Acquired Immune Deficiency Syndrome

1
Acquired Immune Deficiency Syndrome

• Group 8
• Kristi Tuck
• Nathan Watts
• Suellen Yekisa
• Katie Zeller

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What is AIDS?

• AIDS is the final, most advanced stage of the HIV
  infection
• HIV- Human Immunodeficiency virus- weakens a
  persons ability to fight infections and cancer
• People with HIV are said to have AIDS when they
  develop certain infections or cancers or when
  their Immune system CD4 cell count is less than
  200 (determined by a blood test)
• The typical age of onset is around 20-30 years old

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What is a CD4 cell

• It is a type of white blood cell
• Its main function is to fight disease
• When a persons CD4 count gets low, they are more
  susceptible to different illnesses
• HIV attacks and destroys these cells

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Do people with HIV have AIDS?

• NO
• Having HIV does not always mean you have AIDS
• It may take many years for a person with HIV to
  develop AIDS

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HIV/AIDS Etiology

• A person acquires HIV when an infected persons
  body fluids (blood, semen, fluid from the vagina,
  or breast milk) enter his/her bloodstream
• The virus enters the blood through linings in the
  mouth, anus, sex organs, or broken skin

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Contracting HIV
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• It is possible to contract HIV in many ways
  including
• Sharing a needle to take drugs
• Having unprotected sex with an infected person
• Being born to a mother with HIV infection
• Receiving a blood transfusion (very unlikely in
  U.S. and Western Europe)

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You CANNOT get HIV/AIDS from

• Touching or hugging someone with HIV/AIDS
• Public bathrooms or swimming pools
• Sharing cups, utensils, or telephones with
  someone who has HIV/AIDS
• Bug bites

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Statistics

• According to the Center for Disease Control and
  Prevention, the estimated number of people with
  HIV/AIDS in the U.S. is 1,185,000
• Approximately 25 of them are unaware of their
  infection (thats 296,250 people)
• The estimated number of new cases of HIV each
  year is 42,000

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• http//webs.wichita.edu/mschneegurt/biol103/lectur
  e15/aids_map.jpg

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Statistics Continued

• Approximately 40.3 million people are currently
  living with HIV/AIDS globally
• About 25 million people world wide have died
  since the start of the AIDS epidemic

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Statistics continued

• According to the World Health Organization, by
  2030, AIDS may be the worlds 3rd leading cause
  of death
• They also say that the worlds most common
  diseases in 2030 will be HIV/AIDS, depression,
  and heart disease

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Symptoms of HIV

• Lack of energy
• Weight loss
• Frequent fevers and sweats
• Persistent or frequent yeast infections
• Persistent skin rashes or flaky skin
• Short-term memory loss
• Mouth, genital, or anal sores from herpes
  infection
• Following the initial infection, you may have no
  symptoms. The progression of the disease varies
  widely among individuals. This state may last
  from a few months to more than 10 years
• -you can still transmit the infection to others
  during this symptom free period

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Signs that HIV is turning to AIDS

• A fever that wont go away
• Sweating while you sleep
• Feeling tired all the time (not from stress or
  lack of sleep)
• Feeling sick all the time
• Losing weight
• Swollen glands (neck, groin or underarms)

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Symptoms of AIDS

• Cough or shortness of breath
• Seizures and lack of coordination
• Difficult or painful swallowing
• Mental symptoms such as confusion and
  forgetfulness
• Severe and persistent diarrhea
• Fever
• Vision loss
• Nausea, abdominal cramps, and vomiting
• Weight loss and extreme fatigue
• Severe headaches with neck stiffness
• Coma
• Also prone to develop various cancers
• most of these conditions are infections caused
  by bacteria, viruses, fungi, parasites, and other
  organisms

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AIDS Defining IllnessesCommon infections/conditio
ns that people with AIDS get

• Kaposis Sarcoma- a skin tumor that looks like
  dark purple blotches
• Fungal infections- cause mental changes and
  headaches (also caused by tumors in the brain and
  spinal cord)
• Infections of the lungs- cause shortness of
  breath and difficulty breathing
• Dementia
• Severe malnutrition
• Chronic diarrhea

