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Day 3

Day 3. HIV/AIDS –Part I. Homework Review . Self Care Contract Page 33 & Which self-care activity did you do last night?. Women’s Bodies (page 41-42). Complete page 41, 42 with your partner. Women’s Body. Vulva Labia majora Labia minora Vaginal opening Anus Hymen

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Day 3

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  1. Day 3 HIV/AIDS –Part I

  2. HomeworkReview Self Care Contract Page 33 & Which self-care activity did you do last night?

  3. Women’s Bodies(page 41-42) Complete page 41, 42 with your partner.

  4. Women’s Body • Vulva • Labia majora • Labia minora • Vaginal opening • Anus • Hymen • Urethra – pee hole • Clitoris

  5. 4 Stages In a Woman’s Body • Puberty • Reproductive years • Perimenopause • Menopause

  6. HIV & the Immune System

  7. The Immune System • Is like a screen in a window….it keeps the bugs out. • The body’s defense against illness. • It keeps the body healthy and prevents infections. • It is made of cells, tissues and organs that work together to protect the body.

  8. Parts Of The Immune System • White Blood cells (CD4+ T helper cells) • Lymph • Thymus • Spleen • Bone marrow • Antibodies

  9. An Immune Response • When a foreign substance (antigen) enters our bodies, our immune system goes those a series of steps to fight the foreign substance and protect our bodies. • The antigen is like a “critter” that can cause an illness • Virus, fungi, bacteria, protozoa (like an insect)

  10. Our Immune response Some of the “players” include... B-cell Antigen Presenting cells - Cells of the immune system that bring intruders to CD4+ T cells. (e.g. macrophages and dendritic cells ) CD4+ T-cells(also may be called “T4 helper cells”, “T4 cells”, or less accurately “T-cells”. CD4+ T cells are the conductors of the immune system. CD4+T-cell CD8+ T-cells - Some CD8+ T cells, when ordered by CD4+ cells will seek out and destroy infected cells. CD8+ T-cell B cells - During an immune response B-cells make antibodies. Antibodies - Antibodies are made by B-cells, they attach to “critters”, marking them for destruction by the immune system. Antibodies are specific to the “critter” (bacteria, virus, or other harmful toxins).

  11. HIV and the Immune System • HIV primarily attacks the CD4+ T cells • The CD4+ cells are the conductor of the immune system • CD4+ cells are changed into “HIV” producing cells. • Without a healthy conductor the immune system can’t work properly. • Let’s talk about how HIV changes the CD4+ cells……

  12. HIV Life Cycle Page 53

  13. HIV Treatment 101

  14. A Holistic Approach To Your Health . Anti-HIV Strategies OI Strategies Supportive Therapies Immune Strategies General Health Maintenance

  15. Making a Treatment Decision • Choose and develop a relationship with a doctor • Get informed • Learn about HIV • Understand anti-HIV treatment and how to take care of your health. • Know your body! Know yourself • Plan for the long term • Find a support network • Ask, ask, ask until you understand

  16. Fundamentals • The immune system is our body’s defense against infections and diseases. • HIV infects CD4+ T cells (a key component of the immune system) and other cells. • Loss of CD4+ cells and other factors cause the immune system to weaken gradually. • Body gradually loses ability to fight off infections. • Other factors can further weaken the immune system • Active infections, stress, poor nutrition, other lifestyle factors

  17. PROLONG and improve the quality of life. SUPRESS the amount of HIV produced (viral load). OPTIMIZE your options for Anti-HIV therapy. MINIMIZE drug toxicity and manage side effects and drug interactions. Goals of Anti-HIV Therapy

  18. HIV Medications • Entry Inhibitors • Fusion Inhibitors • Reverse Transcriptase Inhibitors • Nucleoside Analog Reverse Transcriptase Inhibitors • Non-Nucleoside Analog Reverse Transcriptase Inhibitors • NucleoTIDE Analog Reverse Transcriptase Inhibitors • Protease Inhibitors • Integrase Inhibitors • Multi-class Combination Drugs

  19. NARTI’s Combivir (Retrovir= Epivir) Retrovir (zidovudine, AZT) Ziagen (abacavir, ABC) Epivir (lamivudine,3TC) Emtriva (emtricitabine) Epizicom (Ziagen + Epivir) Truvada (Retrovir+ Epivir+Ziagen) Zerit (stavudine, D4T) Videx/Videx E-EC (didanosine, ddI, ddI-EC) Trizivir (AZT+ 3TC+ abacavir) Viread (tenofovir DF) NNRTIs Sustiva (efavirenz) Viramune (nevirapine) Rescriptor (delavirdine) Intelence (etravine) Protease Inhibitors Aptivus (Tipranavir) Crixivan (indinavir) Fosamprenavir (Lexiva) Kaletra (lopinavir/ritonovir ) Viracept (nelfinavir) Norvir (ritonavir) Invirase, Fortovase (saquinavir ) Lexiva (Fosamprenavir) Prezista (Darunavir) Reyataz (atazanavir) Fusion Inhibitors T20 (Fuzeon, enfurvirtide) Seizentry (maraviroc) Integrase Inhibitors Isentress (raltegravir, MK-O518) Combination/Multi-class drugs Atripla (Sustiva +Viread+Emtriva)** The Toolbox of HIV Medications

  20. When To Start Medication?Page 55-62 • Viral load • CD4+ cell count • General health/symptoms • Co-infection/Other illnesses • Drug Interactions • Drug Resistance

