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10/4/13
1
HIV/AIDS: The Current "State of Affairs"
Presented by: Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical Supervisor, LAC, MAC
October 9, 2013
Earn Free Con*nuing Educa*on thru NAADAC -‐ www.naadac.org/educa*on
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Misti Storie, MS, NCC
Director of Training & Professional Development
NAADAC, the Associa9on for Addic9on Professionals
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o The educa9on delivered in this webinar is FREE to all professionals.
o 1 CE is FREE to NAADAC members and Accucare subscribers who aQend this webinar. Non-‐members of NAADAC and non-‐subscribers of Accucare receive 1 CE for $15.
o If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)
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o A CE cer9ficate will be emailed to you within 21 days of submi^ng the quiz and payment (if applicable) – usually sooner.
o Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.
Define HIV/AIDS and describe the transmission and course of these diseases
Name 3 symptoms of ini9al infec9on w/HIV and 3 condi9ons necessary for diagnosis w/AIDS
Name 5 risk factors for contrac9ng HIV
Explain the process of diagnosing HIV
Describe 4 harm reduc9on ac9vi9es that reduce the risk of HIV infec9on
Discuss treatment op9ons
Describe 3 classes of medica9ons used to prevent and/or slow progression of HIV
Discuss HIV in special popula9ons of concern
Webinar Objectives
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Presented By
Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical
Supervisor, LAC, MAC
hQp://www.nlm
.nih.gov/exhibi9on
/visu
alcultu
re/hivaids31.htm
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Overview 2013: HIV and AIDS Presenter: Mita M Johnson Content: • Defini9on of Terms • Can I have AIDS without HIV? • Brief Timeline • Sta9s9cs: HIV Infec9on and AIDS Diagnoses • Transmission Routes • HIV Infec9on: stages of disease progression • Update: tes9ng • Update: treatment medica9ons • Implica9ons for clinicians and other professionals
Defini9on of Key Terms
hQp://www.ra9onalavenue.com/aids-‐the-‐miracle-‐cure-‐and-‐the-‐promises-‐ahead
virus versus bacteria or parasite Retrovirus genotype HIV: human immunodeficiency virus AIDS: acquired immunodeficiency syndrome immune system: T-‐cells, an9bodies, CD4 receptor site seroconversion: sero-‐nega9ve and sero-‐posi9ve false nega9ves and false posi9ves infec9ous-‐ability: STIs and STDs IDU: injec9on drug users ART: an9-‐retroviral therapy
hQp://w
ww.stdhivtraining.org/ar9cle.htm
l?id=47
What is HIV? Can I have AIDS without HIV?
hQp://w
ww.stdhivtraining.org/ar9cle.htm
l?id=47
What is HIV? Can I have AIDS without HIV?
hQp://w
ww.stdhivtraining.org/ar9cle.htm
l?id=47
What is HIV? Can I have AIDS without HIV?
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hQp://www.vircolab.com/hiv-‐educa9onal-‐forum/understanding-‐hiv
hQp://www.iayork.com/MysteryRays/2008/02/28/hiv-‐virulence-‐over-‐the-‐years/
T R A N S M I S S I O N
hQp://www.care-‐mates.com/blog/?m=200804
T R A N S M I S S I O N
hQp://www.piperreport.com/archives/2005_05.html
Primary Modes of Transmission: HIV • specific bodily fluids: blood, semen/cum, pre-‐seminal fluid/pre-‐cum, rectal fluids, vaginal fluids, breast milk
• direct blood-‐to-‐blood contact: injec9on or damaged 9ssues or mucous membranes
• having unprotected sex: anal sex has the highest risk, vaginal sex has the second highest risk; abs9nence has lowest risk
• sharing needles, syringes, rinse water, or other equipment/works used to prepare injec9on drugs
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hQp://www.tht.org.uk/myhiv/HIV-‐and-‐you/Simple-‐science/The-‐immune-‐system
Stages of HIV Disease Progression to AIDS
Acute Infec9on: 2 – 4 weeks aoer infec9on: worst flu ever: acute retroviral syndrome (ARS) or primary HIV infec9on.
Clinical latency: aoer acute phase: asymptoma9c HIV or chronic HIV infec9on: can last 8 years or longer depending on many variables.
