Showing posts with label bbs approved HIV and Aids online ceus. Show all posts
Showing posts with label bbs approved HIV and Aids online ceus. Show all posts
September 29, 2012
Popular HIV drug may cause memory declines
December 01, 2011
HIV Variants in Spinal Fluid May Hold Clues in Development of HIV-related Dementia
NIMH-funded researchers found two variants of HIV in the cerebrospinal fluid (CSF) of infected study participants that were genetically distinct from the viral variants found in the participants’ blood. The study, published October 6, 2011, in the journal PLoS Pathogens, suggests these CSF variants may help to inform research on the development and treatment of cognitive problems related to HIV infection.
Background
The advent of antiretroviral medications has helped many with HIV to manage the illness effectively. But even with proper treatment, a significant percentage of HIV-infected people develop HIV-associated dementia (HAD) or more mild neurological disorders. Research suggests that some people with HAD harbor variants of HIV in their cerebrospinal fluid (CSF) that may be less responsive to current treatments and thus contribute to cognitive decline. Understanding the role of HIV in HAD may also inform efforts to treat or prevent mild neurocognitive disorders associated with HIV.
To explore this issue, Ronald Swanstrom, Ph.D., of the University of North Carolina at Chapel Hill, and colleagues collected samples of blood and CSF from 11 people with HIV. All samples were collected just before and shortly after the person started antiretroviral therapy. The researchers also had access to additional samples from two of the 11 participants, collected several years prior to their starting treatment ceus for counselors
Results of the Study
The researchers found two variants of HIV in participants’ CSF that were genetically distinct from HIV found in their blood. Among participants diagnosed with HAD, the HIV variants in CSF showed greater genetic differences from the type of HIV in their blood, compared with participants with no HAD symptoms.
HIV typically targets a type of immune cell called T-cells. However, researchers found that one CSF variant replicated in macrophages, a different type of immune cell that typically lives longer than T-cells. In one of the participants with longer-term data, the researchers found evidence of this variant before the participant was diagnosed with HAD. During that time, the participant’s neurological assessments reported only mild impairment. The proportion of macrophage-targeting variants in the CSF increased over time, particularly in the first month after the participant was diagnosed with HAD.
In the other participant with longer-term data, the researchers noted the presence of the second CSF variant, which targeted T-cells, after the participant was diagnosed with HAD. Before the participant was diagnosed with HAD, the T-cell-targeting variant was not present in CSF samples.
Significance
The findings indicate that the genetically distinct variants of HIV in the CSF may each play a role in the development of HAD and related neurological disorders.
According to the researchers, the variant that targets macrophages provides clues to how HIV may evolve in order to replicate in a new cell type. The presence of the T-cell-targeting variant suggests that HIV infection may cause T-cells to migrate into the CSF. If confirmed, this migration would provide an alternative mechanism for maintaining viral replication in the central nervous system, which is associated with neurocognitive impairment.
What’s Next
Examining samples of blood, CSF, and brain tissue from a larger number of HIV- infected people with more mild symptoms of neurocognitive impairment may reveal physiological features that distinguish the two CSF variants identified in the current study. According to the researchers, identifying such features may help predict either current or future neurocognitive impairment and would emphasize the benefits of starting treatment early.
Reference
Schnell G, Joseph S, Spudich S, Price RW, Swanstrom. HIV-1 Replication in the Central nervous System Occurs in Two Distinct Cell Types. PLoS Pathog. 2011 Oct;7(10):e1002286
May 22, 2010
Children’s Mental Health Facts: Bipolar Disorder
Children’s Mental Health Facts: Bipolar DisorderHelping Children and Youth With Bipolar Disorder: Systems of Care
This fact sheet provides basic information on bipolar disorder in children and describes an approach to getting services and supports, called “systems of care,” that helps children, youth, and families thrive at home, in school, in the community, and throughout life.
What Is Bipolar Disorder?
Bipolar disorder is a brain disorder that causes persistent, overwhelming, and uncontrollable changes in moods, activities, thoughts, and behaviors. A child has a much greater chance of having bipolar disorder if there is a family history of the disorder or depression. This means that parents cannot choose whether or not their children will have bipolar disorder.
