HIV / AIDS 보편적 overview

딱히 동의 할 수 없는 내용들이 많다 - 특히 psychosocial 에 관한 정보들은 매우 편협적이라고 생각한다. 하지만 상당히 전반적인 범위를 포함한 내용 - Pharmacy Assistant Licence 를 위해 필요했던 HIV / AIDS lesson. Natural Science라기보다 Social Science 에 가까운. .매우 보편적인 내용 들 -
가장 충격적인 것은 하루에 HIV 에 감염되는 아이들만 2000 명. . 아이들 2000 명 , 하나 둘 셋 ..이천 명.. 또한 내용 중 bisexual men에 관한 내용들이 많은데 얼만큼 정확한 것인지 모르겠다 - 정말로 HIV의 대부분 인구가 남자 동성애자들인걸까, 음. 흥미롭지만 전혀 유쾌하지 않은, 차별인 듯한 느낌을 받았다.





Human Immunodeficiency Virus – viral infection, damages immune system

Acquired Immune Deficiency Syndrome – third HIV infection stage, due to decreasing immune function, ‘opportunistic’ infections, cancer, nervous system disorders, symdromes

3 Stages of HIV infection

- No symptoms

- Non specific symptom: mild fever, diarrhea, yeast infections, etc.

- Specific symptoms

             Kaposi’s sarcoma

             HIV wasting syndrome

             HIV encephalopathy

             Pneumocystis carinii pneumonia

AIDS Diagnosis

             Positive HIV antibody test OR

             Evidence of HIV infection AND

             Appearance of certain specific complication

AIDS Progression

             1^st few years after untreated HIV developing AIDS: 1-2%

             10^th year: 50%

             HIV infection is life-long

             Average 10-12 years to develop AIDS if untreated

HIV History

             Earliest 1959

Basic mechanism

- Invasion

             HIV virus binds and invades certain cells

             Integrates own viral DNA into cell’s DNA

             Virus copied and produced by host cell (T4 cell)

             Virus attacks a key white blood cell of immune system – T4 Lymphocyte

- Depletion

             T4 cell (helper cell) – recognize invasion of foreign antigen / produce antibody

             Virus depletes number of T4 cells

             HIV exhausts non-specific activation / differentiation of CD8+ T cell

             T8 suppressor cells shut down immune response after threat has been met

- Progression

             1. Window period – btw HIV infection / first positive HIV antibody test

                           Infectious but produced insufficient antibodies for HIV test to detect

                           Average 6 months

                           Positive – 2-3weeks

                           Negative – after 12 months indicates not infected

             2. Incubation period – btw HIV infection / first identifiable symptoms

 *(low fever, cold, yeast infection, weight loss, skin lesion, diarrhea)

             3. Latency period – btw HIV infection / initial manifestation of specific and persistent AIDS symptoms

                           *(Kaposi’s sarcoma, HIV wasting syndrome, HIV encephalopathy, pneumocystis carinii pneumonia, cytomegalovirus)

Statistics

- Worldwide

             33+ million w/ HIV/AIDS

             2.7 million new HIV/yr

             2.1 million die HIV/AIDS /yr

             10 million AIDS orphans

             2000 children infected each day

- US

             1,100,000 w/ HIV/AIDS

             56,000 new HIV / yr

             17,000 die / yr

- Washington

             11,500 HIV/AIDS

             570 new HIV / yr

             100 die / yr

Transmission – source, sufficient dose, vehicle, susceptible target

             Source: any sufficiently contaminated body fluid of HIV infected person

                           Blood, Semen, Vaginal secretion, Breast milk

                           (Cerebrospinal, Pleural, Pericardial, Peritoneal, Synovial, Amniotic fluid)

             Sufficient Dose:

                           Viability – how strong

                           Virulence – how infectious

                           Viral Load – how much HIV in bloodstream  

             Vehicle: any avenue allows fluid transmission

                           HIV does not live long outside body

                           Not spread via casual contact, nonsexual contact, work, school, home

             Target: any person own body fluids become exposed to contaminated body fluid

 

3 ways HIV commonly spread

Sexual intercourse, Needles, Pregnant, Breastfeeding

Infection Control

-          Mandated Standards

n           Occupational Exposure to Bloodborne Pathogens (BBP)

n           Any pathogen in blood OR Other Potentially Infectious Material (OPIM)

n           Hepatitis B and C viruses (HBV / HCV), HIV, Malaria, Hepatitis D, Syphilis, Brucellosis, Ebola, Viral hemorrhagic fever

n           Covered employees: nurse, firefighter, police officers, med facility housekeepers, first aid providers

n           Personal Protective Equipment (PPE) provided, engineering / work practice control utilized, Exposure Control Plan implemented at companies

n           Required: BBP training, protective equipment, vaccination benefits w/in 10 days of employment