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Stages of HIV to AIDS

• Stage 1 Primary HIV Infection
• Lasts for a few weeks
• Accompanied by a short flu-like illness
• Diagnosis of HIV infection is often missed

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Stages of HIV to AIDS

• Stage 2 Clinically Asymptomatic Stage
• Lasts an average of 10 years
• Free from major symptoms
• Will show positive HIV results

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Stages of HIV to AIDS

• Stage 3 Symptomatic HIV Infection
• Immune system is failing and symptoms begin to
  develop
• Symptoms are initially mild but worsen over time

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Stages of HIV to AIDS

• Stage 4 Progression from HIV to AIDS
• As the immune system becomes more and more
  damaged the illnesses that occur become more and
  more severe leading eventually to an AIDS
  diagnosis
• CD4 cell count lt200

21
Diagnosis

• There are Three types of tests available to test
  for HIV
• HIV antibody test
• P24 Antigen test
• Viral load test

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HIV Antibody Test

• When the virus enters the system, antibodies are
  produced in response to the infection. This test
  determines whether or not there are antibodies to
  HIV.
• For many people, it takes a minimum of 3 months
  for enough antibodies to develop for this test to
  be effective

23
P24 antigen test

• This test is usually used for blood screening.
  It detects the P24 antigen protein which is
  present in large amounts in people with HIV.
• This test can be done very early on in the
  infection and can detect the virus before the
  antibody test.

24
Viral load test

• This test is reserved for people who already know
  they are HIV positive and is used for testing the
  level of the virus in the blood.

25
Diagnosis

• In each of the three tests, a small amount of
  blood is taken from the arm then sent to a lab to
  be tested. If someone does not like having their
  blood taken, it can be done orally through
  saliva, though few countries besides America make
  this test widely available.

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Prognosis

• At the present time, there is no cure for AIDS
• Treatment stresses aggressive combination drug
  therapy for those patients with access to the
  expensive medications and who tolerate them
  adequately.

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Prognosis

• The use of these multi-drug therapies has
  significantly reduced the numbers of deaths in
  this country, resulting from AIDS. These drugs
  along with other drug therapies have the
  potential to prolong life indefinitely by
  boosting the immune system, keeping the virus
  from replicating, and warding off opportunistic
  infections.

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Treatment

• These are the 3 main types of medication
• Protease Inhibitors (Pis)
• Nucleoside/Nucleotide Reverse Transcriptase
  Inhibitors (NRTIs)
• Non-Nucleoside Reverse Transcriptase Inhibitors
  (NNRTIs)

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Protease Inhibitors

• Protease Inhibitors prevent CD4 cells that have
  been infected with HIV from producing new copies
  of the virus

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Protease Inhibitors (PIs)

• Aptivus example of PI drug
• Dosing two 250mg capsules plus two 100mg
  capsules twice a day
• Side effects bleeding in the brain, rash, and
  increased bleeding in patients with hemophilia

31
NRTIs

• NRTIs prevent healthy CD4 cells in the body from
  becoming infected with HIV
• NRTIs contain faulty versions of the nucleotides
  used by reverse transcriptase to convert RNA to
  DNA. When reverse transcriptase uses these
  faulty building blocks, the new DNA cannot be
  built correctly. In turn, HIVs genetic material
  cannot be incorporated into the healthy genetic
  material of the cell and prevents the cell from
  producing the new virus.

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NRTIs

• Entriva example of NRTI
• Dosing 1 200mg capsule once a day
• Side effects buildup of acid in the blood
  fatty liver

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NNRTIs

• NNRTIs attach themselves to reverse transcriptase
  and prevent the enzyme from converting RNA to
  DNA. In turn, HIVs genetic material cannot be
  incorporated into the healthy genetic material of
  the cell, and prevents the cell from producing
  new virus

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NNRTIs

• Example Sustiva
• Dosing one 600mg tablet once a day
• Side effects rash central nervous system
  symptoms, such as drowsiness, insomnia,
  confusion, inability to concentrate, dizziness,
  and vivid dreams increased liver enzymes

35
Treatment

• PIs, NRTIs, and NNRTIs are used in combination to
  block the replication of HIV in a persons blood.
  These three drugs are currently approved by the
  FDA for use in these combination therapies

36
Entry Inhibitors

• Entry inhibitors work by preventing HIV from
  entering healthy CD4 cells in the body. They
  work differently than PIs, NRTIs, and NNRTIs
  which are active against HIV after it has
  infected a CD4 cell.