Although bipolar disorder affects at least 750,000 children in the United States 1 , it is often difficult to recognize and diagnose in children. If left untreated, the disorder puts a child at risk for school failure, drug abuse, and suicide. That is why it is important that you seek the advice of a qualified professional when trying to find out if your child has bipolar disorder.
Symptoms of bipolar disorder can be mistaken for other medical/mental health conditions, and children with bipolar disorder can have other mental health needs at the same time. Other disorders that can occur at the same time as bipolar disorder include, but are not limited to, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, anxiety disorders, autistic spectrum disorders, and drug abuse disorders. The roles that a family’s culture and language play in how causes and symptoms are perceived and then described to a mental health care provider are important, too. Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses—which are serious problems when a child needs help. That is why it is important that supports be in place to bridge differences in language and culture. Once bipolar disorder is properly diagnosed, treatment can begin to help children and adolescents with bipolar disorder live productive and fulfilling lives.
What Are the Signs of Bipolar Disorder?
Unlike some health problems where different people experience the same symptoms, children experience bipolar disorder differently. Often, children with the illness experience mood swings that alternate, or cycle, between periods of “highs” and “lows,” called “mania” and “depression,” with varying moods in between. These cycles can happen much more rapidly than in adults, sometimes occurring many times within a day. Mental health experts differ in their interpretation of what symptoms children experience. The following are commonly reported signs of bipolar disorder:
Excessively elevated moods alternating with periods of depressed or irritable moods;
Periods of high, goal-directed activity, and/or physical agitation;
Racing thoughts and speaking very fast;
Unusual/erratic sleep patterns and/or a decreased need for sleep;
Difficulty settling as babies;
Severe temper tantrums, sometimes called “rages”;
Excessive involvement in pleasurable activities, daredevil behavior, and/or grandiose, “super-confident” thinking and behaviors;
Impulsivity and/or distractibility;
Inappropriate sexual activity, even at very young ages;
Hallucinations and/or delusions;
Suicidal thoughts and/or talks of killing self; and
Inflexible, oppositional/defiant, and extremely irritable behavior.
What Happens After a Bipolar Disorder Diagnosis?
If a qualified mental health provider has diagnosed your child with bipolar disorder, the provider may suggest several different treatment options, including strategies for managing behaviors, medications, and/or talk therapy. Your child’s mental health care provider may also suggest enrolling in a system of care, if one is available.
What Is a System of Care?
A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families, children, and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. Specifically, a system of care can help by:
Tailoring services to the unique needs of your child and family;
Making services and supports available in your language and connecting you with professionals who respect your values and beliefs;
Encouraging you and your child to play as much of a role in the design of a treatment plan as you want; and
Providing services from within your community, whenever possible.
How Can I Find a System of Care for My Child With Bipolar Disorder?
Contact the system of care community in the box on the back of this fact sheet. If none is listed or that system of care community is not in your area, visit mentalhealth.samhsa.gov/cmhs and click “Child, Adolescent & Family” and then “Systems of Care” to locate a system of care close to you. If you prefer to speak to someone in person to locate a system of care, or if there is not a system of care in your area, contact the National Mental Health Information Center by calling toll-free 1.800.789.2647 or visiting mentalhealth.samhsa.gov.
Are Systems of Care Effective?
National data collected for more than a decade support what families in systems of care have been saying: Systems of care work. Data from systems of care related to children and youth with bipolar disorder reflect the following:
Children and youth demonstrate improvement in emotional and behavioral functioning.
Caregivers report that children and youth have a reduction in conflicts with others in the family.
Caregivers experience an increased ability to do their jobs.
Caregivers report fewer missed days and a reduction in tardiness from work.
Children and youth with bipolar disorder improve in school-related tasks, such as paying attention in class, taking notes, and completing assignments on time.
Children and youth with bipolar disorder have fewer contacts with the juvenile justice system after enrolling in a system of care.
