NTA Level 4 • Semester 1 • PST04102

Identification of Patients with HIV/AIDS

Disease Control and Prevention • Source Session/Topic 27

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Session 27: Identification of Patients with HIV/AIDS

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of HIV/AIDS

• Describe Mode of Transmission of HIV/AIDS

• Describe Major Signs and Symptoms of HIV/AIDS

• Explain Treatment of HIV/AIDS

• Explain prevention and control of HIV/AIDS

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD Projector

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of HIV/AIDS (10 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What causes HIV/AIDS? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Human Immunodeficiency Virus (HIV) infection:

• State of being infected with the Human Immunodeficiency Virus without

showing signs and symptoms

Acquired Immunodeficiency Syndrome (AIDS)

• A state of being HIV infected with presentation of signs and symptoms

STEP 3: Mode of Transmission of HIV/AIDS (30 minutes)

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What is the mode of transmission of HIV? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Unprotected sexual intercourse with infected partner

• Vertical transmission:

o During pregnancy

o During delivery

o During breast feeding

• Contact with infected blood products

• Transfused with infected blood

• Injection drug use (IDU) through needle-sharing, needle stick accidents,

unsterilized needles.

Factors influencing transmission of HIV/AIDS

• Risky sexual behaviour e.g. unsafe sex with infected partner and multiple

sexual partners

• Social economic e.g. commercial sex

• Cultural practices e.g. female genital mutilation

• Biological e.g. young age and early sexual indulgence

• Political e.g. war and political instability

• Unsterile procedures e.g. sharing instruments for circumcision

• Peer pressure towards involvement into sexual intercourse

• Substance abuse e.g. cocaine, bhang, heroine and alcohol

[pic][pic]Handout 27.1: Life cycle of HIV for further reading

STEP 4: Signs and Symptoms of HIV/AIDS (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is the signs and symptoms of HIV/AIDS? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Signs and symptoms of HIV infection:

• Fever

• Headache

• Cough

• Lymphadenopathy

• Skin rashes, which resolve spontaneously

• Mental illness (dementia)

The natural history of HIV can be explained in different stages or clinical

presentation

• Acute HIV infection (window period): can present as any acute viral

illness

o HIV antibodies take time to be produced and show up on a blood test

o Window period is the period between time of infection and hen initial

detection of HIV antibodies is possible by laboratory tests

o People who test HIV negative must be tested again after 3 months, when

antibodies should have developed

o DNA/RNA testing can be used to diagnose HIV infection before

antibodies are formed

• Latent HIV infection

o This is a period when the patient has no symptoms at all

o The body is still able to fight against most of the diseases just as

in HIV negative individuals

o Patient may have generalized lymphadenopathy

• Late stages of HIV infection

o The immunity of the patient falls and severe life threatening

infections occur e.g. cryptococcal meningitis, toxoplasmosis and

pneumocystis pneumonia

STEP 5: Treatment of HIV/AIDS: (10 minutes)

• Not all HIV positive patients are eligible for treatment withARVs

• Two classes of patients eligible to begin treatment:

o All patients in WHO stage 3 and 4 clinical criteria, regardless of CD4

cell count.

o All adolescences and adults including pregnant women with a CD4 count

< 350cells/mm3, regardless of clinical symptoms

• Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

o Zidovudine (AZT)

o Lamivudine (3TC)

o Abacavir (ABC)

o Emtricitabine (FTC)

o Stavudine (d4T)

• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

o Nevirapine (NVP)

o Efavirenz (EFV)

• Nucleotide Reverse Transcriptase Inhibitors (Nucleotide Analogues)

o An example of this relatively new class of antiretroviral drugs is

Tenofovir (TDF)

• Protease Inhibitors (PIs)

o Lopinavir (LPV)

o Atazanavir (ATV)

• Antiretroviral therapy involves the use of a combination of 3 drugs

(triple therapy) e.g.

o 2 NRTI + 1 NNRTI, OR

o 2 NRTI + 1 PI, OR

o 3 NRTI’s

STEP 6: Prevention and Control of HIV/AIDS: 40 minutes

|Activity: Group discussion (30 minutes) |

| |

|DIVIDEstudents into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the preventive and control measures of HIV/AIDS? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Development/Empowerment Interventions

