1. Hepatitis & HIV/AIDS

2. Hepatitis HAV HBV HCV U.S. Stats 25,000 new infections/yr
Transmission
Ingestion of fecal matter
Contact w/ infectious body fluids
Contact w/ infected blood
Severity
Usually no lasting damage, rarely fatal
Most fully recover;
Some develop liver disease; ~3,000 die / yr
60-70% develop chronic liver disease; 1-5% will die from liver cancer
Vaccine?
Vaccine available
No vaccine
Symptoms
Fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, joint pain, jaundice
43,
CDC, 2012

3. HIV Human Immunodeficiency Virus = The cause of AIDS
AIDS = the end-stage of HIV disease

4. In what year were the first cases of AIDS reported?
B: 1981
C: 1991
D: 2001

5. HIV About 30-40 million people worldwide are living with HIV
How many of those live in the US?
Approximately 1 million
Approximately 1 in 5 of them don’t know they have HIV

6. More HIV About 40,000 Americans become HIV-infected every year.
About 10% of new cases are already drug-resistant in US.
½ of all new HIV infections in the US occur in people under 25 years of age.
6th leading cause of death for ages 25-44
Potential years of life lost

7. HIV in Oregon

8. HIV infection involves 2 elements:
1: A virus
2: Humans
Monkeys have SIV, not HIV

9. Which of the following is NOT a way that a person can become infected with HIV?
A: Sharing a drinking glass
B: Unprotected sex
C: Injecting drug use
D: None of the above – they are all ways that a person could become infected with HIV.

10. How is HIV most commonly spread?
Sexual Transmission = most common
Are all sexual behaviors equally risky?
What is meant by “having sex”?
Need to define:
Ex: President Clinton “I did not have sexual relations with that woman.”
Ex: “Sexually active”

12. #2 reason for HIV spread Sharing needles and syringes
Direct blood-to-blood transmission
Most efficient transmission
The drugs themselves do not transmit HIV
Ex: sharing steroid needles, tattoo, ear piercing

13. Which drug is MOST involved in HIV transmission?
Alcohol
Sexual risks, sexual assaults and other risks while under the influence.

14. Exposure to how many viruses are necessary to become infected with HIV?
Exposure to at least 1,000 HIVs are necessary for infection.
Immune system responds to HIV
Overexposure necessary
Ex: Ejaculate contains about 100 million sperm
“Low sperm count” = 20 million sperm

15. Where are the most HIVs in a person infected with HIV?
Lymph nodes

16. However, we are concerned with body fluids
Body fluids with the most risk have a high viral load
Not all body fluids have the same viral loads.

17. What body fluid has the most HIV?
Blood, including menstrual blood
Ex: 2 billion HIVs in 1 pint of blood in person with end-stage AIDS
Viral load varies with disease stage
Note: “Non-detectable HIV” does not mean the person is disease free.

18. What body fluid has the 2nd most HIV?
Semen
Including pre-seminal fluid (pre-cum)
High HIV levels in semen still possible even though “non-detectable” in blood

19. What body fluid has the 3rd most HIV?
Vaginal fluid
Vaginal fluid can help prevent micro-tears in the vagina.
Micro-tears are portals on entry for HIV.

20. What body fluid has the 4th most HIV?
Breast milk
10-20% risk of HIV transmission to infant from breastfeeding IF mom not being treated.
Note: some areas of the world have such poor water quality that the death risk to the infant is greater with exposure to the water than to breast milk with HIV.

21. Any other body fluids that carry HIV?
Saliva
Extremely small amounts of HIV in saliva
More HIV when blood is in the saliva
Blood-free saliva is a “theoretical risk”
Ex: At least 1 quart of saliva to get 1,000 HIVs
NO documented case from exposure to saliva only.
Tears
Would require approximately 2 quarts (64 oz) of tears directly into a body to get 1,000 HIVs
Theoretical risk only
No known HIV case ever acquired through tears.

22. Is the skin an effective barrier?
YES
Skin-to-skin contact is NOT a risk for HIV.
No risk: handshake, hugs, kissing
Blood on outer skin does not seep in
What is the exception?
A fresh opening in the skin = portal of entry for HIV

23. Portals of entry for viruses
Mucosal surfaces
(inner skin)
HIV may seep through:
Mouth, penis, vagina, anus, urethra, etc.

24. General rule: No one else’s body fluids touches your mucosal surfaces unless you know her/his HIV status

25. What mucosal surface can HIV enter the easist?
Anal Canal
Epithelium of the rectum is fragile and only 1- cell layer thick
Easily torn with penetration
Microtears are additional portals of entry for HIV
Irritated areas, hemorrhoids, HPV are all portals of entry for HIV

26. Vagina is portal of entry for HIV
Epithelium of vagina is 7-cell layers thick

27. Who is at higher risk to become infected with HIV during vaginal intercourse – the male or the female?

28. Why? 1) Vagina has larger mucosal area than penis
2) Micro-tears during intercourse = portals of entry
3) More HIV in semen than in vaginal fluids
4) More semen exposure
5) Women more likely to have unknown vaginal infection leading to irritated tissues, more T cells fighting infection
6) Semen contains immuno-suppressant

29. got it from vaginal intercourse
That said…
Worldwide,
most males who have HIV
got it from vaginal intercourse

30. #3 portal of entry
Penis
Urethra mucosal surface is portal of entry

31. Mouth
A few cases of HIV transmission documented through oral sex – both performing and receiving
Ex: blood in the saliva or cuts/sores around mouth
Micro-abrasions increase risk: floss, brush, biting lips
Ex: monkeys transmit SIV through oral sex
Recommend condoms/barriers for oral and anal sex

32. Given “dangerous” body fluids and “dangerous” mucosal skins, what is the MOST risky sexual behavior?
Anal intercourse
Which is more risky – penetrator or recipient?
Answer: Recipient of anal sex is MOST risky behavior for HIV

33. There is a continuum for safer sex
“Unprotected sex is group sex”
“Safe sex” = outer skin-to-skin contact
One person must be HIV-infected before it can be transmitted through sex
Know the HIV-status of your partner
You can’t tell by looking
Be an agent of your own care

34. Why don’t mosquitoes transmit HIV?
HIV is treated like food and digested along with the blood meal.
Even if it did, too few HIV to initiate an infection.
No documented HIV transmission after years of study
Mosquitoes bite more infants & old people
HIV rates are lowest in infants & old people

35. “Yes, you can get HIV from mosquitoes if you have unprotected anal sex with a mosquito.”
Randy Shilts, “And the Band Played On”

36. HIV Testing
According to the CDC, which of the following groups should get routinely tested for HIV during health/medical visits?
A: Anyone between 18 and 44
B: Anyone between 13 and 64
C: Just young people, between 15 and 24
D: Only those at high risk regardless of age

37. HIV testing ELISA, confirmed with Western Blot
Positive P24 antigen test
Home tests
Recently approved

38. Anything new? The Affordable Care Act of 2010 2013 Budget
Reduce number of new infections
Increase access to care
Reduce HIV-related disparities
2013 Budget
Estimated $28.4 billion for domestic and global HIV/AIDS activities