Anele Waters RN BSc Hons MRes HIV Research Nurse North Middlesex Hospital UK HIV Transmission HIV is NOT transmitted via saliva tears sweat faeces or urine UNLESS There is a visible presence of blood ID: 406675
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Slide1
HIV Transmission, Testing and Diagnosis
Anele
Waters, RN, BSc (
Hons
),
MRes
HIV Research Nurse
North Middlesex Hospital, UKSlide2
HIV TransmissionSlide3
HIV is NOT
transmitted via
saliva, tears, sweat, faeces or urine
UNLESS
There is a visible presence of bloodSlide4
HIV has been found at infectious levels in five principal body fluids:
blood
semen
cervicovaginal
secretions
rectal secretions
breast milk.Slide5
HIV TransmissionSlide6
Live virus in a contaminated body fluid or body tissue.
Sufficient quantity of virus
Effective route of transmission
Must reach susceptible cells to infect
4 conditions for HIV transmissionSlide7Slide8
Infection ControlSlide9
Universal Precautions
1983 USA
Center
for Disease Control (CDC) "
Guidelines"Blood
and Body Fluid Precautions.
In 1987 CDC update (Universal Precautions)
recommended that blood and body fluid precautions be consistently used for all patients
regardless of their blood-borne infection status
.Slide10
Standard precautions
In 1996 CDC updated their infection control guidanceSlide11
Potentially infected substances
Blood
Peritoneal fluid
Cerebrospinal fluid
Pleural fluid
Pericardial fluid
Synovial fluid
Amniotic fluid
FaecesSemenVaginal secretionsBreast milkVomitUrine
Sputum
Saliva
Any fluid with visible blood
Not TearsSlide12
NO exposure
Potential exposure
High Risk for Exposure
Gown/Apron
possibly
Yes
Yes
Gloves
Not required
Yes
Yes
Wash hands before/after
Yes
Yes
Yes
Eye protection/mask
Not required
If appropriate
If appropriate
Dispose linen at bedside
Yes
Yes
Yes
Dispose soiled linen as infected
Not required
Yes if soiled
Yes if soiled
Dispose soiled waste as clinical waste
Not required
Yes if soiled
Yes if soiled
Decontaminate equipment
Between patients
Yes
Sharps disposable at bedside
Yes
Yes
YesSlide13
Sharps & Waste DisposalSlide14
• Discard sharps bins when 3/4 full
• Do
not pass sharps from hand to hand.
• Dispose of used sharps straight
away
•
Do not leave used sharps
up
.• Sharps bin at the bedside.Never re-sheath used
needlesSlide15
Inoculation and Needle stick injuries Slide16Slide17
Inoculation and needle stick injuries
A penetrating injury
A splash of blood to the mouth or eyes.
A bite that breaks the skin or fluids into an open wound.Slide18
1 in 3 when source is +ve for Hep B e antigen.1 in 30 when source is carrying Hepatitis C.
1 in 300 when source is HIV positive.
How infectious is a needle stick injury?Slide19
What to do if you have a
needle
stick injury
Encourage the wound to bleed – do not suck it!
Wash well with soap under LOTS of running water.
Cover the wound with a waterproof dressing.
Report it!Slide20
Risks of InfectionHow likely does the donor carry the virus?
How infectious is the donor?
How deep, if at all, was the recipient’s skin or mucous membranes penetrated?
How much blood from the donor was on the device? Slide21Slide22
HIV Testing and DiagnosisSlide23
Prevention of late diagnosis HIV and AIDs
Early diagnosis and treatment can mean a near normal lifespan
Prevent onwards transmission of HIV
A HIV +
ve
diagnosis test will change medical management for patients
Why do we want to test for HIV? Slide24
In 2012 Half of these cases of HIV were reported as late presenters (LP) (CD4 <350/mm3)
30% of LP had advanced HIV infection (CD4 <200/mm3)
Highest in heterosexually acquired cases originating from sub-Saharan Africa (62%) and among IVDU (56%).
Late diagnosis in EuropeSlide25
35 year old sex worker requesting an HIV Test
Recently found out her former partner a former IVDU died of AIDS
Has a 5 year old child with this partner
They live with Lydia’s mother
Sex work is the only income for family
LydiaSlide26
All with differential diagnosis of HIV
All with sexually transmitted infections (STI)
All sexual partners of those
HIV+ve
All MSM (and female partners of)
All IVDU (and their partners)
All those known to be from a country of high HIV prevalence (and those they have sex with)
Who should be tested?Slide27
Brief discussion with Lydia
Has she had any prior HIV tests
Her risk factors
Sexual history
Who will give the results to her
Pre HIV testingSlide28
Detects HIV antibodies and or p24 antigen
Antigens can be detected
Antibodies can be detected
Tests for HIV-1 and HIV-2
Different types, venous blood, oral fluid, finger prick, urine
The testSlide29
Post test: HIV positiveSlide30
Post test: HIV positiveLydia tests HIV positive
What might be her initial concerns?
About herself
About her daughter
About her mother
About her incomeSlide31
What’s next for Lydia?
Disclosure
Prevention of Transmission
Blood tests
Appointment with HIV doctorSlide32