HIV / AIDS

IMPORTANT

Overview:

HIV is a virus, like the flu or cold. A virus is really nothing but a set of blue prints for making new viruses, wrapped up in some fat, protein and sugar. Without living cells, a virus cannot do anything – it is like a brain without a body. In order to make more viruses (and to do all of the other nasty things that viruses do), a virus has to infect a cell. HIV mostly infects T-cells, also known as CD4+ cells, or T-helper cells. These cells are white blood cells that turn the immune system on to fight disease. Once inside the cell, HIV starts producing millions of little viruses, which eventually kill the cell and then go out to infect other cells.

AIDS (Acquired ImmunoDeficiency Syndrome)

Acquired – means that the disease is not hereditary but develops after birth from contact with a disease causing agent (in this case, HIV).

ImmunoDeficiency – means that the disease is characterized by a weakening of the immune system.

Syndrome – refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system

Mode of Transmission:

HIV is transmitted by contact with blood or bodily fluids (such as semen, vaginal secretions, breast milk, wound exudates or saliva) of a person who is infected with the virus.

Examples of Transmission:

Occupational exposure can occur by:

Being stuck with a needle or another sharp object that contains the blood of an infected person.
Contact between broken skin, wounds or mucous membranes and HIV-infected blood or blood contaminated body fluids.
Being bitten by a person who has HIV. These cases occurred when there was severe trauma to the skin and the presence of blood. There is no risk of transmission if the skin remains intact.

Prevention:

There is currently no HIV vaccine for clinical use. The best way for fire fighters and other first responders to prevent exposure to HIV is to become educated about the safety procedures in their workplace and consistently use universal precautions

Precautions:

Universal

Signs and Symptoms:

The symptoms of HIV may range from an asymptomatic (which means that the person has no symptoms of a disease) carrier state to debilitating and even fatal disorders. Typically, the first symptoms of HIV include "flu-like" symptoms such as fever, fatigue, sore throat, and headache. Because the symptoms are not very specific, the only way to know for sure if you are infected or not is to be tested. HIV infection progresses through several stages. The most widely used classification includes the following stages: acute HIV infection, asymptomatic HIV infection, symptomatic HIV infection and AIDS. During acute HIV infection, the symptoms may be mild and flu-like, so that they may not detected by the infected patient. HIV antibody tests may not be positive yet. In asymptomatic HIV infection, patients also do not have symptoms, but their HIV antibody test will be positive and they can infect others. Once a person develops symptomatic HIV infection, they will show signs of the disease, which can vary greatly. As the disease progresses further, people are considered to have full-blown AIDS, the most severe form of the infection, when their T-cell count drops below 200 or they develop an AIDS-defining illness.

Exposure Determination:

If yes is the answer to 1 or more of the following questions then an exposure has occurred:

Did a contaminated needle stick injury occur? (Was the needle ever in the patient’s body?)
Did blood/OPIM make contact with the surface of the eye, or inner surface of the nose or mouth?
Did blood /OPIM make contact with an open area of the skin?
Were there cuts caused by sharp objects covered with blood or OPIM?

What Is The Risk Of Infection After An Occupational Exposure: The risk for acquiring HIV post-blood borne sharps injury exposures is 0.3 percent with a known HIV positive source. The risk following an HIV mucous membrane exposure is 0.09 percent. The risk after exposure of skin to HIV infected blood is said to be even less than 0.09 percent. A small amount of blood on intact skin probably poses no risk at all. There have been no documented cases of HIV transmission due to an exposure involving a small amount of blood on intact skin (a few drops of blood on skin for a short period of time). The risk may be higher if the skin is damaged (for example, by a recent cut) or if the contact involves a large area of skin or is prolonged (for example, being covered in blood for hours).

