HIV, Hepatitis, and Other Blood-Borne Pathogens

1. 34 HIV, Hepatitis, and Other Blood-Borne Pathogens

2. Learning Outcomes 34.1 Describe ways in which blood-borne pathogens can be transmitted. 34.2 Explain why strict adherence to Universal Precautions is essential in preventing the spread of infection. 34.3 Describe the symptoms of hepatitis and AIDS. 34.4 List and describe the blood tests used to diagnose HIV infection.

3. Learning Outcomes(cont.) 34.5 Identify chronic disorders often found in patients who have AIDS. 34.6 Compare and contrast drugs used to treat AIDS/HIV infection. 34.7 Describe the symptoms of infection by other common blood-borne pathogens.

4. Learning Outcomes(cont.) 34.8 Describe the steps involved in reporting a communicable disease. 34.9 Explain how to educate patients about minimizing the risks of transmitting blood-borne infections to others. 34.10 Describe special issues you may encounter when dealing with patients who have terminal illnesses.

5. Introduction • Chapter 34 expands on OSHA Blood-Borne Pathogen Standard • How to reduce your risk of exposure • HIV, hepatitis, and other blood-borne infections • Reporting guidelines • Educating patients • Issues associated with terminal illnesses such asAIDS

6. Transmission of Blood-Borne Pathogens • Blood-borne pathogens are disease-causing microorganisms carried in the host’s blood. • Transmission occurs from one host to another through contact with infected • Blood • Tissue • Body fluids • Mucous membranes

7. Cerebrospinal fluid Synovial fluid Pleural fluid Peritoneal fluid Pericardial fluid Amniotic fluid Transmission(cont.) • Transmission agents for blood-borne diseases • Blood • Blood products • Human tissue • Semen • Vaginal secretions • Saliva from dental procedures Identified by the Centers for Disease Control and Prevention (CDC)

8. Tears Urine Vomitus Saliva Transmission(cont.) • Transmission agent only if there is visible blood • Feces • Nasal secretions • Perspiration • Sputum

9. Blood-borne pathogens may be introduced into a new host by Needlesticks Cuts or abrasions Any body opening Transfusion of infected blood Transmission(cont.)

10. People at Increased Risk • Anyone who comes in contact with substances that may harbor the pathogens • Health-care professionals • Law enforcement officers • Mortuary or morgue attendants • Firefighters • Medical equipment service technicians • Barbers and cosmetologists

11. Pathogens Hepatitis B virus (HBV) Hepatitis C virus (HCV) HIV  AIDS People at Increased Risk (cont.)

12. Incidence of many infectious diseases Reported to state health departments Information then sent to CDC Trends in spread Identify control tactics Allocate resources Research

13. Good Answer! Apply Your Knowledge How are blood-borne pathogens transmitted from host to host? ANSWER: Transmission occurs from one host to another through contact with infected blood, tissue, body fluids, and mucous membranes.

14. The most effective means of preventing the spread of HIV, hepatitis, and other blood-borne pathogens is to avoid contamination Universal Precautions are required by OSHA Universal Precautions

15. Universal Precautions • For medical offices, includes all • Body fluids • Secretions • Excretions • Moist body surfaces • Assume every patient is contaminated

16. Apply Your Knowledge In a medical office, to what items do Universal Precautions apply, and with which patients should you practice these precautions? • ANSWER: In medical offices, Universal Precautions apply to body fluids, secretions, excretions, and moist body surfaces. Assume every patient is contaminated and use Universal Precautions with everyone. Right!

17. Disease Profiles • Keep up-to-date so you can • Identify symptoms that may indicate that a patient has a blood-borne disease • Identify habits of your patients that increase risk of spreading the disease • Educate patients to limit risks of contracting disease

18. Hepatitis • Viral infection of the liver that can lead to cirrhosis and death • Hepatitis A – spread by fecal-oral route • Hepatitis B – blood-borne disease that spreads by contact with contaminated blood or body fluids or sexual contact

19. Hepatitis(cont.) • Hepatitis C (non-A/non-B) • Spread through contact with contaminated blood or body fluids and sexual contact • No cure • Many people are carriers • Flu-like symptoms, if any • Damages liver; causing cirrhosis, liver failure, and cancer

20. Hepatitis (cont.) • HepatitisD (delta agent hepatitis) • Occurs only in people that are infected with HBV • May mimic symptoms of hepatitis B, but more severe • Associated with liver cancer • Hepatitis E • Caused by hepatitis E virus (HEV) • Transmitted by fecal – oral route

21. Risk factors – same for HBV and HCV Occupation that requires exposure to blood and body fluids High-risk sexual activity IV drug use Hemophilia Travel to areas with high incidence Blood transfusions prior to screen Hemodialysis Living with partner with hepatitis B or hepatitis C Multiple sexual partners Hepatitis (cont.)