• Development/empowerment interventions improve general living conditions

through:

o Poverty-alleviation and income-generation programmes e.g. MKUKUTA

o Improvements to infrastructure

o Workshops and training to address gender inequality or to empower

youth

Health-Services Interventions

• Improve health-services issues:

• Provider-initiated testing and counseling (PITC) or voluntary counseling

and testing (VCT)

• Provision of ART and care of People Living with HIV (PLHIV)

• Strengthening management of STIs

• Strengthening prevention of mother-to-child-transmission services (PMTCT)

and provision of ART

• Strengthening training for health-care providers

• Integrating HIV prevention into care and treatment services

• Safe medical practices such as use of sterile syringes and needles

• Post exposure prophylaxis (PEP) to health workers

Management of STIs

• All patients should be assessed by clinicians for STIs because:

o STIs share similar risk factors with HIV infection

o STIs increase the risk of HIV acquisition or HIV transmission

o STIs can often be treated and cured

• Abstinence

o Encourage delaying sexual activity for young people

• Sexual and reproductive health education to young people in and out of

school

• Faithfulness (have one faithful uninfected partner)

• Using condoms correctly and consistently

o Correcting myths and misconceptions about condoms

• Screening and effective treatment of asymptomatic cases

• Male circumcision

STEP 6: Key Points (5 minutes)

• HIV/AIDS is a viral infection affecting all age groups

• Mode of transmission is mainly through unprotected sexual intercourse

• Infection may be asymptomatic in early stages

• Not all HIV positive patients are eligible for treatment with ARVs

• Antiretroviral therapy involves the use of a combination of 3 drugs

(triple therapy)

• Prevention of HIV/AIDS includes developmental or empowerment

initiatives; health service interventions and management of STIs

STEP 7: Evaluation (5 minutes)

• What causes HIV/AIDS?

• How is HIV/AIDS transmitted?

• What are the major signs and symptoms of HIV/AIDS?

• What is the treatment of HIV/AIDS?

• What are the preventive and control measures of HIV/AIDS?

STEP 8: Assignment (5 hours)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on common causes of food poisoning in their |

|area. |

| |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended reference |

References

Cook, G., & Zumla, A. (2003). Manson’s Tropical Diseases. (21st ed.).

London:

Saunders Ltd.

Denyer, S. P. Hodges, N. A. & Gorman, S. P (2011) Ed. Hugo & Russell’s

Pharmaceutical Microbiology (8thed). Oxford: Willey-Blackwell publishing

Eshuis, J. &Manschot, P. (1992).Communicable diseases, (1st ed). Nairobi:

AMREF

GoT (2004): National Infection Prevention and Control (IPC) Guidelines for

Healthcare Workers. Dar es Salaam: MOHSW

GoT (2013) Standard Treatment Guidelines & National Essential Medicines

List (4thed). Dar es Salaam: MOHSW

GoT (2013) National Tuberculosis and Leprosy Programme: Manual for the

management of tuberculosis and leprosy (6thed) Dar es Salaam: MOHSW

GoT (2012) National Guidelines for Management of HIV and AIDS. (4thed) Dar

es Salaam:

MOHSW/NACP

GoT. (2007) National Guidelines for Management of Sexually Transmitted and

Reproductive

Tract Infections (1sted). Dar es Salaam: MOHSW

Nordberg, E., Kingondu, T., &Mugambi, E., et al. (2008) Communicable

Diseases. (4thed.). Nairobi: AMREF

Nordberg, E. (1999): Communicable Diseases, A Manual for Health Workers in

Sub-Saharan Africa, Nairobi: AMREF

|[pic] |Handout 27.1: Life Cycle of HIV |

Life cycle of HIV is divided into seven (7) main steps as described below

• Attachment of HIV virus through the interaction between viral

glycoprotein and CD4 receptors and co-receptors:

o The spikes on HIV virus attach to special areas on the surface of T-

cells called receptors

• Fusion and release of RNA into the cytoplasm of the cell:

o After attachment the envelope and capsid fuse with cell membrane of

the human cell thus releasing the RNA into the cytoplasm of the human

white blood cell

• Reverse transcription to produce viral DNA

o Using other components from the T- cell, the viral enzyme, reverse

transcriptase produces a DNA copy of viral RNA; this DNA copy is

called a pro-viral DNA

• Integration of pro-viral DNA to host DNA using other components from the

T- cell.

o The viral enzyme (integrase) integrates the proviral DNA into the T-

cell DNA.

