AIDS Update

       It was spring of 1996 when Beth Bye says she returned from the dead. The Wisconsin woman hadn't actually died, but with her body ravaged in the late stages of AIDS infection, she had run out of options, and death was, indeed, near. AIDS related dementia and blindness had crept in signs that her doctor told her meant time was short. She made funeral arrangements and considered moving to a hospice for her remaining days.

      Then, as if to say "not so fast," medical science handed her another option. New drugs called pro­tease inhibitors, first approved in 1995, were about to revolutionize the treatment of patients in­fected with the AIDS virus. These drugs usually are taken with two other drugs called reverse transcriptase inhibitors. The combined drug "cocktail" has helped change AIDS in the last three years from being an automatic death sentence to what is now often a chronic, but manageable, disease.

Within two months of beginning the triple cocktail treatment, also known as highly active antiretroviral therapy (HAART), Bye's viral load a measure of new AIDS virus produced in the body dropped to undetectable levels. Her red and white blood cell counts normalized, an important sign that the immune system was starting to work again. Suddenly she could do simple things she had long given up, such as walk the dog for 2 miles. Bye, now 40, was even able to return to her teaching job and currently works 30 hours a week.

"My recovery was like being on death row and getting that last minute pardon from the governor, she says.

This so called "Lazarus Effect," named for the biblical figure who was raised from the dead, has occurred with many AIDS patients who take the triple therapy. "It returns many who were debili­tated and dying to relatively healthy and productive life," says Richard Klein, HIV/AIDS coordinator for the Food and Drug Administration's Office of Special Health Issues.

In 1997, for the first time since 1990, AIDS fell out of the top 10 causes of death in the United States, dropping from 8th to 14th place, according to the national Centers for Disease Control and Prevention. By 1998, about 16,000 people were still alive who would have died the previous year if AIDS mortality had continued at its former rate. Still, about 40,000 new infections occur yearly.

 

Learning Objectives

Chapter 1: Human Immunodeficiency Virus

  1. Describe the genetic makeup of human immunodeficiency virus and explain the mode of transmission of HIV infection.

  2. List 3 primary types of contact that can result in transmission of HIV, and distinguish these from other less efficient modes of transmission of HIV.

  3. Explain why casual contact will not result in transmission of HIV infection.

Chapter 2:  HIV Terms to Know

  1. Define various terms related to HIV and AIDS, such as AIDS, body fluids, CD4 cells, exposure-prone invasive procedures, universal precautions, window period, etc.

Chapter 3: Understanding HIV

  1. Discuss some of the questions that a person infected with HIV may want to ask his or her healthcare provider.

  2. Discuss possible benefits and risks of talking about your HIV infection.

  3. List at least 6 helpful hints that may help an HIV-infected person stay well longer.

  4. Discuss the connection between HIV and tuberculosis, syphilis, mouth and eye problems, pap tests for women with HIV, and pregnancy.  

  5. Discuss the implications of pregnancy with an HIV-infected woman, and formulate at least 7 questions that the woman may want to ask of her healthcare provider.  

Chapter 4: Epidemiology of HIV Infection

  1. Describe the risk of HIV infection in certain population groups, such as intravenous drug users, homosexuals, male and female heterosexual IDUs, women, and adolescents.

  2. Explain why intravenous drug users with unsafe sexual practices are at greatest risk of HIV infection.

Chapter 5: Tests for HIV

  1. Describe 3 primary tests for HIV infection detection, and explain the differences between the tests that measure the virus and those that measure the presence of antibodies to the virus in the blood.  

  2. List 5 physical conditions or symptoms that are indicative of HIV presence.

Chapter 6:  Serologic Testing for Infection  

  1. Explain the sensitivity and specificity of EIA tests with Western blot for HIV infection.  

  2. Describe 5 principles of a patient testing program.  

  3. Provide an assessment of the risk of HIV infection from patients to healthcare workers and from healthcare workers to patients.  

  4. Discuss the management of infected healthcare workers.  

Chapter 7: From HIV to AIDS  

  1. Explain how HIV infection progresses to AIDS, and describe physical symptoms  and responses at each stage to the development of AIDS.  

  2. List at least 10 infections indicative of AIDS, and list 8 cancers associated with AIDS.  

Chapter 8:  New Ways to Prevent and Treat AIDS  

  1. Describe various new tests for detection of HIV approved by the FDA, namely Confide, Orasure Western blot, Coulter and Amplicor-HIV-1 Monitor Test.  

  2. Describe five layers of overlapping safeguards that have made the risk of HIV transmission from blood transfusion almost nil.  

Chapter 9:  Update on AIDS

  1. Discuss the role of combination drug therapy in reducing AIDS-related deaths.

  2. Describe how protease inhibitors work.

  3. Discuss how viral load test can help in predicting the course of AIDS disease.

  4. Describe the progress made by researchers in developing a vaccine for AIDS.

  5. List some of the new drugs that are being developed to fight AIDS.

Chapter 10:  Universal Precautions

  1. Define universal precautions and describe six measures a healthcare worker should take in following universal precautions.

  2. List body fluids to which universal precautions apply and other fluids to which universal precautions do not apply.  

  3. Discuss three guidelines that a healthcare worker should use with protective barriers to prevent the transmission of HIV.  

  4. Describe five guidelines to use in the selection of gloves.  

  5. Describe five precautions to take for invasive procedures.  

  6. Describe four precautions for people engaged in the practice of dentistry for prevention of transmission of HIV.  

  7. Discuss precautions to take for healthcare workers in the areas of dialysis and those working in laboratories.  

Chapter 11: Environmental Considerations for HIV Transmission

  1. Discuss the principles for sterilization and disinfections in healthcare settings.

Chapter 12: Employer Responsibilities

  1. Describe the classification of work activities into three categories of potential exposure and the requirement of personal protective equipment in each category of work.

  2. Provide examples of recommended personal protective equipment for worker protection against HIV and HBV transmission in pre-hospital settings.  

  3. Discuss the management of healthcare workers who have been exposed to blood and other infectious body fluids, hepatitis B virus, human bites, and HIV.

  4. Describe reprocessing methods for equipment used in the pre-hospital setting using sterilization and various levels of disinfection.

Evaluation of Individual Objectives

To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.

Course Outline

Human Immunodeficiency Virus                        

HIV Terms to Know                                 

Understanding HIV                             

Epidemiology of HIV Infection                

Tests for HIV                                   

Serologic Testing for HIV Infection                  

From HIV to AIDS                            

New Ways to Prevent and Treat AIDS               

Update on AIDS                                

Universal Precautions                           

Environmental  Considerations for HIV Transmission                         

Employer Responsibilities                   

Post-Test                               

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