AIDS: number of CD4 cells has fallen below 200 cells per cubic milliliter of blood and increased vulnerability for opportunis9c infec9ons.
hQp://aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/hiv-‐in-‐your-‐body/stages-‐of-‐hiv/
HIV Tes9ng: Types of HIV tests:
• An9body tests • An9gen tests • PCR (Polymerase chain reac9on) test • Home test kits
test loca9ons tes9ng frequency pre-‐post test counseling opt-‐out tes9ng confiden9al and anonymous tes9ng -‐ HIPAA
hQp://www.aids.gov/hiv-‐aids-‐basics/preven9on/hiv-‐tes9ng/hiv-‐test-‐loca9ons/index.html
Drugs Tackle Each Stage of the HIV Life Cycle
hQp://i-‐base.info/guides/star9ng/hiv-‐lifecycle
Overview of HIV Treatment Drug Categories – based on their ac9ons Nucleoside/Nucleo9de Reverse Transcriptase Inhibitors (NRTIs)
• NRTIs are “nukes” that act as faulty building blocks in the reproduc9on of viral DNA
• nukes block HIV’s ability to use a special type of enzyme (reverse transcriptase) to correctly build the new gene9c material (DNA) that the virus needs
• Medica9ons that act as NRTIs include:
▪ Combivir (lamivudine/zidovudine) ▪ Emtriva (emtricitabine, or FTC) ▪ Epivir (lamivudine, or 3TC) ▪ Epzicom (abacavir/lamivudine) ▪ Retrovir (zidovudine, AZT, or ZDV) ▪ Trizivir (abacavir/lamivudine/zidovudine) ▪ Truvada (emtricitabine/tenofovir) ▪ Videx EC and Videx (didanosine, or ddI) ▪ Viread (tenofovir DF, or TDF) ▪ Zerit (stavudine, or d4T) ▪ Ziagen (abacavir, or ABC)
hQp://www.aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/treatment-‐op9ons/overview-‐of-‐hiv-‐treatments/
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Drug Categories – based on their ac9ons Non-‐Nucleoside Reverse Transcriptase Inhibitors (NNRTIs):
• NNRTIs are “non-‐nukes” that act in a manner very similar to NRTIs; non-‐nukes block HIV’s ability to use the enzyme reverse transcriptase to correctly build the new gene9c material (DNA) that the virus needs
• NNRTIs work directly on the enzyme to prevent it from working correctly
• Medica9ons that act as NNRTIs include: ▪ Edurant (rilpivirine, or RPV) ▪ Intelence (etravirine, or ETR) ▪ Rescriptor (delavirdine, or DLV) ▪ Sus9va (efavirenz, or EFV) ▪ Viramune XR and Viramune (nevirapine, or NVP)
hQp://www.aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/treatment-‐op9ons/overview-‐of-‐hiv-‐treatments/
Drug Categories – based on their ac9ons Protease Inhibitors (PIs):
• When HIV replicates within the T cells, it creates long strands of its own gene9c material. These long strands have to be cut into shorter strands in order for HIV to create mul9ple copies of itself.
• The enzyme that acts to cut up these long strands is called protease. Protease inhibitors (stoppers) block this enzyme and prevent those long strands of gene9c material from being cut up into func9onal pieces.
• Medica9ons that act as Protease Inhibitors include: ▪ Ap9vus (9pranavir, or TPV) (must be taken with Norvir) ▪ Crixivan (indinavir sulfate, or IDV) ▪ Invirase (saquinavir, or SQV) (must be taken with Norvir) ▪ Kaletra (lopinavir/ritonavir, or LPV/r) ▪ Lexiva (fosamprenavir calcium, or FPV) ▪ Norvir (ritonavir, or RTV) ▪ Prezista (darunavir, or DRV) (must be taken with Norvir) ▪ •Reyataz (atazanavir sulfate, or ATV) ▪ Viracept (nelfinavir, or NFV)
hQp://www.aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/treatment-‐op9ons/overview-‐of-‐hiv-‐treatments/
Drug Categories – based on their ac9ons Entry/Fusion Inhibitors:
• These medica9ons work to block the virus from ever entering your cells in the first place.
• HIV needs a way to aQach and bond to your CD4 cells, and it does that through special structures on cells called receptor sites. Receptor sites are found on both HIV and CD4 cells (they are found on other types of cells too).
• Fusion inhibitors can target those sites on either HIV or CD4 cells and prevent HIV from "docking" into your healthy cells.
• Medica9ons that act as Entry/Fusion Inhibitors include: ▪ Fuzeon (enfuvir9de, T-‐20, ENF) ▪ Selzentry (maraviroc, or MVC)
hQp://www.aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/treatment-‐op9ons/overview-‐of-‐hiv-‐treatments/
Drug Categories – based on their ac9ons Integrase Inhibitors:
• HIV uses your cells’ gene9c material to make its own DNA (a process called reverse transcrip9on) – think “photocopy machine”. Once that happens, the virus has to integrate its gene9c material into the gene9c material of your cells. This is accomplished by an enzyme called integrase.
