The Stigma of HIV and AIDS
Opportunistic Infections andModes of Transmission
Week 17 12- 8 - 03
A Brief History of HIV/AIDS
1926 - 1945• HIV may have spread from monkeys to humans (may have first jumped from chimpanzees to humans in 1675
1959
• Man died in Congo in what researchers now say was first proven AIDS death
1978
• Gay men in the US & Sweden & heterosexuals in Tanzania & Haiti -- begin showing signs of AIDS
A Brief History of HIV/AIDS
1981:• Gay men with Pnuemocystitis carinii (PCP) in LA & Kaposi’s Sarcoma (KS) in New York
• PCP in drug addicts
• Called Gay-Related Immune Deficiency (GRID) 1982:
• Blood-borne virus suspected as etiology • Named AIDS when immune system involvement
recognized.
• First blood transfusion recipient & first babies identified as AIDS + (AIDS in 14 nations)
A Brief History of HIV/AIDS
1983:• Regional disease patterns noted in US (New Jersey gay men minority of cases & IV drug users half, different in other parts of US • Report of 2 separate epidemics in Europe: 1)
linked to Africa; 2) gay men who’d been in US • Recognized AIDS virus transmitted via:
pregnancy, birth & blood transfusions • AIDS now in 33 countries, 3000 Americans
infected; 1283 deaths
A Brief History of HIV/AIDS
1984:• AIDS retrovirus isolated; blood testing begun • SF gay bathhouses closed
• Patient “zero” dies • 7000 American have AIDS 1985:
• First diagnostic kit approved by FDA • Rock Hudson dies; Ryan White barred from
school
• 51 countries with AIDS; 1st AIDS conference
A Brief History of HIV/AIDS
1986:• Zidovudine (AZT) being used to tx AIDS • World Health Organization recommends to give
needles & syringes to addicts 1987:
• Princess Diana opens first AIDS hospital in UK • Zambian president’s son dies of AIDS
• First panel for AIDS memory quilt • US home burned (sons with AIDS) • Infants born HIV+ not always HIV + • 100,000-150,000 cases in 127 countries
• FDA allows treatment development shortcuts • US launches AIDS campaign
• Needle exchange programs begin 1989:
• New drugs(antiretrovirals) & AZT available 1990:
• Ryan White dies; Ryan White CARE Act passed • New York needle exchange closed down
• Breastfeeding risk known
• WHO reports HIV: 8 million; AIDS: 307,000
A Brief History of HIV/AIDS
1991• Kimberley Bergalsis with AIDS from dentist asks mandatory testing of HCWs
• Magic Johnson tests HIV+ • Red Ribbon campaign launched • New antiretroviral drugs • Drug resistance appears 1992:
• Arthur Ashe announces he is HIV+ • First combo drug treatment available
A Brief History of HIV/AIDS
1993:• Rudolf Nureyev & Arthur Ashe die of AIDS • AZT not useful for asymptomatic HIV+ 1994:
• Tom Hanks wins Oscar for Philadelphia Story • AZT shows benefit to infants of HIV+ moms • AIDS is leading cause US death age 25-44 1995:
• Combo treatment becomes standard • FDA approves first protease inhibitor • WHO program replaced by UNAIDS
A Brief History of HIV/AIDS
1996• Magic returns to pro basketball • Triple drug treatment introduced • New HIV infections Decline in ; SF AIDS
hospice closes 1997
• Concerns re protease inhibitor side effects & resistance
• UNAIDS reports HIV epidemic much worse than previous estimates (30 million HIV+)
A Brief History of HIV/AIDS
1998• Canada: outbreak of HIV+ drug addicts • AZT price cut; still too costly
• More new drugs; AIDS vaccine trials begun; 1999
• US MD sentenced to 50 yrs after injecting HIV+ blood into former lover;
• Chimp claimed to be source of HIV • South Africa forces drug co. price cut • World: 33 million living with HIV/AIDS
2001 HIV/AIDs Statistics
North America• 900,000 living with HIV • 45,000 new infections each year
• # HIV infections increasing among women, teens, people of color, those who live in rural areas are poor or have violence in their lives Globally
• Most devastating epidemic in history, still in early stages; 42 million living with HIV
• Major mode of transmission is heterosexual sex • Young, productive people lost to disease; vicious
semen, vaginal secretions, amniotic fluid, breastmilk) containing HIV or infected T-lymphocytes
• Any behavior resulting in break in skin or mucosa increases risk of exposure
• Blood & blood products can transmit HIV but risk minimal with current donor & blood
screening practices (window between infection & development of antibodies)
Modes of Transmission
• Direct contact with blood or body secretions,usually through break in skin or across mucous membranes (sexually, injection, transfusion) • Not spread via hugging, shaking hands, sharing
eating utensils
• HCWs not at increased risk for HIV AIDS if standard precautions observed.