  21. Readiness to Start • Disclosure • Dealing with HIV • Understanding Anti-HIV therapy • Belief in therapy • Side effects • Adherence

  22. Federal Guidelines • Issued by Department of Health and Human services. • Guidelines to help doctors treat people with HIV in the U.S. • Guidelines for adults, adolescents, children, pregnant women, treating opportunistic infections • Topics include: goals of therapy,when to start treatment, monitoring, side effects, medications during pregnancy

  23. What to start with? • Varies from individual to individual • Highly Active Antiretroviral Therapy (HAART) • At least 3 medications • From at least 2 classes • Most impact on virus—undetectable viral load • Keep in mind side effects and toxicities

  24. How do I know if it’s working? • Viral Load • CD4+ T-cell count • General health and symptoms Remember! There is no cookbook answer…. Listen to your body

  25. Viral Load • Reduce HIV levels as low as possible • Undetectable • At least below 5,000 copies • Minimal change is 3-fold reduction • (Many physicians believe a 10 fold decrease is necessary) • Trends are important • Consider at least two consecutive test • Is viral load going up? Unchanging? Going down?

  26. CD4+ T-Cell Count • Keep/Get CD4+ T-cell count above 200 • People with initially low CD4+ cell counts may take longer to see increases • People with initially high CD4+ cell counts might not see dramatic increases

  27. General Health and Symptoms • How do you feel? • Are your symptoms changing? • Getting better? Worse? Unchanged? • Side effects

  28. Medication Side EffectsPage 61-70 • Not everyone will experience side effects • Short term • First 3-6 weeks of starting • Nausea, headaches, diarrhea, menstrual irregularities • Long term • Lipodystrophy • Peripheral neuropathy • Strategies to cope: diet, rest, over the counter medication, change regimen, talk with your doctor

  29. Time for change? • Viral Load • Undetectable Detectable • Remains detectable 4-6 months after starting therapy • 3x or greater increase from lowest level • Persistent decrease in CD4+ cell count • Unable to tolerate side effects • Symptoms of HIV • Adherence

  30. When is it time to change anti-HIV Therapy? • Based on two viral load tests spaced about 2 weeks apart. • Consider what other factors may be affecting viral load/and or CD4+ cell counts. • Consider, if appropriate, the option to wait and get another CD4+ cell count, viral load test or resistance test before deciding.

  31. The Pipeline HIV Drugs in development NRTI’s • Racivir (RCV) • Amdoxovir (AMDX,DAPD) • Apricitabine (SPD754, AVX754) • Elvucitabine (ACH-126, 443, Beta-L-Fd4C) NNRTI’s • Ripivirine (TMC-278) Fusion/ Entry Inhibitors • Vicriviroc (SCH-417690, SCH-D) • PRO 140 • TNX-355 Integrase Inhibitors • Elvitegravir (GS-9137) Maturation Inhibitors • Bevirimet (PA-457) Cellular Inhibitors • Droxia or Hydrea (hydroxyurea, HU) Immune- based Therapies • Immunitin (HE2000, alpha-ebibromide) • Proleukin (aldesleukin, Interleukin-2, IL-2) • Remune (HIV-1 Immunogen, Salk vaccine) • BAY 50-4796 • IR103

  32. Lower viral load levels at similar CD+ cell counts as men Higher levels of drug found in blood Increased or varied side effects More nausea, vomiting and malaise, more severe rash Candidiasis, changes in menstrual cycle Protease inhibitors may increase or decrease levels of estrogen. Anti-HIV Treatment and Women

  33. Other Resources • UC San Francisco HIV Insite • www.hivinsite.ucsf.edu • Project Inform • www.projectinform.org • AIDS meds • www.Aidsmeds.org • The Body • www.thebody.com • The Well Project (for women) • www.Wellproject.org • Department of Health and Human Services • www.aidsinfo.nih.gov

  34. Scenario 1 You have a client who has just been told by her doctor that she will have to start taking HIV medications. She is very nervous and scared. She has heard lots of stories from other women in her support group and most of them are not good. • What are 2 open ended questions that you can ask your client to get more information from her? • What information or resources can you provide for her?

  35. Scenario 2 You have a client who started HIV medications 2 months ago. She has been having very bad nausea and diarrhea. She wants to stop taking her meds and calls you crying one day. • What are two affirming statements that you could give your client to encourage her to continue taking the medications? • What information or resource can you give to your client in this situation?

  36. Peer Advocate Role In Helping Clients with Treatment Regime • Support client where she is at • Information, education, and resources • Share your experiences (good and bad) but remind them that they are YOUR experiences • Serenity Prayer • Do a trial run • Go with her to the doctor • List of questions

  37. Meditation for Taking Medication Pg 71

  38. Empower yourself… “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You must do the thing you cannot do..” Eleanor Roosevelt

  39. Questions????

  40. Homework Complete pages 32-37

  41. Day 4 HIV/AIDS- Part 2

  42. Homework Review pages 32-37 at your table.

  43. What is Safer Sex and Harm Reduction? Strategies that reduce the likelihood of contracting or spreading STDS and HIV. “Meeting Clients Where They Are At”

  44. Safest Behaviors? • Abstinence • Not sharing injection drug needles or works • Not using drugs at all • Hugging • Massaging • Mutual Masturbation These are not always realistic…so we have to practice strategies that reduce our risk.

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