HIV/AIDS

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    Definition

    AIDS (Acquired Immune Deficiency Syndrome) is a disease caused by a virus called HIV (Human Immune Deficiency Virus). The virus enters the body and attacks the defense (immune) system which leads to illness. Certain degrees of illness are classified as AIDS.

    HIV is a blood borne virus and is not spread through everyday social activities. Sexual contact or contact with blood of someone who already has the virus creates an exposure, and if HIV enters the body in the process, infection may occur. Once infected (HIV+) there is no known cure for the virus. For years HIV can be present without the individuals knowledge, producing no major illnesses (HIV disease). Even during this period of relative health, when unaware of infection, HIV can be passed during unprotected sex or through blood. Many years after infection while the virus is attacking the immune system (body defense), serious damage, will occur in most people. Over time as the body has difficulty continuing to fight the virus, people become sick from an infection which takes the opportunity to do damage while the body is weak (Opportunistic Infection-OI). When one has HIV and the body is sick from an OI, it is at that point people are classified with full-blown AIDS. AIDS is also diagnosed when HIV is present and measurement of the immune system function has declined to very low levels. 


     

    Symptoms

    People with HIV infection may or may not have symptoms. Early infection with HIV can sometimes produce flu- like illnesses including fever, swollen glands, poor appetite, and increased tiredness. For women, HIV infection can also trigger an increase in yeast infections. Because these symptoms may be the result of early HIV infection or another explainable cause, confirmation of HIV infection must occur through medical examination and blood testing. 


     

    Risk Factors

    HIV can be spread through high risk body fluids from an infected individual, when barriers and safety precautions are not used or not used properly during sex. Some other body fluids pose no risk to spread HIV, for although the virus may be present, it is found at levels too low to transmit. 


     

    Body fluid risk in spreading HIV

    High risk

    • blood
    • sexual fluids (male-semen, female-vaginal fluids)
    • breastmilk
    • sterile body fluids (ie. amniotic)

    No risk

    • saliva
    • tears
    • sweat
    • urine/feces

     


     

    High risk behaviors

    Unprotected sex (oral, anal, or vaginal sex) - HIV can be spread during any type of sexual activity. When blood or sexual fluids are present and a method of entry is created (ie. cut, abrasion), HIV can pass from the infected partner to another. HIV+ individuals must also avoid reinfection, for the more virus that enters the body, the potential for more damage to be done.

    Sharing Needles / Works - Any type of instrument (works) used while drugs are injected (shooting up) is a potential risk for HIV transmission, due to the presence of blood. When these works (ie. needle,syringe, cooker, etc.) are shared, if either individual is positive, there is a potential for blood entry and HIV infection to occur to the one who is not infected.

    Maternal transmission (mother to child) - A mother can spread HIV to her child while carrying the baby (across the placenta), during the birthing process (contact with Mom's exposed blood) or through breastfeeding (after birth). All babies born to HIV+ women are at risk (exposed), but all will not definitely receive HIV from their mother. The risk to the baby when mom is HIV+ is about 15-25%, but studies show that with the most recent prevention measures, the risk is close to none. HIV testing before/during pregnancy allows women to be aware of their HIV status so they can make informed decisions on treatment options (see Maternal-Child).

    Blood transfusions - Transfusion are generally safe in regards to HIV. There has never been any risk to donate (give) blood. Before strict guidelines were put into practice, receiving (accepting) blood had a risk. Now with routine HIV testing of donated blood (started in 1985) and the safety precautions enacted, the risk of receiving infected blood is very rare (about 2 in a million). As a further precaution, when donating semen (for sperm banks) and body parts (for transplants), the donor's blood is also tested for HIV.

    Occupational exposures - HIV transmission in a work environment is a very low occurrence, but it can happen through a needlestick, bloodsplash or other direct contacts with blood or high risk body fluids. For this reason universal precautions are used in the medical setting, including gowns, gloves, masks, goggles, etc. when a risk of blood exposure is possible. 


     

    Prevention

    HIV transmission is prevented when there is no exchange of high risk body fluids. Universal precautions must be used professionally, as well as using personal protections socially, when there is a potential risk of an exchange of blood, semen, vaginal fluids, breastmilk or sterile body fluids.

    Barrier methods (ie. condoms) must be used to prevent the exchange of sexual body fluids during all types of sexual practices. Sexual toys should never be shared without proper cleaning between use. Needle sharing of any kind should always be discouraged. Shared needles for insulin usage, steroid treatments or vitamin therapy, is as dangerous as for illicit drug use. Maternal HIV testing prior to pregnancy will assist women in deciding if pregnancy is an option for them. If an HIV+ woman decides to initiate a pregnancy, staff should encourage the initiation of protocols to reduce the risk of transmission to the child.

    Blood transfusions are not a major risk for HIV infection at this time due to the inclusion of protocols to protect the public safety. The blood supply is protected through the use of a detailed questionnaires to screen out those with potential risk. Payment for blood donations have been eliminated, and an anonymous clause to allow donor release of blood only for research purposes was included.

    Creation and proper instruction in the workplace of tested devices which lessen the risk of blood and body fluid exposure, will enable workers to function in a safer environment. 


     

    Testing

    Determining if someone is infected with HIV requires a simple blood test. A sample of blood is sent to a lab to check if HIV antibodies are present. If the antibodies specific for HIV are found within the blood sample, it is known that the person from which the blood was obtained, has been infected with HIV.

    As per New York State law HIV testing can occur confidentially (name is known and result is part of medical record) through a hospital, clinic or physician office or anonymously (name is not known) through the State Department of Health testing sites. Either site requires the patient to be counseled on basic information about the virus, testing procedures and laws governing testing. After the pre test counseling occurs the patient must express understanding and agree to testing, documented through a signed consent form. 


     

    Treatment

    Regardless of symptoms, some people with HIV/AIDS should receive treatment on a regular basis. The goal of treatment is to maintain and/or improve the quality of life, helping individuals to live longer, stay as healthy as possible and fight the diseases and infections which may arise.

    Medical care focuses on monitoring the disease process and creating an individualized treatment plan based on viral load and immune system indicators. A qualified medical doctor should be contacted early on in the process to initiate the program and monitor the results.

    The viral load reflects the amount of HIV in the bloodstream at a given time. The greater the viral load, the greater the risk of damage to the immune system. Ultimately the desire of treatment is to reduce the amount of virus in the blood, often lowering it to the point where it is not easily identified on standard test . Reducing the virus to these undetectable levels does not mean the individual is no longer infected, for the virus is found in other areas of the body. Yet this reduction is a good sign that the virus is being better controlled, decreasing the chance of damage to the immune system.

    Determining the health of the immune system is obtained through careful monitoring of a specific type of white blood cell . This white blood cell called the CD4 cell helps to fight off diseases and infections which invade the body, and is the primary cell that HIV infects.

    Maintaining an adequate number of CD4 cells is therefore important, thus the concentration on the CD4 count (a blood test to monitor the immune system function). 

     

    What you need to know about AIDS today.

    For additional information, please call (631) 444-4000.


    What is PrEP?

    Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection. If you are interested in using PrEP you should contact your Primary Care Physician at Stony Brook.

    For more information on PrEP: http://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf

     

    What is Pep?

    Post Exposure Prophylaxis or PEP is a way for people who may have been exposed to HIV to try to reduce the chance of becoming HIV-positive. It involves taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after exposure. If you think you were exposed to HIV and need PEP report to the Stony Brook University Hospital Emergency Department for evaluation and treatment .

     

    For more information on PEP: http://www.cdc.gov/hiv/basics/pep.html