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Entry Inhibitors

• Example Fuzeon
• Dosing two 90mg injections per day
• Side effects itching, increased risk of
  bacterial pneumonia, serious allergic reaction

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Whats new in AIDS research and Treatment

• Research is being directed in 3 major areas
• 1) using available drugs more safely and
  effectively
• 2) developing new and better medicines
• 3) developing AIDS vaccines

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Whats new in AIDS research and Treatment

• The first approach is to learn how best to use
  the drugs that are available now. A recent study
  found that a 4 drug regimen containing
  lamivudine/zidovudineindinavirefavirenz
  suppressed virus growth much better than several
  other regimens in patients with advanced HIV
  infection.

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Whats new in AIDS research and Treatment

• The second line of research is the development of
  new and more effective drugs that (1) are more
  effective, (2) act on different functions of HIV
  to be added to the present regimens, and (3) have
  fewer side effects than the drugs currently being
  used

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Whats new in AIDS research and Treatment

• A new class of drugs called fusion inhibitors has
  been developed and the FDA has already approved
  the first of these, Fuzeon. An even newer class
  of drugs called integrase inhibitors are in very
  early tests. There are many new drugs in the
  development and testing stage.

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Whats new in AIDS research and Treatment

• Finally, the most important target of research
  for the future is the development of an AIDS
  vaccine. Millions are being spent to develop
  vaccines, specifically vaccines designed to
  prevent HIV infection.

43
Whats new in AIDS research and Treatment

• Evaluation of several experimental vaccines is
  already underway. To date, more than 12,000
  volunteers have participated in HIV vaccine
  clinical trials. Most of 20 promising HIV
  vaccines are in the early stages of testing.

44
Life Expectancy

• The life expectancy of individuals with HIV and
  AIDS continues to grow.
• The average time between HIV infection and the
  appearance of signs that could lead to an AIDS
  diagnosis is 8-11 years.
• This time varies greatly from person to person
  and can depend on many factors including a
  person's health status and behaviors.
• A recent study shows that after individuals are
  diagnosed with AIDS they typically live for 6
  years.

45
AIDS in the Media

• The red ribbon is the international symbol of HIV
  and AIDS awareness. It is worn by people around
  the world to demonstrate their care and concern
  about HIV and AIDS
• The Red Ribbon offers a symbol of hope and
  support for those living with HIV, for the
  continuing education of those not infected, for
  maximum efforts to find effective treatments,
  cures or vaccines and for those who have lost
  friends, family members or loved ones to AIDS

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AIDS in the Media

• Wearing a Red Ribbon is the first step in the
  fight against HIV/AIDS. It can be worn on any
  day of the year, but especially on World AIDS
  Day, December 1st
• The next step is to do something more for those
  suffering from HIV/AIDS

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Client Factors

• Body Structures
• Mental Functions
• Sensory Functions
• Neuromusculoskeletal Movement Related Disorders
• Cardiovascular, Hematological, Immunological,
  Respiratory Functions
• Voice and Speech Functions
• Digestive, Metabolic, Endocrine System
  Functions
• Genitourinary Reproductive Functions
• Skin and Related Functions

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Keep in Mind

• AIDS is a deficiency of the immune system
• Most of the conditions are infections caused by
  bacteria, viruses, fungi, and parasites
• The immune system typically defends the body from
  these infections
• The infections will typically affect more than
  one area of the body
• Individuals with AIDS will experience a general
  lack of energy or fatigue

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Body Structures

• None due to HIV or AIDS
• May have infection that affects the body
  structures

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Mental Functions

• Toxoplasmosis
• Caused by the single-celled parasite, Toxoplasma
  gondii
• Usually infects the brain causing toxoplasma
  encephalitis, but it also causes disease in the
  eyes, heart, and lungs
• Results in discrete lesions in the brain
• Progressive multifocal leukoencephalopathy
• Caused by a viral disease of the brian, JC virus
• Results in a severe decline in cognitive and
  motor functions

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Mental Functions (cont.)

