Resource Packages: HIV
Historical Overview
HIV
Human Immunodeficiency Virus is a retrovirus that seriously weakens the body’s natural immune system by infecting and taking over healthy cells and reproducing copies of itself.
AIDS
Acquired Immune Deficiency Syndrome is a severe life threatening clinical condition, first recognized as a distinct syndrome in 1981. This syndrome represents the late clinical stage of infection with HIV, which often results in progressive damage to the immune system and other organs including the central nervous system.
HIV disease was first recognised in 1981 when rare diseases (usually seen in people with immune deficiency) began to appear in homosexual men, namely Kaposi’s sarcoma and Pneumocystis carinii pneumonia. Similar cases were soon reported in injecting drug users and recipients of blood transfusions suggesting that the infectious agent was not only transmissible sexually but also through parenteral contact. Two blood tests, Western Blot and Enzyme-Linked Immunosorbent Assay (ELISA) were developed by 1984 to detect HIV antibodies in blood which indicate infection.
Where did HIV come from?
Although not conclusive, researchers from the University of Alabama at Birmingham in 1998 provided evidence that HIV may have originated in non-human primates, probably chimpanzees. HIV in humans may have resulted from cross species transmission, through bites and/or human contact with infected blood from primates.
Transmission
HIV is transmitted by three major means:
- By sharing injection equipment e.g. syringes, that contains blood from an infected person, or injuries sustained from an infected sharp such as a needle that has been used for a medical procedure.
- By unprotected vaginal or anal intercourse or any other
sexual activity when blood, semen or vaginal fluid from an infected
person passes into broken skin, mucous membranes or into the blood stream
of another.
Oral sex with ejaculation carries a relatively low risk. - A woman can transmit HIV to her child during pregnancy, during birth or through breast-feeding. This is known as vertical transmission.
Incubation Period
The time from infection to the development of detectable antibodies is generally 1-3 months. The time from HIV infection to diagnosis of AIDS has a range of 1 to 10 years or longer. Treatment with anti-retroviral therapy may prolong the incubation period.
Symptoms
Onset of clinical illness can be:
- Recurrent fevers, night sweats, chills
- Rapid weight loss, for no apparent reason
- Swollen lymph glands in the neck, groin, underarm
- White spots or unusual blemishes in the mouth
- Loss of appetite
- Skin blotches or bumps
- Persistent or dry cough
- Diarrhoea
Identification
Group 1 (acute primary infection)
An acute illness can occur on initial infection with HIV in about 50% of cases. The illness is characterized by glandular fever-like symptoms. Time frame: first 12 weeks post infection.
Group 2 (asymptomatic infection)
People who are usually well but infected and HIV antibody positive. Time frame, several years depending on the individual and response to treatments/medication.
Group 3 (persistent generalized lymphadenopathy/symptomatic infection)
Characterized by the presence of lymph node enlargement or where they display symptoms or signs of HIV infection. Time frame, several years depending on treatment/medication.
Group 4 (AIDS and related conditions)
Includes all serious diseases attributable to HIV infection, e.g. opportunistic infections that include Pneumocystis carinii pneumonia, Kaposi’s sarcoma as well as neurological complications such as toxoplasmosis.
Occurrence
Cumulative total in Australia up to March 1999:
- 19,581 infected with HIV
- 8,103 diagnosed with AIDS
- 5,753 deaths
Global summary of HIV
In 1998 there were:- 5.8 million newly infected people with HIV
- 33.4 million people living with HIV
- 2.5 million AIDS deaths
- 13.9 million AIDS deaths since the beginning of the pandemic
The World Health Organization predicts that by the year 2000 there will be 40-50 million cases worldwide.
A new case of HIV infection occurs every 15-20 seconds in the world.
By year 2000, 90% of global infections will be acquired through heterosexual sex.
Treatment
Specific antibiotics and antiviral drugs have been prescribed for patients with clinical HIV to overcome secondary infections associated with the disease. In addition, therapy is available to deal with other complications such as Kaposi’s sarcoma or lymphoma. The introduction of combination therapy using anti-retroviral and protease inhibitor medications has shown to improve the well being of persons infected with HIV and to reduce the incidence of secondary infections. A variety of HIV vaccines are currently on trial.
Occupational Exposure to HIV
Occupational exposure is defined as an incident which occurs during the course of a person’s employment and involves contact with blood or other body substances such as a needlestick injury or splash exposure. These exposures may put a person at risk of acquiring a blood borne infection.
