PYC2605 Exam prep 2021.

PYC2605 Exam prep 2021. HIV/AIDS Care And Counselling. Definition - What is AIDS? AIDS is short for Acquired Immune Deficiency Syndrome.  We say that this disease is acquired because it is not a disease that is inherited. It is caused by a virus (the human immunodeficiency virus or HIV) that enters the body from outside.  Immunity is the body’s natural ability to defend itself against infection and disease. A deficiency is a shortcoming – the weakening of the immune system so that it can no longer defend itself against passing infections.  A syndrome is a medical term for a collection of specific signs and symptoms that occur together and that are characteristic of a particular condition. Although we use the term ‘disease’ when we talk about it, AIDS is not a specific illness. It is really a collection of many different conditions that manifest in the body (or specific parts of the body) because the HI virus has so weakened the body’s immune system that it can no longer fight the diseasecausing agents that are constantly attacking it. It is therefore more accurate to define AIDS as a syndrome of opportunistic diseases, infections and certain cancers — each or all of which has the ability to kill the infected person in the final stages of the disease.  An opportunistic infection o is caused by pathogens which usually do not attack a healthy immune system. o takes the ‘opportunity’ to attack a deteriorated immune system.  HI virus first isolated by scientists in 1983 The important defensive cells of the human immune system (i.e. the CD4 cells or T helper cells) have no way of defending themselves against the virus.  The HI Virus directly attacks and hijacks these important CD4 cells, slowly reducing their numbers and weakening the cells ability to defend itself against attacks from outside The reason why HIV - the virus that causes AIDS - is so dangerous to human beings is because HIV ‘hijacks’ the most important cells in the immune system, namely the CD4 cells , and ‘forces’ them to make more HI viruses.  the macrophages warn the lymphocytes (B and T-cells) that they should mobilise to protect the body against an organic invader such as a virus o The macrophages surround the virus, grab an antigen from it and display it like a ‘banner of war’ in order to mobilise the lymphocytes. o This flag/banner (the antigen plays a critical role in the immune system response because it alerts the next regiment to attack the invaders). Stages Infection Asymptomatic Minorsymptomatic Majorsymptomatic Severe symptomatic acute seroconversion latent aids defining conditions CD4 200 cells /mm3 Viral load very rapid very Symptoms – flu/none none/swollen glands minor majoropportunistic disease aids + severe infection Activity - normal normal normal despite symptoms bed 50% of day bed ,50% day 2. Transmission of HIV  contact with infected blood. For example if there is an injury on the sports field and the blood of an infected This study source was downloaded by from CourseH on :34:58 GMT -05:00 player comes into contact with the broken skin or sores of another player. This study resource was shared via CourseH  unprotected sex, or when learners have sexual intercourse without a condom.  sharing needles for drug usage.  breastmilk  blood transfusions Can’t contract through –  coughing or sneezing  handshaking or hugging  mosquito bites  swimming pools Women are biologically more vulnerable to HIV infection than men, because  women are the recipients of semen and are exposed to semen for a longer time during sex than men are to vaginal fluids,  and semen contains higher concentrations of HIV than do vaginal fluids.  A woman also has a larger surface area of mucosa (the thin lining of the vagina and cervix) exposed to the partners secretions during sexual intercourse. Nobody is to blame for AIDS but it is our responsibility to protect ourselves from contracting the virus as well as caring for those infected. 3. Symptoms and diseases associated with HIV/AIDS to manage HIV infection, it is important for the clinician to monitor the individual’s CD4 cell count and the viral load in his or her blood on an ongoing basis. CD4 cell counts are important  to evaluate the status of the immune system (or to see how healthy or sick the person is)  and to indicate when to start to prevent or treat opportunistic infections (for example, we start giving medication for TB to an HIV positive person as soon as the CD4 cell count drops lower that 350 cells, to prevent TB).  The health status of a person can be predicted by doing a CD4 cell count. The lower the CD4 cell count, the sicker the person will be and the higher the possibility of opportunistic infections. There is a special relationship between the viral load and the CD4 cell count An infected person is most infectious soon after becoming infected as well as during the latter stages when AIDS has developed. The reason why a person is more infectious during the beginning and final phases of the disease, is because the viral load in the blood and semen is very high during these stages of infection. And if you have sex with a person with a very high viral load in his blood or semen, your chances of getting infected are so much higher. The treatment of STIs (sexually transmitted infections) in Africa is based on either the diagnostic or the syndromic management approach.  advantages of syndromic case management: o it does not require laboratory support o and it does not require highly trained STI specialists. People with STIs have very low antibody counts and this opens the ‘gates of the immune system’ for all kinds of opportunistic diseases such as HIV, to attack them. symptoms of tuberculosis  Fever with chills, night sweats, a persistent cough and weight loss. HIV infection has become a manageable chronic disease. What we should worry about now is tuberculosis(TB) and the development of drug-resistant TB organisms. Drug-resistant TB is very hard to treat and thousands of people will die at the hand of this new threat in our midst.” (World Health Organisation official,2001).  