• AIDS Dementia Complex (ADC)
• Specific neurological impairments are manifested
  by cognitive, behavioral, and motor abnormalities
• Associated with low CD4 cell levels and high
  plasma viral loads
• Cryptococcal Meningitis
• Infection of the meninges by the fungus
  Cryptococcus neoformans
• Yeast that causes infection in the lining of the
  brain
• Results in seizures and confusion, if untreated
  it can be lethal

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Mental Functions (cont.)

• Result of Infections
• Short-term memory loss
• Confusion
• Forgetfulness
• Coma
• Death

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Sensory Functions

• Vision loss
• Result of infection
• Toxoplasmosis
• Loss of taste
• Result of lesions in mouth
• Increase pain and discomfort
• Result of dermatitis and lesions

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Neuromusculoskeletal and Movement Related
Disorders

• Lack of coordination
• Result of PML
• Stiffness in neck and joints
• Due to infection

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Cardiovascular, Hematological, Immunological,
Respiratory Functions

• Cardiovascular
• Toxoplasmosis
• Affects heart, lungs, eyes as well as brain
• Hematological
• Mycobacterium avium
• Blood infection by a bacteria related to
  tuberculosis

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Cardiovascular, Hematological, Immunological,
Respiratory Functions

• Immunological
• HIV can weaken the immune system to the point
  that the system has difficulty fighting off
  certain infections
• Opportunistic infections
• Healthy immune systems can prevent these
  infections
• The Immune system has weakened to the point that
  medical intervention may be necessary to prevent
  or treat serious illness
• The most common problems with the immune system
  are infections, especially to the lungs, and they
  are prone to develop various cancers

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Cardiovascular, Hematological, Immunological,
Respiratory Functions

• Respiratory
• Tuberculosis
• An infectious disease caused by tubercle bacillus
  and characterized by the formation of tubercles
  on the lungs and other tissues of the body
• Leading cause of death for individuals with AIDS
• Candida esophagitis
• Painful yeast infection of the esophagus

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Tuberculosis of the Lung
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Cardiovascular, Hematological, Immunological,
Respiratory Functions

• Respiratory cont.
• Pneumocystis jiroveci pneumonia (PCP)
• Attacks the lungs, making it difficult to
  breathe. Symptoms include a cough that doesn't go
  away, fever and trouble breathing.
• Rare in healthy people, common in people with
  AIDS
• In developing countries it is still one of the
  first indications of AIDS in untested individuals

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Voice and Speech

• Voice and speech are affected due to the problems
  that arise with respiration and lesions or sores
  in the mouth
• Shortness of breath is a typical symptom with
  tuberculosis and pneumonia which can exacerbate
  the voice and speech difficulties

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Digestive, Metabolic, Endocrine System Functions

• Cryptosporidium diarrhea
• Extreme, chronic diarrhea caused by one of many
  parasites
• Esophagitis
• Inflammation of the lining of the lower end of
  the esophagus
• Difficult or painful swallowing
• Result of fungal, viral, or bacterial infection
• Wasting Syndrome
• Loss of at least 10 percent of body weight
• Severe malnutrition
• Nausea, abdominal cramps, and vomiting

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Genitourinary Reproductive Functions

• Vaginal or oral thrush
• Yeast infection of the mouth or genitals
  typically persistent or frequent
• Sexually transmitted diseases (STD) can increase
  a persons risk of becoming infected with HIV
• Irritation of skin, breaks or sores make it
  easier for HIV to enter the body during sexual
  contact
• Even without breaks or sores HIV transmission is
  more likely
• HIV/AIDS can be passed on through pregnancy

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Skin and Related Functions

• Seborrheic Dermatitis
• Persistent skin rashes or flaky skin
• Note the redness (erythema) and mild scaling

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/2398.htm
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Skin and Related Functions