Immediately Following Exposure If you are stuck by a needle or other sharp object or get blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin:

Immediately flood the exposed area with water or saline
If skin contact with blood or bodily fluid occurs, even if skin is not visibly soiled, wash your skin with antibacterial soap and water or use an alcohol-based sanitizer immediately
If the exposure is a sharps injury, let the area bleed freely
Rinse nose, mouth, or skin with copious amounts of water
Irrigate eyes with clean water, saline or sterile irrigates
Seek immediate medical attention preferably at the same hospital as the source patient
If you are exposed to HIV, you should have blood drawn as soon as possible after the exposure to determine your baseline status and periodically for at least 6 months after the exposure (e.g. at 6 weeks, 12 weeks, and 6 months)
A Rapid HIV test should be conducted in “hours, but not days” from the time of the exposure. The use of rapid HIV testing has become the standard and has eliminated the need to place healthcare workers on very toxic drugs even for short periods of time. The test takes approximately thirty minutes to one hour to complete. This test is able to identify the HIV-1 antibody as soon as two weeks after an exposure.

Paperwork Required

OC Public Health Communicable Disease Exposure Form (policy 330.96) DO NOT FAX

OC Public Health Communicable Disease Exposure Form

The City “Report of Employee Injury” form
Medical Service Order- RM -67 (when medical care is required)
Sharps Injury Log

HIV Reporting: DO NOT FAX REPORTS. HIV infection is reportable by traceable mail or person-to-person transfer within seven (7) calendar days by completion of the HIV/AIDS Case Report Form (CDPH 8641A). For HIV-specific reporting requirements, see Title 17, CCR, §2641.5-2643.2 and https://archive.cdph.ca.gov/programs/aids/Pages/tOAHIVRptgSP.aspx.

Post Exposure Follow-up

Perform HIV-antibody testing for at least 6 months following the initial exposure (e.g., at baseline, 6 weeks, 3 months and 6 months.)
Perform HIVB antibody testing if illness compatible with an acute retroviral syndrome occurs.
Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period.

Persons known to be exposed to HIV should refrain from blood, plasma, organ, tissue, or semen donation until follow-up testing by the health-care provider has excluded seroconversion. In addition, measures to prevent sexual transmission (e.g., abstinence or use of condoms) should be taken, and breastfeeding should be avoided until HIV infection has been ruled out.

HIV Post Exposure Prophylaxis (PEP)

HIV PEP should be considered only under exceptional circumstances. In the rare event that HIV PEP is considered, it should be initiated as soon as possible after exposure. The patient should be counseled about the availability of PEP and informed about the potential benefits and risks and the need for prompt initiation to maximize potential effectiveness. If PEP is thought to be indicated on the basis of exposure risk, administration should not be delayed for HIV test results.

In the rare event that HIV PEP is administered, specimens should be collected for baseline HIV testing on all patients provided with PEP using a blood or oral fluid rapid test if available; otherwise, conventional testing should be used. Testing should be discussed with the patient if the patient's medical condition permits. Procedures for testing should be in accordance with applicable state and local laws. PEP can be initiated and test results reviewed at follow-up. If the HIV test result is positive, PEP can be discontinued and the patient referred to a clinician experienced with HIV care for treatment.

If PEP is administered, the health-care provider also should obtain baseline complete blood count, renal function, hepatic function tests, and, in women, a pregnancy test. Selection of antiretroviral regimens should aim for simplicity and tolerability. Because of the complexity of selection of HIV PEP regimens, consultation with persons having expertise in antiretroviral therapy and HIV transmission is strongly recommended.

PEP should be started as soon after exposure as possible and continue for 4 weeks. Patients on PEP should be reassessed for adherence, toxicity, and for follow-up of HIV testing (if rapid testing was not available at baseline) within 72 hours by an infectious disease consultant. Patients continuing on PEP should have follow-up laboratory evaluation as recommended previously including a complete blood count and renal and hepatic function tests at baseline and at 2 weeks post exposure, and HIV testing at baseline, 6 weeks, 3 months, and 6 months post exposure.