Nurses Research Publication Presents: AIDS UPDATE 2001 Edition Nurses Research Publication, P.O. Box 480, Hayward, California, 94543-0480 Copyright © 2001, 15th ed., Nurses Research Publication (510) 888-9070 ALL RIGHTS RESERVED. No part of this material may be reprinted, reproduced, transmitted, stored in a retrieval system, or otherwise utilized, in any form or by any means electronic or mechanical, including photocopying or recording, now existing or hereinafter invented, nor may any part of this course be used for teaching without the written permission from the publisher and author. For low-cost copies, contact Nurses Research Publication. License Renewal: In California, the RN and LVN State Board requires you to fill out a form with continuing education information in order to renew your license. The Board does not normally require the completion certificate, just the information printed on your certificate. Do not send the board certificates unless they specifically ask for one. If you should need your certificate rushed, we can FAX a copy for $5. The original certificate will be mailed for free. COURSE OUTLINE/TABLE OF CONTENTS CHAPTER I THE HISTORY AND DISCOVERY OF THE HIV VIRUS Page 5 A. The First Reported Cases B. Definition of the Disease C. The HIV Retrovirus D. Transmission of the HIV Virus CHAPTER II HIV AND AIDS MORBIDITY AND MORTALITY STATISTICS Page 13 The Incidence of AIDS Incidence Tables of HIV infection and AIDS CHAPTER III LABORATORY TESTING FOR THE HIV VIRUS Page 17 Screening Tests for HIV infection Immunological Markers of HIV Disease Progression Virological Markers of HIV Disease Progression CHAPTER IV SIGNS, SYMPTOMS and TREATMENTS of the HIV VIRUS Page 30 Signs and Symptoms of HIV The treatment of signs and symptoms of HIV CHAPTER V THE OPPORTUNISTIC INFECTIONS ASSOCIATED WITH AIDS Page 65 Common Opportunistic Infections and their treatment options CHAPTER VI ALTERNATIVE TREATMENTS Page 103 Definition of Alternative treatments for HIV/AIDS Presentation of the most common alternative treatments CHAPTER VII PSYCHOSOCIAL ASPECTS OF CARE Page 112 Psychosocial aspects of HIV/AIDS testing Counseling techniques CHAPTER VIII AIDS AND HEALTH CARE WORKERS Page 126 A. CDC Guidelines B. Other Considerations CHAPTER IX SUPPORT SERVICES FOR PERSONS WITH AIDS Page 132 List of support services for persons with AIDS and for Health Care Workers 2 PREFACE We believe that we have the most up-to-date information possible for nurses and other health care workers on the topic of AIDS and the HIV virus. Of course, information is being compiled every day due to the extensive research being done with this disease. It is therefore our task to update this workbook as often as possible in order to keep you informed. Keep in mind that statistics change on a daily basis. Also remember that the terminology describing the disease will be changing almost daily. Even different parts of the country will have different ways of referring to the disease and to the persons with the disease. In this course, we will present to you the latest thinking in regards to the cause and treatment of AIDS (thought to be caused by the HIV virus). The one good thing that is now happening, is that the international AIDS community is starting to agree on some common terminology when referring to the disease. These agreements will help nurses and lay people to understand what the doctors are talking about when they refer to the disease. We will inform you of these common terms. The disease of AIDS is still spreading virtually unchecked throughout our population in this country. Education has helped to slow the progression of the disease but it is still affecting thousands of people every day. Nurses are in a unique position to educate the public. You as a health care professional, have the unique responsibility to change attitudes of people toward the disease. There are still too many people who believe that they cannot catch the disease because "only homosexuals get AIDS." Even today, with all the educational programs available, there are many who still believe that only homosexuals and drug abusers can get AIDS. The first step to educating the public is to educate yourself. This course will give you the facts to be able to educate the public about this disease. You can tell people that anyone can get this disease. You can tell people that persons infected with HIV cannot spread the disease by touching you. The only way to spread the HIV virus is with blood-to-blood contact (blood to blood contact, and contact with bodily fluids that contain blood such as semen, vaginal secretions, etc.). Part of this course will also address the concerns of health care workers in clinical practice. "Universal Precautions" is the answer to protecting yourself. However, many