• Kaposis sarcoma
• Cancer of the skin, lungs, and bowel
• Associated with a herpes virus
• More common in men

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/1363.htm
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Skin and Related Functions

• Herpes
• Simplex virus
• Ulcers/vesicles in the mouth or genitals
• Zoster virus (Shingles)
• Ulcers/vesicles over a discrete patch of skin

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Skin and Related Functions

• Molluscum contagiosum
• Lesions associated with the molluscum virus
• Typically present in individuals with a weakened
  immune system
• small, raised, pearly skin lesions caused by the
  molluscum virus

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/2441.htm
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Skin and Related Functions

• Histoplasmosis
• Occurs as a lung infection, but can infect the
  skin or become distributed (disseminated) to
  internal organs

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Key Symptoms that Affect Areas of Occupation

• Weakened immune system
• Very susceptible to infection and cancer
• Memory and cognition
• Motor function
• Respiratory difficulties
• Skin conditions
• Wasting Syndrome
• Malnutrition
• Weight loss
• Fatigue

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Video An Inconvenient Truth

• http//www.youtube.com/watch?vG4FvVGqVGLs

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Areas of Occupations

• ADLs
• IADLs
• Education
• Leisure
• Work
• Social participation

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Major symptoms that affect areas of occupation

• Memory and Cognition
• Motor functions
• Fatigue
• Respiratory conditions
• Skin conditions
• -each area of occupation will be affected
  differently due to different infections or
  cancers
• (weak/lack of immune system)

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ADLs
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ng/SPS124/

• Bathing/Dressing
• Eating/ Feeding
• Bowel Bladder Management
• Sleep

• Motor functions, lack of coordination
• Painful swallowing, mouth sores
• Chronic diarrhea
• Frequent fevers night sweats

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ADLs

• -All ADLs are affected by fatigue and feelings
  of sickness.
• -All ADLs are affected by the cognitive
  impairments.
• Short-term memory loss
• Confusion
• Forgetfulness

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SELF CARE

• Make sure your doctor has experience treating HIV
• Follow your doctors instructions
• Get immunizations (to prevent flu and pneumonia)
• Dont smoke or use illegal drugs
• Eat the healthiest diet you can
• Avoid foods that may put you at risk for
  infection (raw eggs and seafood, unpasteurized
  dairy)
• Drink pure water
• Get regular exercise
• Get enough sleep
• Find ways to relax
• Keep hands clean

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IADLs
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• Shopping
• Care of Others
• Financial Management
• Health Management/ Maintenance

• Lack of energy, motor functions, vision loss,
  shortness of breath
• Fatigue, memory loss, confusion, forgetfulness
• Cognitive impairments, lack of resources (work)
• Cognitive impairments (self-care)

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Education Leisure

• Further education/ schooling
• Sports/physical activities

• Cognitive impairments
• Motor functions, lack of coordination, Chronic
  diarrhea, weight loss

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Work Social Participation

• Most effected areas of occupation.
• Not only because of physical limitations, but the
  negative stigma of AIDS

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Factors which contribute to AIDS related stigma.

• HIV/AIDS is a life-threatening disease
• People are scared of contracting HIV
• The diseases associated with behaviors (such as
  sex between men and injecting drug-use) that are
  already stigmatized in many societies.
• People living with HIV/AIDS are often thought of
  as being responsible for becoming infected.
• Religious or moral beliefs lead some people to
  believe that having HIV/AIDS is the result of
  moral fault (such as promiscuity or deviant
  sex) that deserves to be punished.

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AIDS STIGMA STATS

• In 1999, nearly 1 in 5 American adults surveyed
  said they feared persons with AIDS.
• One in 6 admitted to feelings of disgust
  related to persons with AIDS
• In 2000, a national Internet survey of more than
  5600 American adults, revealed similar findings.
  Nearly 1 in 5 respondents agreed with the
  statement, People who got AIDS through sex or
  drug use have gotten what they deserve.