The Core Values of Systems of Care
Although systems of care may be different for each community, all share three core values. These values play an important role in ensuring that services and supports are effective and responsive to the needs of each child, youth, and family. These core values are:
Systems of care are family-driven and youth-guided.
Systems of care are culturally and linguistically competent.
Systems of care are community-based.
Austin’s Story
At age 12, Austin appears to be a typical sixth grader—he likes to play basketball and video games, and is enrolled in an after-school horseback riding program. He is an honor roll student, and his mother describes him as compassionate, loyal, and a champion for the “underdog.” Austin and his family also manage the challenges of bipolar disorder each day.
Austin was diagnosed in first grade with attention-deficit/hyperactivity disorder and separation anxiety disorder, but Austin’s mother, Kim, recalls a series of incidents that led her to question whether her son’s mental health needs were being met. At age 9, Austin set two fires within a week. The first time it happened, Kim thought it was an isolated incident that would not be repeated— Austin said he was lighting candles.
The second time Austin set a fire, however, the situation was very different. While bringing groceries into the house, Austin set a small fire in the car. When Kim discovered signs of the fire the next morning, she says, “I immediately got on the phone and started calling his physician. Thoughts were flashing through my mind about what could have happened.”
After Kim received a referral from Austin’s physician for diagnostic testing and other mental health services, she learned that her son had been experiencing hallucinations, which were causing him to set the fires. She also learned that his extreme mood swings, as well as his unusual sleep patterns, were signs of bipolar disorder. As a result, Austin was hospitalized for 20 days and diagnosed with bipolar disorder. During this time, Austin was accepted into a system of care through a referral from his school guidance counselor.
Kim says the system of care played an important role in helping Austin make the transition from the hospital to his home—even providing transportation, as Kim’s car was being repaired at the time. System of care staff helped Kim learn more about her son’s disorder. They also helped her locate services and supports tailored to Austin’s needs, including counseling, health care, specialized schooling, after-school programs, transportation, and child care.
The system of care also empowered Kim to be a more effective advocate for Austin’s needs. Before joining the system of care, she says, “I tried to fit the service to the need, rather than fit the need to the service. That was a mistake.”
Kim also assumed that professionals were best able to determine how to meet her child’s needs. After working in partnership with the system of care, Kim now knows that services and supports should be responsive to Austin’s needs and that her and her son’s input into the services and supports is crucial.
Despite the successes her family has had, Kim emphasizes that the journey to wellness is not over. In addition to coping with the symptoms of bipolar disorder, she and Austin also must overcome the stigma associated with mental illnesses. Together, Kim and Austin counter this stigma by educating others that he, and others with mental illnesses, should be known for who they are rather than the disorders they happen to have. Despite the ongoing challenges of stigma and bipolar disorder, Kim believes that the system of care has made a huge difference in terms of helping her family move forward.
What Steps Are Necessary To Enroll in a System of Care?
Although each community’s system of care is different, most children and youth in a system of care go through the following steps to be enrolled:
Step One: Diagnosis and Referral—To be considered for system of care enrollment, your child must have a diagnosed behavioral, emotional, or mental health disorder that severely affects his or her life. Additionally, most children and youth are referred to a system of care by mental health providers, educators, juvenile justice professionals, child welfare professionals, physicians, and others who might already be serving your child.
Step Two: Assessment and Intake—Once your child has been diagnosed and has been referred to the system of care, the system of care may ask you to answer some questions that will help you determine whether or not your child and family are eligible to receive services and supports. If your child and family are eligible, you may have to answer more questions so the system of care can begin to understand your needs. Throughout these steps, the system of care will work with you to fill out all of the necessary paperwork.
Step Three: Care Planning and Partnership Building—After your child and family are enrolled, the system of care will work with you to determine what services and supports best fit your child’s and family’s needs. Once the care planning is complete, the system of care will develop partnerships among you and all of those who are helping your child and family to ensure that services and supports are as effective as possible.