To date there have been four documented seroconversions to HIV acquired through occupational exposure in Australia and these have been while performing venepuncture.
Every health care facility should have a local system established for reporting and managing potential exposures of health care workers (HCW) to blood borne pathogens. An occupational exposure must be fully documented to meet legal requirements, to ensure the health care workers are able to gain support to which they are entitled and access to workers’ compensation if appropriate.
Prevention
Ways that transmission of HIV can be prevented:
- Practicing safe sex, which involves using condoms or femidoms for penetrative sex, avoiding penetration or types of sexual activity that involves the exchange of body fluids from one person to another
- Never share drug injecting equipment (such as needles, syringes, spoons or filters) with another person
- Reducing the risk of transmission during and after pregnancy. Couples planning a pregnancy but who may have risk factors for HIV are advised to have an HIV test first. Pregnant women with HIV are advised to take a course of antiretroviral therapy in the second trimester until birth to reduce the chance of vertical transmission. They are also advised not to breast-feed as HIV can be transmitted in breast milk
Legislative Provisions
Section 13 of the Public Health Act 1991 makes it an offence for a person who knows that he or she suffers from a sexually transmissible disease to have sexual intercourse with another person without informing them of the risk. The other person has to be informed before intercourse takes place and voluntarily agree to accept the risk.
A public health order can be imposed which places restrictions on a person’s behaviour if such restriction is the only effective way to ensure that the health of the public is not, or likely to be, endangered.
Health care establishments should ensure that appropriate infection control guidelines are in place, based on the following current New South Wales circulars:
- 94/78 Definition of HIV Infection and AIDS-Defining Illness
- 97/93 Management of People with HIV Infection Who Risk Infecting Others
- 98/11 Management of Healthcare Workers Potentially Exposed to HIV, Hepatitis B and Hepatitis C
- 99/87 Infection Control Policy
- 99/88 Health Care Workers Infected with HIV, Hepatitis B of Hepatitis C
These policies and guidelines should be followed for the protection of health care workers, their relatives, and patients. At the same time health care workers should take all the necessary precautions to minimise the spread of HIV and to protect the rights of patients without compromising patient care.
Standard Precautions should be practiced at all times
Transmission Based Precautions: Droplet, Airborne or Contact Precautions only need to be followed if the HIV coexists with a medical condition that indicates their use.
Notification to the Public Health Unit - HIV is a notifiable disease and this must be reported to the Public Health Unit. Notification is completely confidential and does not include the person’s name or address (just a code, sex and date of birth).
References
Australian National Council on AIDS (ANCA), AIDS, Facts About Acquired Immune Deficiency Syndrome. 1990, Bulletin No.1, Canberra, ACT.
Bennett JV, Brachman PS and Sandford JP, eds, 1992, Third Edition. Hospital Infections. Little, Brown and Company, Boston.
Department of Health, Housing and Community Services. The AIDS Antibody Test. 1992, B92/21106, Canberra, ACT.
1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. Morbidity and Mortality Weekly Report, Dec 18, 1992, vol 41/no rr-17
The AIDS manual, Third Edition, Albion Street Centre, 1994.
NSW Department of Health, 1994, Circular 94/78, “Definition of HIV Infection and AIDS Defining Illness”, AIDS/ Infectious Diseases Branch.
Benenson AS Ed, 16th Ed, 1995. Control of Communicable Diseases in Man. American Public Health Association, Washington.
NSW Department of Health, 1997, Circular 97/93, “ Management of People with HIV Infection Who Risk Infecting Others” AIDS/Infectious Diseases Branch.
Aids Epidemic Update: December 1998 UNAIDS joint United Nations program on HIV.
NSW Department of Health, 1998, Circular 98/11, “Management of Healthcare Workers Potentially Exposed to HIV, hepatitis B and hepatitis C” AIDS/Infectious Diseases Branch.
Presentation on Origin of HIV-1 at 6th conference on retroviruses and opportunistic infections CDC update Jan 31 1999 Kevin De Cock.
NSW Department of Health, 1999, Circular 99/87, “Infection Control Policy”, AIDS/ Infectious Diseases Branch.
NSW Department of Health, 1999, Circular 99/88, “Health care Workers Infected with HIV, hepatitis B or hepatitis C”, AIDS/Infectious Disease Branch.
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