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Work

• Trouble holding a job
• Lack of energy, fatigue, muscle weakness
• Cognitive problems- memory loss, confusion,
• impaired concentration
• Skin conditions
• Chronic diarrhea, weight loss, limited endurance
• Vision loss
• Lack of a job
• Depression
• Loss of confidence/self
• Financial difficulties
• Perceived loss of self-control
• Social stigma
• Reduced satisfaction with ones quality of life.

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Work- Not only a paycheck

• Employment promotes socialization, independence,
  positive self-esteem self-identity, and active
  participation in daily living.
• Although 93 of the subjects had been gainfully
  employed before the onset of functional deficits,
  67 were unemployed at the time of the
  interview.
• Therefore work is a major area of occupation that
  AIDS affects.

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Work- Common fears

• The fear of telling others.
• The fear of loosing job.
• The fear of not making money, providing for
  family.
• The fear of loosing health insurance.
• Currently, AIDS is the 2nd leading cause of death
  among those 25 to 44 yrs. Half of our nations
  workers are among this age group.

83
Work- How can OTs help?

• Address the physical challenges
• Muscle weakness and impaired ROM often leads to
  decrease endurance and fatigue.
• Address environmental adaptations
• vision loss, assistive devices
• Educate clients families on stress anger
  management techniques, assertiveness training,
  general coping strategies in order to maintain a
  productive live
• Deal with future transitions

84
Social Participation

• Also a major area of occupation affected by AIDS
• Key symptoms include
• Skin condition (sores, rashes, flaky)
• Cognitive impairments
• Chronic diarrhea
• Cough or shortness of breath
• Feeling of sickness
• Fatigue
• STIGMA

85
Social Participation

• People diagnosed with HIV/AIDS commonly
  experience depression, decreased self-esteem,
  alienation, and feelings of disempowerment and
  perceived loss of control.
• Although education and awareness of HIV/AIDS has
  grown since the 1980s, people with a diagnosis
  of AIDS continue to experience much social
  discrimination and stigma.
• Rejection by families, loved ones, and the
  community is common...(seen as shameful)

86
Social Participation

• Important to have the support of friends and
  family.

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What can we do?

• The fear of AIDS is in direct proportion to the
  general education and knowledge about the
  disease. People who know the least are the most
  afraid.
• If we fear AIDS through ignorance and
  misinformation, this will show in our quality of
  care.
• Many will need physical, emotional, social,
  psychological or vocational restoration.

88
Activity!!

• According to a recent University of Michigan
  web-based survey conducted in the fall of 2005
• The average number of sexual partners for women
  is approximately 8.6
• The average number of sexual partners for men is
  approximately 31.9

89
Activity!!

• For this activity you will each be given a small
  cup with a substance in it
• Each student will have up to 4 partners
• Mixing your cup with another student is going to
  be representative of being sexually active with
  that person (without use of any type of
  protection)

90
Activity!!

• How to mix the contents of the cup
• Pour the entire contents of your cup into your
  partners cup
• Mix the fluid around
• Then pour half of the content of the mixed cup
  back into your cup
• You should maintain approximately the same amount
  of fluid in your cup
• Repeat 3 more times until you reach 4 partners
  total

91
Activity!!

• PH Indicator
• Those whose fluid turned yellow, have been
  infected with HIV
• Those whose fluid turned blue have not been
  infected
• Raise your hand if your substance turned yellow

92
Questions

• How many cups do you think were initially
  infected?
• How did it make you feel to find out you had been
  infected?

93
References

• American journal of public health(2002)HIV/AIDS
  Stigma An impediment to Public Health,vol.92.
  No.3
• HIV and AIDS Health Center, http//www.webmd.com/
• AIDS Organization, http//www.aids.org/
• National Library of Medicine, http//www.nlm.nih.g
  ov/medlineplus/ency/article/000594.htm
• Mayoclinic, http//www.mayoclinic.com
• AIDS Global Education Information System,
  http//www.aegis.com/news/wb/2005/WB050114.html
• Avert international charity, www.avert.org
• Medline Plus, www.nln.nih.gov/medlineplus
• AVERT, http//www.avert.org/aidsstigma.htm
• The Body, http//www.thebody.com/encyclo/stigma.ht
  ml
• AOTF, http//www.aotf.org/html/pandemic3.shtml