Stages of HIV Disease
• Usually years between HIV infection & AIDS dx • CDC categorizes progression of HIV infection &AIDS in adults & adolescents on basis of: – CD4+ T-cell counts
– Clinical conditions associated with AIDS • CDC Classifications of HIV/AIDS
– Primary (acute) infection – HIV asymptomatic (Category A) – HIV symptomatic (Category B) – AIDS (Category C)
Primary (Acute HIV) Infection
• Period from infection with HIV to developmentof antibodies
• Intense viral replication occurring & dissemination of HIV throughout body • Symptoms range from none to severe flu-like • Antibodies in typically can be detected in serum
2 to 3 weeks after infection; when antibodies appear, HIV firmly established in host • CD4+ T lymphocyte levels fall then return to
baseline resulting in infection “steady state”
HIV Asymptomatic (CDC Category A)
• After reaching viral set point, chronic,asymptomatic state begins
• CD4+ T lymphocyte cell count > 500/mm3
• On average, 8 to 10 years in this phase • Patients feel well, and show few, if any
symptoms
• Apparent good health continues because CD4 levels high enough to preserve immune response
HIV Symptomatic (CDC Category B)
• CD4+ T lymphocyte levels fall- 200 to 499/mm3• Symptomatic condition(s) appears considered to have clinical course or require management complicated by HIV infection
• Includes oropharyngeal candidiasis (thrush), vaginal candidiasis (yeast infection), shingles, oral hairy leukoplasia, cervical dysplasia, fever or diarrhea > 1 month duration
• CD4+ T lymphocyte levels fall below 200/mm • One of the following develops:
• Opportunistic infection: fungal: pneumocystis carinii pneumonia, viral: cytomagalovirus disease, protozoal: disseminated coccidiomyco-sis, bacterial: mycobacterium avium complex • Opportunistic cancer: Kaposi’s Sarcoma (KS) • Wasting syndrome: loss of ≥10% body mass • Dementia
Pneumocystis carinii (PCP)
• Most common infection in AIDS clients • Causes disease only in immunocompromisedhosts
• Without prophylactic therapy, will develop in 80% of all HIV-infected individuals
• S/sx: fever, fatigue, non-productive cough, progressive SOB and hypoxemia
Kaposis’s Sarcoma
• Most common neoplasm in AIDS clients;especially in homosexual & bisexual men • S/sx:
– Skin: Painless, nodular, reddish lesions varying in size from 0.5-2 cm. Lesions grow & may ulcerate, painful
– Respiratory: dyspnea, respiratory failure – GI: diarrhea, oral & esophageal lesions
Cytomegalovirus (CMV)
• Infection with CMV major cause of diseaseand death in immunocompromised patients • S/Sx:
– Eye: lesions on retina, blurred vision, blindness
– GI: stomatitis, esophagitis, gastritis, colitis, bloody diarrhea, pain, weight loss – Respiratory: pneumonia
Mycobacterium Avium Complex (MAC)
• In disseminated form, is most commonlyreported bacterial infection in AIDS patients • Poor prognosis; survival 3 to 7 months after
infection
• Only body tissues not frequently infected are the brain, bone & muscle.
• S/Sx:
– GI: abdominal pain, diarrhea, debility & wasting.
– Other: fever, night sweats, fatigue, anorexia, malaise & anemia