22. Hepatitis(cont.) • Risk in medical community • HIV • Approximately 0.5% from a single needlestick • Hepatitis B • 6% to 33% from single needlestick The primary risk factor for HBV and HCV infection is occupational exposure to the virus.

23. Hepatitis(cont.) • Infection progression • Acute illness lasts about 16 weeks • Prodromal stage – general malaise, maybe nausea or vomiting, or no symptoms • Icteric, or jaundice, stage – yellowing of the skin, eyes, and mucous membranes • Appears 5 – 10 days after initial infection • Convalescent (after acute stages) – can last 2 to 3 weeks

24. Symptoms Jaundice Decreased appetite Fatigue Nausea and vomiting Joint pain/tenderness Stomach pain General malaise Diagnosis Investigation of Risk factors Exposure incidents Blood tests Antigen-antibody systems Determine stage of disease Hepatitis(cont.)

25. Hepatitis(cont.) • Preventive measures • Avoid contact with contaminated substances • Use Universal Precautions with all patients • Vaccination is available to prevent HBV infections • Will not protect you from other strains of hepatitis • CDC recommends routine vaccination for everyone • HBIG for postexposure inoculation

26. AIDS/HIV Infection • Virus that infects and destroys components of the immune system • HIV infection develops into AIDS • Pathogen destroys • Helper T cells – white blood cells that are a key component of immune system • Neurons, causing demyelination • Patients develop opportunistic infections

27. AIDS/HIV Infection (cont.) • Risk factors • Unprotected sexual activity • Sharing needles used by IV drug users • Passes from mother to fetus during pregnancy or to infant during delivery or breastfeeding • Incubation period of 8 to 15 years

28. AIDS/HIV Infection (cont.) • Risk in medical community • Percutaneous exposure – exposure through a puncture wound or needlestick • Mucocutaneous exposure – exposure through a mucous membrane

29. Progression of AIDS/HIV • Three main stages • Initial infection • Can occur years before symptoms appear • Virus enters cell and makes copies • Helper T cells die • Immune system responds • Cleans the blood supply of the virus • Virus enters an inactive phase

30. Progression of AIDS/HIV (cont.) • Incubation period • Virus genetic material incorporated into the genetic material of the helper T cells • HIV becomes active again and continues to attack and kill helper T cells • Virus trapped in lymph system • As helper T cells decrease, patients are more prone to opportunistic infections • Incubation period can be 8 to 15 years

31. Progression of AIDS/HIV (cont.) • Full-blown AIDS • 200 or fewer helper T cells/mL blood indicates full-blown AIDS • Opportunistic infections and neurological deterioration

32. Diagnosis of AIDS/HIV • Enzyme-linked immunosorbent assay (ELISA) • Confirms presence of antibodies in response to HIV • 85% accurate – cross-reactivity with other viruses • Western Blot Test or immunofluorescent antibody (IFA) • Confirms positive ELISA test • Specific to individual viruses • Accurate diagnosis – ELISA plus one of the other two • Home tests available – may give false results

33. Symptoms of AIDS/HIV • Systemic • Respiratory • Oral – hairy leukoplakia • Gastrointestinal • Peripheral nervous system • Skin-related • Kaposi’s sarcoma

34. Sexual contact Use protection Avoid multiple partners Use condoms correctly IV drug users Avoid sharing or reusing needles Medical procedures Universal Precautions Wash hands Education Dangers of HIV/AIDS How HIV/AIDS is spread and not spread Preventive measures Prevention of AIDS/HIV

35. Apply Your Knowledge Which statements are true and which are false? ____ Risk factors are the same for HBV and HCV. ___ Hepatitis A is spread via contaminated blood or body fluids. ____ Helper T cells are red blood cells and are a key component of immune system. ____ Percutaneous exposure occurs through a puncture wound or needlestick. Right! ANSWER: T F Hepatitis A is spread by the fecal-oral route. F Helper T cells are white blood cells. T

