Chronic illnesses including HIV and domestic family violence

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Notification of HIV and AIDS

HIV is a “routine” condition that must be reported in writing by doctors and pathology services within five days of the diagnosis.

AIDS is not a disease that needs to be reported.

For confidentiality purposes, the only thing required is the name code. This is the first two characters of the surname and the first two alphabets of the first name.

Clinical Features

AIDS is a serious, life-threatening condition that occurs at the end of HIV infection. HIV weakens your immune system by destroying CD4 (or T-helper cells). A few weeks after HIV infection, some infected people develop a glandular-like illness that lasts for a week or two (seroconversion disease). Infected individuals may not experience any clinical symptoms or signs for several months or even years.

The treatment of combination antiretroviral therapies (cART) resulted in a vast reduction in the cases of AIDS and mortality. Infections and cancers other than AIDS, HIV-induced neurological and psychiatric symptoms, and coronary artery diseases are now the main causes of illness. The newer cART regimens have fewer side effects, but they still cause significant long-term consequences, including effects on bone health, blood sugar, and cholesterol.

Diagnosis

A careful history and physical exam, looking for clinical manifestations and risk factors of immunodeficiency, is necessary.

Diagnostic tests are usually performed by using a combination fourth-generation screening test to detect HIV antibodies/p24 antigen, followed by confirmation with western blot. Sometimes, molecular techniques such as polymerase-chain reaction (PCR) are required to confirm indeterminate test results.

Incubation Period of HIV

From infection to primary, seroconversion is typically 1 to 4 weeks. The time between infection and the development of anti-HIV antibodies can be as short as one month, but it may take up to 3 months. Newer tests may have a shorter period where a false positive result is possible early in infection.

From HIV infection until AIDS is diagnosed, the interval can range from 9 months up to 20 years. The median time between HIV infection and AIDS diagnosis is 12 years. A group of people who have a rapid onset develop AIDS in 3-5 years after infection. Another smaller group does not progress to AIDS.

HIV and AIDS: Public health implications and incidence

Worldwide. By the end of 2009, there were more than 30 million HIV/AIDS-positive people and 1.8 million HIV-related deaths. Most HIV infections are found in developing countries.

In Victoria, there were 4,680 HIV diagnoses between 1983 and 2003. About 21 percent of Australia’s total is represented by this figure. Men made ninety-four percent of diagnoses. The majority of diagnoses are due to male-to-male contact, including homosexual or bisexual relationships. The most common risk factors for females are heterosexual contact and injecting drugs.

Transmission of HIV

HIV can be spread from an infected individual by:

Sexual exposure to infected vaginal and body fluids, including semen, during unprotected sex. This includes unprotected oral sex. The estimated transmission risk after unprotected vaginal or anal sex is 0.1-2 percent. The trouble is highest after unprotected anal receptive intercourse.

Inoculation using infected blood, blood products, or organs, such as bone grafts, other tissues or tissue, or artificial insemination using infected semen

Breastfeeding an uninfected baby by an HIV-positive mother is not recommended. The use of cART in pregnancy reduces the risk of vertical transmission of HIV from an infected woman to her unborn child. A cesarean may be recommended when an infected mom has a detectable viral load. The risk of vertical transmission is reduced by avoiding breastfeeding postpartum. Newborns are often given ART to prevent HIV exposure during delivery. The risk of HIV transmission from mother to child is reduced by less than 5% with these interventions. The risk of mother-to-child HIV transmission is estimated at 20-45 percent if there is no intervention during pregnancy.

Sharps injuries include needlestick injuries and other exposures to blood or body fluids. Seroconversion rates following needlestick injuries involving HIV-infected body fluids are less than 0.5 percent, but they depend on the type (deep or shallow) of the injury and the viral load. In cases where HIV-infected body fluids or blood is present, or if the exposure poses a high risk, post-exposure prophylaxis may be given.

Duration of HIV and AIDS transmission

All HIV-positive individuals carry antibodies.

The virus is assumed to be present for life, but successful treatment with cART may reduce the viral load to undetectable levels in the blood and sperm.

HIV susceptibility and resistance

Susceptibility may be increased by the presence of other sexually transmitted infections, particularly those that have skin or mucosal lesions.

HIV Control Measures

It is important to educate the public about condoms, safer sexual practices, and how to use them.

The public should be made aware that unprotected sexual contact with multiple or unknown partners and the sharing of needles by drug users (drug addicts) increases the risk of HIV infection.

Sexual contact with HIV-positive people should be protected.

HIV-infected individuals should receive confidential counseling, screening, and treatment of sexually transmitted infections, as well as appropriate antiviral therapy.

When handling, disposing, and using needles or sharp objects, it is important to take care.

It should be encouraged that injecting drug users use needle exchange programs.

The following are institutional factors:

All healthcare workers and emergency personnel should use appropriate infection control measures.

In all places where skin penetration takes place, such as electrolysis, body piercing, or tattooing, appropriate infection control measures must be taken.

Tests for HIV markers should be performed on blood and blood products, as well as donors of tissue and body fluids such as semen.

Australian Guidelines for the Prevention and Control of Infection in Healthcare should be followed when dealing with sharps injuries and needlestick injuries.

Australian National Guidelines for Post-Exposure Prophylaxis After Non-Occupational Exposure to HIV should be used to assess and manage non-occupational HIV exposure.

Control of Case

The Blue Book contains a section called “Standard Precautions” (Appendix 3), which is applicable to all patients.

Specific infections, like tuberculosis that are found in AIDS patients require additional precautions. Equipment that has been contaminated by blood or other body fluids must be cleaned and disinfected or sterilized as necessary.

Don’t donate blood, organs, or any other human tissue to patients and their partners.

All HIV-infected individuals should be tested for tuberculosis.

Treatment

Antiretroviral therapy is used for HIV infection. Antiretroviral treatment is highly specialized and always changing. Only doctors with experience in HIV management can prescribe it. Further information can be found in the latest edition of Clinical Guidelines: antibiotic as well as the Australasian Society for HIV Medicine website. The Australasian Society for HIV Medicine website has more information.

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