For More Information
Federal Government Resources
National Mental Health Information Center
Substance Abuse and Mental Health Services Administration
mentalhealth.samhsa.gov
Tel: 1.800.789.2647 (toll-free; English/Spanish)
TDD: 1.866.889.2647
National Institute of Mental Health
National Institutes of Health
www.nimh.nih.gov
Tel: 1.866.615.6464 (toll-free; English/Spanish)
TTY: 301.443.8431
Additional Resources
Following are some other resources that may be helpful. This list is not exhaustive, and inclusion does not imply endorsement by the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services.
Child and Adolescent Bipolar Foundation
www.bpkids.org
Tel: 847.256.8525
Federation of Families for Children’s Mental Health
www.ffcmh.org
Tel: 703.684.7710
NAMI (National Alliance on Mental Illness)
www.nami.org
Tel: 1.800.950.6264 (toll-free)
National Mental Health Association
www.nmha.org
Tel: 1.800.969.6642 (toll-free)
For information about children’s mental health contact the National Mental Health Information Center toll-free: 1.800.789.2647 (English/Spanish) 1.866.889.2647 (TDD)
This fact sheet provides basic information on bipolar disorder in children and describes an approach to getting services and supports, called “systems of care,” that helps children, youth, and families thrive at home, in school, in the community, and throughout life.
What Is Bipolar Disorder?
Bipolar disorder is a brain disorder that causes persistent, overwhelming, and uncontrollable changes in moods, activities, thoughts, and behaviors. A child has a much greater chance of having bipolar disorder if there is a family history of the disorder or depression. This means that parents cannot choose whether or not their children will have bipolar disorder.
Although bipolar disorder affects at least 750,000 children in the United States 1 , it is often difficult to recognize and diagnose in children. If left untreated, the disorder puts a child at risk for school failure, drug abuse, and suicide. That is why it is important that you seek the advice of a qualified professional when trying to find out if your child has bipolar disorder.
Symptoms of bipolar disorder can be mistaken for other medical/mental health conditions, and children with bipolar disorder can have other mental health needs at the same time. Other disorders that can occur at the same time as bipolar disorder include, but are not limited to, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, anxiety disorders, autistic spectrum disorders, and drug abuse disorders. The roles that a family’s culture and language play in how causes and symptoms are perceived and then described to a mental health care provider are important, too. Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses—which are serious problems when a child needs help. That is why it is important that supports be in place to bridge differences in language and culture. Once bipolar disorder is properly diagnosed, treatment can begin to help children and adolescents with bipolar disorder live productive and fulfilling lives.
What Are the Signs of Bipolar Disorder?
Unlike some health problems where different people experience the same symptoms, children experience bipolar disorder differently. Often, children with the illness experience mood swings that alternate, or cycle, between periods of “highs” and “lows,” called “mania” and “depression,” with varying moods in between. These cycles can happen much more rapidly than in adults, sometimes occurring many times within a day. Mental health experts differ in their interpretation of what symptoms children experience. The following are commonly reported signs of bipolar disorder:
Excessively elevated moods alternating with periods of depressed or irritable moods;
Periods of high, goal-directed activity, and/or physical agitation;
Racing thoughts and speaking very fast;
Unusual/erratic sleep patterns and/or a decreased need for sleep;
Difficulty settling as babies;
Severe temper tantrums, sometimes called “rages”;
Excessive involvement in pleasurable activities, daredevil behavior, and/or grandiose, “super-confident” thinking and behaviors;
Impulsivity and/or distractibility;
Inappropriate sexual activity, even at very young ages;
Hallucinations and/or delusions;
Suicidal thoughts and/or talks of killing self; and
Inflexible, oppositional/defiant, and extremely irritable behavior.
What Happens After a Bipolar Disorder Diagnosis?
If a qualified mental health provider has diagnosed your child with bipolar disorder, the provider may suggest several different treatment options, including strategies for managing behaviors, medications, and/or talk therapy. Your child’s mental health care provider may also suggest enrolling in a system of care, if one is available.
What Is a System of Care?
A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families, children, and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. Specifically, a system of care can help by:
Tailoring services to the unique needs of your child and family;
Making services and supports available in your language and connecting you with professionals who respect your values and beliefs;
Encouraging you and your child to play as much of a role in the design of a treatment plan as you want; and
Providing services from within your community, whenever possible.