nurses today still feel that they must take "extra" precautions if they have an HIV infected patient. This author has personally spoken to many nurses who say "that patient has HIV so be extra careful." There is no such thing as "extra careful." You must be careful with all patients and use Universal Precautions for every patient. Once these attitudes begin to change, the disease will then be able to be brought under control. Nurses have the opportunity to change attitudes of the public; that any person is at risk for HIV; and persons infected with HIV cannot infect you just by casual contact. However, the nurse must be the first to recognize these facts and then teach others the truth about the disease. 3 AIDS UPDATE COURSE OBJECTIVES At the end of course, each participant will be able to: 1. Name the year in which the HIV virus was first officially described. 2. Define AIDS; name the virus thought to be the cause of AIDS. 3. Discuss how the HIV virus grows and destroys the immune system. 4. Name and discuss at least five major symptoms of AIDS. 5. Name and discuss at least two routes of transmission of the virus. 6. Name and discuss each of the guidelines for Universal Precautions 7. Name two major laboratory tests for detecting the presence of the HIV virus; and the reliability of the tests 8. Discuss Haiti being thought of as the origin of AIDS. 9. Name and discuss the significance of transmission of the HIV virus in groups other than the homosexuals or bisexuals 10. Discuss the new guidelines for diagnosing AIDS. 11. Discuss the major psychosocial problems associated with AIDS. 12. Discuss guidelines the CDC uses in order to educate and/or place children in foster homes. 13. Name and discuss guidelines for teaching people how to avoid the disease. 14. Perform successfully on an objective exam at the end of the course (70% or better) which covers all areas of this text. Notice and disclaimers: Medicine and Nursing are ever-changing sciences. As new information is gained, changes in treatments and drug therapies are required. The author(s), editor, and publisher of this text have used every possible reliable source in order to verify information in this text, to be sure that the information is accurate and the most current and acceptable information available at the time of publication. However, due to human error and/or changes in medical science, neither the editors nor publishers nor any other party involved in the preparation or publication of this text, warrant that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, and in particular, readers should check the product information sheet for any drugs mentioned in this text that you administer. This course is designed to provide nursing professionals with general information to assist in their practices and professional development. The information provided in this course is based on research and consultation with medical and nursing authorities, and is, to the best of our knowledge, current and accurate. However, this course is offered with the understanding that Nurses Research Publication is not engaged in rendering legal, nursing, or other professional advice. This course is not a substitute for seeking professional advice or conducting individual research. In applying the information provided in this course to individual circumstances, all recommendations must be considered in light of the unique circumstances of each situation. This course book is intended solely for individual use, and not for the benefit of providing advice or recommendations to third parties. Nurses Research Publication disclaims any responsibility for any adverse consequences resulting from the failure to seek medical, nursing, or other professional advice, or to conduct independent research. Nurses Research Publication further disclaims any responsibility for updating or revising any programs or publications presented, published, distributed or sponsored by Nurses Research Publication unless otherwise agreed to as part of an individual purchase contract. 4 CHAPTER I THE HISTORY AND DISCOVERY OF THE HIV VIRUS 5 A. THE FIRST REPORTED CASES The first cases of AIDS were officially reported in the U.S. in 1981. However, cases were being reported as early as 1978 in the U.S. and Haiti. In Haiti, AT THAT TIME, more than 550 persons had the disease. In a population of less than six million, that is a high percentage. Two separate groups, one headed by Dr. Freidman-Kein of New York University Medical Center, and the other by Dr. Gottlieb of UCLA Medical Center, reported the development of Pneumocystis carinii pneumonia, as well as a disseminated form of Kaposi's Sarcoma. These diseases developed in previously healthy young homosexual males in New York City and San Francisco, respectively.