• Synthesis of viral proteins:

o Using other cellular components from T. cell, the viral enzyme

(protease) synthesises viral protein necessary for a completion of

virion.

• Assembly and release of a complete virion.

o Virions are distributed to infect other more T-helper cell: virion are

released from T- cells and can infect more T-cell

[pic]

|[pic] |Handout 27.2: Life Cycle of HIV |

• An opportunistic infection (OI): An infection caused by an organism

that does not usually cause disease in a healthy person with a normal

immune system

• When the immune system is compromised such as through HIV infection,

the pathogen then gets an opportunity ‘to infect and cause disease’

• Other examples of people with suppressed immunity include very young

children and very old people, patient with advanced cancer and/or on

chemotherapy, patients taking steroids for a long time, and those on

immunosuppressive therapy following organ transplantation

• Opportunitistic Infections affecting gastrointestinal system include:

o Oral-oesophageal candidiasis (thrush)

o Herpes Simplex Virus

o Kaposis sarcoma as well as diarrhoeal illnesses

o Cytomegalo Virus

• Opportunistic Infections affecting Respiratory System includes:

o Pneumocystis carinii pneumonia (PCP), currently is also known as

pneumocystis jirovecii pneumonia (PJP)

o Recurrent respiratory tract infection (RTI), bacterial

pneumonias

o Pulmonary tuberculosis (PTB) and pleura infusion

• OIs in the cardiovascular system can lead to the following include;

o Pericarditis

o Cardiomyopathy

• OIs affecting Skeletal Muscular System include:

o Herpes zoster and herpes simplex

o Kaposi’s sarcoma o Pyomyositis and Abscesses

• OIs affecting Central Nervous System include:

o Cryptococcus Meningitis

o Toxoplasmosis

|[pic] |Handout 27.3: WHO Clinical Staging of HIV/AIDS in adults |

• The WHO Clinical staging system is based on clinical features believed

to have prognostic significance resulting in four stages of disease

progression

• WHO staging is done where HIV infection is confirmed by HIV antibody

or virological markers

• Staging determines eligibility for ART

• WHO staging looks at the clinical presentation of the client or

patient

• WHO clinical staging can be used effectively without access to CD4 or

other laboratory testing

WHO Clinical Stage I: Asymptomatic

• A person with Stage I infection:

o Feels well and can do all his or her normal activities

o Has no signs or symptoms of any illness

o May experience Persistent Generalized Lymphadenopathy (PGL)

WHO Clinical Stage II: Minor Symptoms

• A person in this stage may feel

o Ill at times, but still can perform all of his or her activities

o Moderate unexplained weight loss (<10% body weight)

o Recurrent respiratory tract infections

o Minor mucocutaneous manifestations

o Herpes zoster

WHO Clinical Stage III: Moderate Symptoms

• People in this stage

o Often cannot do their usual activities, but are in bed less than half

the time

o Severe unexplained weight loss (<10% of presumed or measured body

weight)

o Unexplained chronic diarrhoea for >1 month

o Unexplained persistent fever above 37.6C intermittent or constant for

>1 month

o Persistent oral candidiasis

o Oral hairy leukoplakia

o Pulmonary tuberculosis (current)

o Severe bacterial infections

o Acute necrotising ulcerative stomatitis, gingivitis or periodontitis

WHO Clinical Stage IV: AIDS-Defining Conditions

• A person in this stage is ill often and may stay in bed more than 50% of

the time

o Wasting can take place in this stage: weight loss >10% of body weight

• Involved organ systems:

o Cutaneous and oral

o Respiratory

o Gastrointestinal

o Neurological and ocular

o Generalised

• Main infections include:

o Kaposi sarcoma

o Cryptococcal meningitis

o CNS toxoplasmosis

o Pneumocystis pneumonia

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