, or discussion) that an HIV test will be included in the standard preventive screening tests, and that they may decline the test (opt-out screening).1 A patient's decision to decline testing should be noted in their medical record. HIV prevention counseling should not be a requirement for HIV testing (CDC. 2021) Source: Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE; Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1-17. Conestn inferred If don't decline automotaiclly done Done to her when giving birth, not really giving formal consent but receive results Should have conversation, but maybe not

riskiest places for HIV

http://www.miaminewtimes.com/news/miami-named-americas-number-two-hiv-hotspot-8955693 Southern states have the highest rates of new HIV-positive diagnoses, the highest percentage of people living with HIV and the lowest rates of survival for those who are HIV-positive. Nearly 52 percent of all new diagnoses of HIV occurred in southern states, even though only 37 percent of the U.S. population lives in the South. Communicable disease and the poverty connection: The South suffers from disproportionate rates of concentrated poverty - the clustering of poor populations in very poor communities - that increasingly exists in smaller cities, suburban areas and rural counties. Issue with diagnosis too? (21:12 paused) In the southwest belt, can see different education gap. Are we testing doing what is recommended? Or are we seeing an issue with diagnosis? Cutlureal norms of south that are contributing to thi

Partial Timeline (4:10)

https://www.kff.org/hivaids/video/aids-at-30-the-u-s-epidemic/ HIV was found in tissue samples from an African-American teenager who died in St. Louis in 1969. Therefore the virus began to exist in the USA from the 1960s/1970s. HIV was also found in tissue samples from a Norwegian sailor who died around 1976. And, the first two official AIDS deaths in South Africa were recorded in 1982. Seeing these opportunistic infections AZT - for cancer, but saw that it helps slow progression of HIV producition

False Negative HIV test

§Causes include: §Acute HIV Infection (too soon to test) §Advanced HIV disease (rare) §Antiretroviral Therapy A false-negative result happens when a person who has HIV receives a negative result after being tested for HIV. False-negative results are less common than false-positive results, although both are rare. A false-negative result can happen if a person gets tested too soon after contracting HIV. OR when the immune system has not yet produced detectable amounts of HIV antibodies, but the virus is still active. •In the time between contracting the virus and seroconversion, where most people do not know that they have HIV. If they take a test at this point, their result will likely be negative. • • •Viral count soo low, doesn't pick it up for this