Notification requirement for HIV infection and AIDSHIV is a ‘routine’ notifiable condition and must be notified by medical practitioners and pathology services in writing within 5 days of diagnosis. Show
AIDS is not notifiable. To maintain confidentiality, only the name code (the first two letters of the surname followed by the first two letters of the first name) is required. This is a Victorian statutory requirement. Primary school and children’s services centre exclusion for HIV infection and AIDSExclusion is not required. Infectious agent of HIV infection and AIDSHuman immunodeficiency virus (HIV) types 1 and 2 are members of the family Retroviridae. A number of subtypes exist within HIV-1 and HIV-2. Identification of HIV infection and AIDSClinical featuresAIDS is a severe, life-threatening disease that represents the late clinical stage of infection with HIV. HIV weakens the immune system by destroying a type of white blood cell (CD4 or T-helper lymphocytes). Several weeks after infection with HIV, a number of infected individuals will develop a self-limiting glandular fever–like illness lasting for a week or two (seroconversion illness). Infected people may then be free from clinical signs or symptoms for months or years. Treatment with combination antiretroviral therapy (cART) has resulted in vast reductions in cases of AIDS and mortality. The burden of illness is now increasingly due to non-AIDS infections and malignancies, neurological and psychiatric manifestations of HIV, and coronary artery disease accelerated by a pro-inflammatory state induced by HIV. Newer cART regimens are much less toxic, but significant long-term side effects (including effects on blood glucose, cholesterol and bone health) still occur. Untreated individuals are at risk of specific opportunistic infections and malignancies, and a range of other AIDS-defining illnesses, including:
DiagnosisCareful history and physical examination, looking for risk factors and clinical manifestations of immunodeficiency, are necessary. Diagnostic testing generally involves detection of HIV antibody/p24 antigen by a fourth-generation combination screening test, and confirmation by western blot analysis. Molecular techniques, such as polymerase chain reaction (PCR) to detect proviral DNA sequences, are occasionally necessary to clarify indeterminate results. Incubation period of HIVThe period from infection to the primary seroconversion illness is usually 1 to 4.weeks. The period from infection to development of anti-HIV antibodies is usually less than 1 month but may be up to 3 months; newer tests have a shorter window period, where a false negative result may be obtained early in infection. The interval from HIV infection to the diagnosis of AIDS ranges from about 9 months to 20 years or longer, with a median of 12 years. There is a group of people with a more rapid onset of disease who develop AIDS within 3–5 years of infection, and another smaller group who do not seem to progress to AIDS. Public health significance and occurrence of HIV infection and AIDSOccurrence is worldwide. More than 30 million people were living with HIV/AIDS by the end of 2009, and an estimated 1.8 million people died from HIV-related illnesses that year. The vast majority of HIV infections occur in developing countries. For the period 1983–2003, there was a cumulative total of 4,680 HIV diagnoses in Victoria. This represents about 21 per cent of Australia’s total. Males accounted for 94 per cent of the diagnoses. Male-to-male sexual contact, including homosexual and bisexual contact, accounts for the majority of new diagnoses in men. In females, heterosexual contact and injecting drug use are the most common risk factors. Reservoir of HIVHumans are the reservoir. Mode of transmission of HIVHIV can be transmitted from an infected person by:
Period of communicability of HIV infection and AIDSAll antibody-positive people carry the HIV virus. Infectivity is presumed to be lifelong, although successful therapy with cART can lower the viral load in blood and semen to undetectable levels. Susceptibility and resistance to HIV infectionEveryone is susceptible to infection. The presence of other sexually transmissible infections, especially those with skin or mucosal ulceration, may increase susceptibility. Control measures for HIV infectionPreventive measuresPreventive measures for HIV centre on personal and institutional factors. Personal factors include the following:
Institutional factors include the following:
Control of caseSee ‘Standard precautions – Appendix 3’ of the Blue Book, which applies to all patients. Additional transmission-based precautions apply for specific infections that occur in AIDS patients, such as tuberculosis. Equipment contaminated with blood or body fluids should be cleaned, and then disinfected or sterilised as appropriate. Patients and their sexual partners should not donate blood, organs or other human tissue. All HIV-infected people should be evaluated for the presence of tuberculosis. TreatmentAntiretroviral drug therapy is used to treat established HIV infection. Because such treatment is specialised and constantly changing, only those doctors experienced in HIV management should prescribe antiretroviral therapy. For further information, see the current edition of Therapeutic guidelines: antibiotic and the Australasian Society for HIV Medicine website. Other treatment includes specific treatment or prophylaxis for the opportunistic infectious diseases that result from HIV infection. Control of contactsIf a person is diagnosed as having HIV infection, the diagnosing practitioner has a responsibility to ensure that sexual and needle-sharing contacts are followed up, where possible. Assistance with partner notification may be provided by the department through its partner notification officers. Pre- and post-test counselling must be provided for all contacts seeking HIV testing. Control of environmentThe procedure for dealing with spills of blood and body fluids is in Appendix 5. Outbreak measures for HIV infectionThe epidemiology of HIV is closely monitored in Victoria. Public health action is informed by enhanced epidemiological information notified to the department. Special settingsHealthcare workersRegistration boards should be consulted in relation to their policies regarding healthcare workers with bloodborne viruses. F. Recommendations are also included in the Communicable Diseases Network of Australia publication, Australian Guidelines for the management of health care workers known to be infected with blood-borne viruses. Antenatal careAntenatal care should include a comprehensive assessment of HIV risk factors. All pregnant women should be encouraged to undergo HIV testing after appropriate pre-test counselling. Other settingsAll workplaces should have policies and procedures in place regarding action to be taken in the event of a blood spill or sharps injury. Refer to Australian guidelines for the prevention and control of infection in healthcare. International measuresThe World Health Organization initiated a global prevention and control program in 1987. Since 1995, the global AIDS program has been coordinated by the Joint United Nations Programme on HIV/AIDS (UNAIDS). Nearly all countries have developed an AIDS prevention and care program. |