TB prophylactic (preventive) medication should only be given to HIV positive individuals with low CD4 cell counts who do not show any signs of active tuberculosis and who are committed to adhering to the medication programme. This study source was downloaded by from CourseH on :34:58 GMT -05:00 This study resource was shared via CourseH 4. HIV testing If a person knows he/she is HIV positive it is easier to confirm and treat symptoms, prevent opportunistic diseases and to put the person on an ARV programme when necessary. Rapid HIV antibody test –  Results in 10-30 minutes  Reacts to antibodies in blood which have formed in reaction to HI virus  In a baby younger than 15 to 18 months, it is impossible to say if the antibodies in the baby’s blood are those of the baby or the mother. Therefore, we do not test young babies with HIV antibody tests.  In order to eliminate possible false negative or false positive results, o the health care worker should make sure that the tests are stored at the correct temperature and o he/she should confirm all positive results with a second rapid test from a different batch of tests. Things in the AIDS field change very rapidly and it is important that you stay abreast of new developments  ‘dried blood spot (DBS) plasma p24 antigen test’ o new test available for the assessment of paediatric HIV infection in resource-limited countries. o The test reacts to the p24 antigen (protein particle of HI Virus) in the baby’s blood (and not to antibodies). o The test is easy to use, inexpensive, can be used in resource-limited settings. and has high levels of sensitivity and specificity. o But the best part of the dried blood spot test is that it can be done on babies younger than 18 months of age. o “Old” HIV antibody tests cannot be done on babies younger than 18 months old because they will still have the antibodies of their mothers in their blood. o The dried blood spot test, however, react to the p24 antigen which is a protein particle of the HI virus. A negative HIV antibody test can mean  the person may have tested negative because they are not infected with HIV.  the person may have tested negative because the antibodies have not yet formed against the virus,  or the antibody levels are still too low to be picked up by the antibody test (which means that the person is still in the window period.) The main issue being debated is the human rights versus public health issues about the two approaches to HIV testing, provider-versus client initiated testing. Typical human rights versus public health debate in the HIV/AIDS field refer to the achievement of a healthy balance between the rights of the HIV infected individual and the rights of the public in general.  Provider initiated testing refers to health providers such as clinics who offer voluntary counselling and testing by default and if clients do not want to be tested they specifically have to decline the service. o provider initiated testing could violate human rights if patients are not well informed that HIV testing and counselling is offered by default and will not necessary know that they have a right to refuse being tested. o disadvantages of provider initiated counselling and testing include that we might miss many opportunities to diagnose and counsel individuals who do not visit hospitals and sometimes the rights of people in vulnerable positions like prisoners might be violated because they will not have a choice to decline testing if it’s offered as a matter of course in prisons.  Client initiated testing refers to the fact that clients have to initiate HIV counselling and testing by going to a health provider and asking for the test o Unfortunately not many people initiate their own testing. The slow uptake of VCT worldwide, is one of the reasons why the provider initiated testing initiative was launched. 5. Antiretroviral therapy The general aim of antiretroviral therapy is to reduce the HIV viral load in the blood as much as possible for as long as possible. This study source was downloaded by from CourseH on :34:58 GMT -05:00 This study resource was shared via CourseH Advice for those who refuse to take antiretrovirals to keep as healthy as possible  must visit his local clinic regularly for check-ups,  and go to the clinic immediately when sick.  should eat healthy foods, take vitamins and avoid unhealthy practices to keep immune system as healthy as possible. Although HIV infection can be treated with antiretrovirals so that  the viral load is kept low and the immune system is kept as healthy as possible,  there is still no cure for AIDS or HIV infection.  ARVs only lower the viral load in the body,  and if you have unprotected sex, you can get re-infected with HIV and your viral load can go up again.  Antiretroviral may have negative side-effects on some patients  and involves a strict and complex regime which is often difficult for patients to follow.  The medication has to be taken everyday throughout a person’s life.  Antiretroviral therapy does not eliminate the HI virus completely from the system, but it manages or controls the HIV infection. in some cases, so effective that the viral load becomes undetectable in a person's blood. o This means that The virus will always be in the body but at such low levels that the tests may not be sensitive enough to detect its presence. Theme 2 – Prevention of HIV infection 6. Preventing HIV  By always practising safer sex.  By always using a condom when you have sex.  By never having unprotected sex.  By abstaining from sex altogether.