36. Patient Profile • No one is immune to AIDS • 2005: 40.3 million men, women, and children were HIV-infected worldwide. • People infected • Homosexual males (rate decreasing) • Young people in large metropolitan areas • IV drug users • Women

37. Chronic Disorders of the AIDS Patient • Impaired immune system permits opportunistic infections • Pneumocystis carinii pneumonia • Protozoal infection • Occurs in 75% of AIDS patients • Kaposi’s sarcoma • Aggressive malignancy • Non-Hodgkin’s lymphoma • Second most common malignancy associated with HIV infection

38. Chronic Disorders (cont.) • Tuberculosis • Often drug-resistant • Mantoux skin test often negative in AIDS patients • Anergic reaction – no response to any substances injected as a skin test • Mycobacterium avium complex (MAC) infections • 97% of nontuberculous bacterial infections • Meningitis • Can lead to AIDS dementia complex

39. Chronic Disorders (cont.) • Candidiasis • Oral – thrush • Vaginal – females • Herpes simplex • Infections caused by HSV can be mild to life-threatening • Herpes zoster • Virus that causes chickenpox becomes dormant • Returns as herpes zoster, or shingles • Lesions last longer in immunocompromised patients – patients with impaired or weakened immune systems

40. Treating Opportunistic Infections • Drug side effects problematic • Patients develop • Allergies to treatment • Intolerance to medications • Pathogens become resistant to treatments • Treatments may conflict with other treatments

41. Testing Regulations • CDC does not require mandatory HIV testing for health-care workers • Health-care workers’ chances of being infected by a patient are greater than a patient being infected by a health-care worker

42. Drugs Slow reproduction of virus, no current cure List of FDA approved drugs – Table 21-2 Treatment goals Increase the time between infection and symptomatic disease Improve quality of life Reduce transmission To uninfected Maternal-infant Reduce HIV-related deaths Drug Treatments

43. Drug Treatments (cont.) • Treatment guidelines • Panel of Clinical Practices for Treatment of HIV Infections • Initial and follow-up testing • Drug resistance testing • HAART – combination of drug treatment • Initiating therapy • Decision made by patient and physician • AIDS diagnosis or CD4 T cell count is < 200cells/mm3

44. Drug Treatments (cont.) • Delayed treatment • Benefits • Postponement of drug-related adverse affects • Delayed development of drug resistance • Preserving treatment options • Risks • Irreversible immune system damage • Increased risk of transmission of disease

45. Early treatment Benefits Suppression of viral replication (preserves immune function) Reduction in chance of transmission Helps patient live symptom-free longer Disadvantages Drug toxicity Drug resistance Adverse effects on quality of life Loss of treatment options Drug Treatments (cont.)

46. Treating complications Must also treat opportunistic infections Patients more prone to Bacterial infections Protozoal infections Viral infections Fungal infections Malignancies Continuing research Global issue Keep informed of new treatments and prevention methods Drug Treatments (cont.)

47. Identify where these opportunistic infections affect the body. Herpes simplex Pneumocystis carinii Kaposi’s sarcoma Tuberculosis Meningitis Oral candidiasis Apply Your Knowledge ANSWER: mouth, lips, genitalia lungs arms, legs, chest, neck, face, conjunctiva, palate lungs brain CORRECT! mouth, tongue

48. Cytomegalovirus Antibodies found in 80% of adults Erythema infectiosum Parvovirus B19 Fifth disease Human T-cell lymphotropic virus HTLV-1 Appears in IV drug users, among others Listeriosis Caused by bacteria Listeria monocytogenes Fever, shock, rash, and aches Other Blood-Borne Infections All are problematic for people with impaired immune systems.

49. Malaria Parasite enters bloodstreamthrough mosquito’s bite Cyclical symptoms Syphilis Caused by spirochete Treponema pallidum Three stages Difficult to identify and treat in HIV-positive persons Toxoplasmosis Caused by Toxoplasma gondii in cat feces Other Blood-Borne Infections (cont.)

50. Apply Your Knowledge Which blood-borne pathogen is found in 80% of adults and rarely causes noticeable symptoms? ANSWER: Cytomegalovirus (CMV) Good Job!