How Can I Find a System of Care for My Child With Bipolar Disorder?
Contact the system of care community in the box on the back of this fact sheet. If none is listed or that system of care community is not in your area, visit mentalhealth.samhsa.gov/cmhs and click “Child, Adolescent & Family” and then “Systems of Care” to locate a system of care close to you. If you prefer to speak to someone in person to locate a system of care, or if there is not a system of care in your area, contact the National Mental Health Information Center by calling toll-free 1.800.789.2647 or visiting mentalhealth.samhsa.gov.
Are Systems of Care Effective?
National data collected for more than a decade support what families in systems of care have been saying: Systems of care work. Data from systems of care related to children and youth with bipolar disorder reflect the following:
Children and youth demonstrate improvement in emotional and behavioral functioning.
Caregivers report that children and youth have a reduction in conflicts with others in the family.
Caregivers experience an increased ability to do their jobs.
Caregivers report fewer missed days and a reduction in tardiness from work.
Children and youth with bipolar disorder improve in school-related tasks, such as paying attention in class, taking notes, and completing assignments on time.
Children and youth with bipolar disorder have fewer contacts with the juvenile justice system after enrolling in a system of care.
The Core Values of Systems of Care
Although systems of care may be different for each community, all share three core values. These values play an important role in ensuring that services and supports are effective and responsive to the needs of each child, youth, and family. These core values are:
Systems of care are family-driven and youth-guided.
Systems of care are culturally and linguistically competent.
Systems of care are community-based.
Austin’s Story
At age 12, Austin appears to be a typical sixth grader—he likes to play basketball and video games, and is enrolled in an after-school horseback riding program. He is an honor roll student, and his mother describes him as compassionate, loyal, and a champion for the “underdog.” Austin and his family also manage the challenges of bipolar disorder each day.
Austin was diagnosed in first grade with attention-deficit/hyperactivity disorder and separation anxiety disorder, but Austin’s mother, Kim, recalls a series of incidents that led her to question whether her son’s mental health needs were being met. At age 9, Austin set two fires within a week. The first time it happened, Kim thought it was an isolated incident that would not be repeated— Austin said he was lighting candles.
The second time Austin set a fire, however, the situation was very different. While bringing groceries into the house, Austin set a small fire in the car. When Kim discovered signs of the fire the next morning, she says, “I immediately got on the phone and started calling his physician. Thoughts were flashing through my mind about what could have happened.”
After Kim received a referral from Austin’s physician for diagnostic testing and other mental health services, she learned that her son had been experiencing hallucinations, which were causing him to set the fires. She also learned that his extreme mood swings, as well as his unusual sleep patterns, were signs of bipolar disorder. As a result, Austin was hospitalized for 20 days and diagnosed with bipolar disorder. During this time, Austin was accepted into a system of care through a referral from his school guidance counselor.
Kim says the system of care played an important role in helping Austin make the transition from the hospital to his home—even providing transportation, as Kim’s car was being repaired at the time. System of care staff helped Kim learn more about her son’s disorder. They also helped her locate services and supports tailored to Austin’s needs, including counseling, health care, specialized schooling, after-school programs, transportation, and child care.
The system of care also empowered Kim to be a more effective advocate for Austin’s needs. Before joining the system of care, she says, “I tried to fit the service to the need, rather than fit the need to the service. That was a mistake.”
Kim also assumed that professionals were best able to determine how to meet her child’s needs. After working in partnership with the system of care, Kim now knows that services and supports should be responsive to Austin’s needs and that her and her son’s input into the services and supports is crucial.
Despite the successes her family has had, Kim emphasizes that the journey to wellness is not over. In addition to coping with the symptoms of bipolar disorder, she and Austin also must overcome the stigma associated with mental illnesses. Together, Kim and Austin counter this stigma by educating others that he, and others with mental illnesses, should be known for who they are rather than the disorders they happen to have. Despite the ongoing challenges of stigma and bipolar disorder, Kim believes that the system of care has made a huge difference in terms of helping her family move forward.
