HIV/AIDS
North Dakota Department of Health
HIV/AIDS Program
H Human
I Immunodeficiency
V Virus
A Acquired
I Immuno
D Deficiency
S Syndrome
HIV Transmission
• HIV enters the bloodstream through:
– Open Cuts
– Breaks in the skin
– Mucous membranes
– Direct injection
HIV Transmission
• Common fluids that are a means of
transmission:
– Blood
– Semen
– Vaginal Secretions
– Breast Milk
HIV in Body Fluids
Blood
Semen
18,000 Vaginal
11,000
Fluid Amniotic
7,000 Fluid
4,000 Saliva
1
Average number of HIV particles in 1 ml of these body fluids
Routes of Transmission of HIV
Sexual Contact: Male-to-male
Male-to-female or vice versa
Female-to-female
Blood Exposure: Injecting drug use/needle sharing
Occupational exposure
Transfusion of blood products
Perinatal: Transmission from mom to baby
Breastfeeding
HIV-Infected T-Cell
HIV HIV Infected New HIV
T-Cell T-Cell Virus
Virus
Window Period
• This is the period of time after becoming
infected when an HIV test is negative
• 90 percent of cases test positive within
three months of exposure
• 10 percent of cases test positive within
three to six months of exposure
HIV Infection and Antibody
Response
---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage---
Flu-like Symptoms
Or Symptom-free AIDS Symptoms
No Symptoms
----
Infection Virus
Occurs
Antibody
----
< 6 month ~ Years ~ Years ~ Years ~ Years
Importance of Early Testing
and Diagnosis
• Allows for early treatment to maintain and
stabilize the immune system response
• Decreases risk of HIV transmission from
mother to newborn baby
• Allows for risk reduction education to
reduce or eliminate high-risk behavior
HIV Testing
• Requires a blood or oral fluid sample
• HIV test detects the body’s antibody
response to HIV infection
• The test does NOT detect the HIV virus
HIV Testing in North Dakota
• Confidential vs. anonymous testing
• Testing offered free-of-charge at state-
funded HIV test sites for those at risk
• Test results are available within a week
• For a list of HIV test sites in North
Dakota call 1.800.70.ndhiv or visit
www.ndhiv.com
HIV Testing
• Those recently exposed should be retested at
least six months after their last exposure
• Screening test (EIA/ELISA) vs. confirmatory
test (IFA)
EIA/ELISA (Reactive)
Repeat EIA/ELISA (Reactive)
IFA (Reactive)
Positive for HIV
HIV Testing
EIA/ELISA
Test
Negative Positive
No HIV Exposure HIV Exposure Repeat
Low Risk High Risk Positive
Negative Repeat ELISA Run IFA
Every 3 months Positive
Confirmation
for 1 year
Repeat every
6 months for continued
Indeterminate Negative Positive
High risk behavior
Repeat at Repeat at
End Testing Negative 3 weeks 2-4 months
HIV
+
North Dakota Law
for HIV Testing
• Requires informed consent
• No premarital testing requirement
• Prenatal testing not required but
recommended
• School notification not required for positive
staff or students (universal precautions)
North Dakota Law
for HIV Testing (cont.)
• Allows testing of individuals:
– 14 years of age or older without parental
consent
– Mandatory testing for prison inmates in
grade 1, grade 2, regional facilities, and
the state penitentiary as defined in
NDCC:23-07-07.5
– Court ordered testing for defendants
charged with a sex offense as defined in
NDCC: 23-07.7-01
HIV AIDS
• Once a person is infected they are always
infected
• Medications are available to prolong life
but they do not cure the disease
• Those who are infected are capable of
infecting others without having symptoms
or knowing of the infection
HIV Risk Reduction
• Avoid unprotected sexual contact
• Use barriers such as condoms and
dental dams
• Limit multiple partners by maintaining a
long-term relationship with one person
• Talk to your partner about being tested
before you begin a sexual relationship
HIV Risk Reduction
• Avoid drug and alcohol use to maintain
good judgment
• Don’t share needles used by others for:
Drugs
Tattoos
Body piercing
• Avoid exposure to blood products
Condoms
Using condoms is not 100 percent
effective in preventing transmission of
sexually transmitted infections
including HIV
Condoms = Safer sex
Condoms ≠ Safe sex
Condom Use
• Should be used consistently and
correctly
• Should be either latex or polyurethane
• Should be discussed with your partner
before the sexual act begins
• Should be the responsibility of both
partners for the protection of both
partners
• Male and female condoms are available
People Infected with HIV
• Can look healthy
• Can be unaware of their infection
• Can live long productive lives when
their HIV infection is managed
• Can infect people when they
engage in high-risk behavior
HIV Exposure and Infection
• Some people have had multiple
exposures without becoming infected
• Some people have been exposed one
time and become infected
“When you have sex with
someone, you are having sex
with everyone they have had
sex with for the last ten years.”
Former Surgeon General
C. Everett Koop
HIV and Sexually
Transmitted Diseases
HIV and Sexually
Transmitted Diseases
STDs increase infectivity of HIV
– A person co-infected with an STD and HIV
may be more likely to transmit HIV due to an
increase in HIV viral shedding
– More white blood cells, some carrying HIV,
may be present in the mucosa of the genital
area due to a sexually transmitted infection
HIV and Sexually
Transmitted Diseases
• STDs increase the susceptibility to HIV
– Ulcerative and inflammatory STDs
compromise the mucosal or cutaneous
surfaces of the genital tract that normally
act as a barrier against HIV
– Ulcerative STDs include: syphilis,
chancroid, and genital herpes
– Inflammatory STDs include: chlamydia,
gonorrhea, and trichomoniasis
HIV and Sexually
Transmitted Diseases
• The effect of HIV infection on the
immune system increases the the risk
of STDs
A suppressed immune response due to
HIV can:
• Increase the reactivation of genital ulcers
• Increase the rate of abnormal cell growth
• Increase the difficulty in curing reactivated or
newly acquired genital ulcers
• Increase the risk of becoming infected with
additional STDs
HIV Post Exposure
Prophylaxis
HIV Occupational Exposure
• Review facility policy and report the incident
• Medical follow-up is necessary to determine
the exposure risk and course of treatment
• Baseline and follow-up HIV testing
• Four week course of medication initiated
one to two hours after exposure
• Liver function tests to monitor medication
tolerance
• Exposure precautions practiced
HIV Non-Occupational
Exposure
PREVENTION --- FIRST
• No data exists on the efficacy of antiretroviral
medication after non-occupational exposures
• The health care provider and patient may
decide to use antiretroviral therapy after
weighing the risks and benefits
• Antiretrovirals should not be used for those
with low-risk transmissions or exposures
occurring more than 72 hours after exposure
HIV Non-Occupational
Exposure
• Provider Considerations:
– Evaluate HIV status of patient and risk history of
source patient
– Provide necessary medical care and counseling
– Evaluate risk event and factors for exposure
– Determine elapsed time from exposure
– Evaluate potential for continuous HIV exposure
– Obtain informed consent for testing and treatment
– Evaluate pregnancy status of females
– Monitor for drug toxicity and acute infection