• Integrase inhibitors block this enzyme and prevent the virus from adding its DNA into the DNA in your CD4 cells. Preven9ng this process prevents the virus from replica9ng and making new viruses.
• Medica9ons that act as Integrase Inhibitors include: ▪ Isentress (raltegravir, or RAL) ▪ Dolutegravir (or DTG) (inves9ga9onal drug) ▪ Elvitegravir (or EVG) (inves9ga9onal drug)
hQp://www.aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/treatment-‐op9ons/overview-‐of-‐hiv-‐treatments/
Drug Combina9ons: Fixed-‐dose Combina9ons • These are not a separate class of HIV medica9ons but combina9ons of the above classes and a great advancement in HIV medicine.
• They include an9retrovirals which are combina9ons of 2 or more medica9ons from one or more different classes. These an9retrovirals are combined into one single pill with specific fixed doses of these medicines.
hQp://www.aids.gov/hiv-‐aids-‐basics/just-‐diagnosed-‐with-‐hiv-‐aids/treatment-‐op9ons/overview-‐of-‐hiv-‐treatments/
Treatment Considera*ons: What are the CDC guidelines for
when to begin treatment? What is involved in ini9a9ng
treatment? What medical tests might be
ordered? Is a thorough assessment of service
and support needs ini9ated? What lifestyle changes are there to
consider? Medica9on side effects?
short-‐term long-‐term
Medica9on adherence. When is treatment stopped or
changed? What is drug resistance? Are there clinical trials out there? Alterna9ve therapy? Adjunc9ve therapies?
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hQp://www.hivcenternyc.org/newsleQer/preview/acutehivinfec9on.html hQp://www.nlm.nih.gov/medlineplus/ency/imagepages/17015.htm
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pson/MEDIA/AIDS/AIDSPressRelease.htm
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hQp://www.nakedtruth.idaho.gov/do-‐I-‐have-‐an-‐std.aspx
Risk Factors for Contrac9ng HIV
Risk Factors for Contrac9ng HIV A person who has a current STD is at higher risk for picking up HIV or herpes or other infec9on.
A person with Chlamydia is 3 to 4 9mes more likely to contract HIV. A person with herpes is at higher risk for picking up HIV due to a taxed immune system.
Any disease that causes lesions increases the possibility of blood-‐to-‐blood or blood-‐to-‐semen contact.
All substances affect the body’s immune system and its ability to resist any disease organism. Alcohol and illicit drugs (1) suppress the immune system, and (2) alter the individual’s judgment to the extent that engaging in high risk behaviors such as unprotected sex is more likely. (Hatcher, A., 2010)
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Co-‐Factors which Increase Disease Progression
hQp://hepcproject.typepad.com
/hep_c_project/preven9on/
Copyright 2012
Harm Reduc9on?
abs9nence easily accessible, free condoms easily accessible, free tes9ng counseling needle exchange programs bleach universal precau9ons myths
What are the most pressing issues in HIV care today?
• access to treatment – access to care – access to resources & support • non-‐HIV primary care – care con9nuum – cascade of care • figh9ng HIV s9gma and ignorance • inflamma9on and accelerated aging • funding for health coverage for uninsured and underinsured • emerging comorbidi9es: non-‐HIV chronic diseases • cultural competence and sensi9vity versus culturally incompetent • morbidity and mortality rates • test and treat
hQp://www.thebodypro.com/content/72261/what-‐is-‐the-‐most-‐pressing-‐issue-‐in-‐hiv-‐care-‐today.html?getPage=14
Thank you for participating!
1001 N. Fairfax Street., Ste. 201 Alexandria, VA 22314 phone: 703.741.7686/800.548.0497 fax: 703.741.7698/800.377.1136 [email protected] www.naadac.org/educa9on
Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical Supervisor, LAC, MAC [email protected]
[email protected] www.myaccucare.com
10/4/13
9
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o The educa9on delivered in this webinar is FREE to all professionals.
o 1 CE is FREE to NAADAC members and Accucare subscribers who aQend this webinar. Non-‐members of NAADAC and non-‐subscribers of Accucare receive 1 CE for $15.
o If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)
www.naadac.org/webinars
www.myaccucare.com/webinars
o A CE cer9ficate will be emailed to you within 21 days of submi^ng the quiz and payment (if applicable) – usually sooner.
o Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.
10/4/13
10
Thank you for participating!
1001 N. Fairfax Street., Ste. 201 Alexandria, VA 22314 phone: 703.741.7686/800.548.0497 fax: 703.741.7698/800.377.1136 [email protected] www.naadac.org/educa9on
Mita M. Johnson, LPC, LMFT, ACS, AAMFT-‐approved Clinical Supervisor, LAC, MAC [email protected]
[email protected] www.myaccucare.com