-          Standard Precautions

n           Method of infection control for ALL infectious BBP

n           Personal Protective Equipment (PPE) required

n           Work practice controls engineering

n           Always place barrier btw self and moist substance from another person

n           PPE – gloves, protective eyewear, face shield, apron, mask, cap, boots (head to toe coverage)

n           Engineering Controls – sharps disposal container, self sheathing needles, needle-less systems, engineered sharp-injury protection

n           Do not recap needles, scalpels, glass – place in puncture-resistant container

n           Color code waste containers /  label with BIOHAZARD sign – leakproof

n           Decontaminate, sterilize all surface, tools, equipment, 10% bleach

n           Never store food / drinks

n           Never eat, drink, smoke, share cosmetics, in potentially contaminated area

-          Managing Exposures

n           Exposure determination: identify task, procedure of possible exposure

n           Written protocol: insure written protocols developed / affective disinfectants purchased

n           Standard precautions: PPE, workplace controls, engineering controls

n           Medical requirements: medical action required in event of exposure / records maintained

n           Required training: initial / annual training provided / documented. Exposure Control Plan copy accessible to employees

n           Exposure Control Plans: Bloodborne Pathogen Training: trained prior to any potential exposure, w/in 10 days of employment, informational training, worksite specific training, knowledge of Exposure Control Plan

u            Annual retaining required / updates on every change in procedure

u            Medical Requirements

l         Medical evaluation: counseling, testing, treatment, follow-up w/o cost

l         Hepatitis B Immune Globulin: Hepatitis B vaccine

l         No post exposure HCV treatment recommended

l         Post exposure prophylaxis (PEP): of anti-HIV medication

u            Hepatitis B Vaccine

u            Evaluation of exposure incidents: notified promptly, IMMEDIATE confidential medical evaluation / follow-up, review exposure, why, procedures, protocols

u            Post Exposure Prophylaxis (PEP): latest information on post-exposure treatment, follow-up for HIV, HBV, HCV, other pathogens

Legal / Ethical Issues

-          Reporting AIDS / HIV

n           Report required by state – 7 days for provider to confidential report to local health authorities, local authorities have 90 days to assign code, remove reference to individual’s name, coded case report forwarded to Department of Health

n           Notify spouse – good faith effort

-          Confidentiality

n           Information disclosed except individual w/ signed permission

-          Disability / Discrimination

n           HIV / AIDS considered disability

n           Protected by federal / state law against discrimination

n           May file complaint for discrimination – Office for Civil Rights of US Dept of Health / Human Service / State Human Rights Commission

n           Protection from: insurance transaction, employment, health care, legal service, home repair, personal service, public accommodation, loan, credit, rental, purchase, sales of real estate, recruitment, hiring, transfer, layoffs, termination, rate of pay, job assignment, leave of absence, harassment, intimidation, personal distinctions, education, supervision, flex-time, rest breaks, altered environments, employers may not ask questions of HIV status,

-          Endangering Behaviors

n           Protect public from spread of Sexually Transmitted Diseases (STD)

u            Interview persons authority, notify partners, order suspected infected person to receive examination, counseling, testing, treatment, issue orders to cease and desist from conduct, detain person for up to 90 days when other measures fail

u            Health care provider responsibilities: provide instruction, report

u            Local health office: investigate, insure public health / safety

Psychosocial Issues

Emotional, Tangible, Informational

-          Infected Individuals

n           Physical decline, premature death, social stigma, personal guilt, prolonged disease course, disabling infection, worsening quality of life, forced lifestyle changes

n           Loss: work, income, security, physical, mental abilities, housing, possession, friends, family support, self-sufficiency, privacy, self-esteem

n           Guilt, grief, helplessness, disbelief, rage, anxiety, insomnia, hypochondria, depression, suicide

n           Time of vulnerability: first notification, physical symptoms, decline in CD4 count, opportunistic infection, hospitalization

n           Grief: shock, disbelief, anger, despair, searching, bargaining, resolution, acceptance

-          Caregivers

-          Special Populations

 

 

 

 

Acquired – produced by influences originating outside of body, not hereditary, enters body through bloodstream when virus exposed from another person’s blood or infectious body fluid

Immunodeficiency – deficiency in body’s immune response

Antibody – produced by body, against specific disease antigens

Syndrome – set of symptoms

Opportunistic – infectious agent ordinarily poses little threat to healthy person