What Steps Are Necessary To Enroll in a System of Care?
Although each community’s system of care is different, most children and youth in a system of care go through the following steps to be enrolled:
Step One: Diagnosis and Referral—To be considered for system of care enrollment, your child must have a diagnosed behavioral, emotional, or mental health disorder that severely affects his or her life. Additionally, most children and youth are referred to a system of care by mental health providers, educators, juvenile justice professionals, child welfare professionals, physicians, and others who might already be serving your child.
Step Two: Assessment and Intake—Once your child has been diagnosed and has been referred to the system of care, the system of care may ask you to answer some questions that will help you determine whether or not your child and family are eligible to receive services and supports. If your child and family are eligible, you may have to answer more questions so the system of care can begin to understand your needs. Throughout these steps, the system of care will work with you to fill out all of the necessary paperwork.
Step Three: Care Planning and Partnership Building—After your child and family are enrolled, the system of care will work with you to determine what services and supports best fit your child’s and family’s needs. Once the care planning is complete, the system of care will develop partnerships among you and all of those who are helping your child and family to ensure that services and supports are as effective as possible.
For More Information
Federal Government Resources
National Mental Health Information Center
Substance Abuse and Mental Health Services Administration
mentalhealth.samhsa.gov
Tel: 1.800.789.2647 (toll-free; English/Spanish)
TDD: 1.866.889.2647
National Institute of Mental Health
National Institutes of Health
www.nimh.nih.gov
Tel: 1.866.615.6464 (toll-free; English/Spanish)
TTY: 301.443.8431
Additional Resources
Following are some other resources that may be helpful. This list is not exhaustive, and inclusion does not imply endorsement by the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services.
Child and Adolescent Bipolar Foundation
www.bpkids.org
Tel: 847.256.8525
Federation of Families for Children’s Mental Health
www.ffcmh.org
Tel: 703.684.7710
NAMI (National Alliance on Mental Illness)
www.nami.org
Tel: 1.800.950.6264 (toll-free)
National Mental Health Association
www.nmha.org
Tel: 1.800.969.6642 (toll-free)
For information about children’s mental health contact the National Mental Health Information Center toll-free: 1.800.789.2647 (English/Spanish) 1.866.889.2647 (TDD)
April 09, 2010
An Overview of the Illness Management and Recovery Program
An Overview of the Illness Management and Recovery Program
for more on this topic,
mft ceus
The Illness Management and Recovery Program consists of a series of weekly sessions where mental health practitioners help people who have experienced psychiatric symptoms to develop personalized strategies for managing their mental illness and moving forward in their lives. The program can be provided in an individual or group format, and generally lasts between three and six months. In the sessions, practitioners work collaboratively with people, offering a variety of information, strategies, and skills that people can use to further their own recovery. There is a strong emphasis on helping people set and pursue personal goals and helping them put strategies into action in their everyday lives.
Materials for Providing the Illness Management and Recovery Program
In the Practitioners’ Workbook (this document) there are two sets of materials for Illness Management and Recovery: the Practitioners’ Guide (Chapters 1-10) and Educational Handouts. The educational handouts contain practical information and strategies that people can use in the recovery process. The handouts are not meant to stand alone. Practitioners are expected to help people select and put into practice the knowledge and strategies that are most helpful to themselves as individuals. The following topics are covered in nine educational handouts:
Recovery Strategies
Practical Facts about Schizophrenia/Bipolar Disorder/ Depression
The Stress-Vulnerability Model and Strategies for Treatment
Building Social Support
Using Medication Effectively
Reducing Relapses
Coping with Stress
Coping with Problems and Symptoms
Getting Your Needs Met in the Mental Health System
Chapter 1 of the Practitioners’ Guide contains overall strategies for conducting the program, and Chapters 2-10 contain practitioner guidelines for using each of the educational handouts to conduct sessions. The guidelines contain specific suggestions for using motivational, educational, and cognitive behavioral techniques to help people use strategies from the handouts in their daily lives. They also provide tips for developing homework assignments and for dealing with problems that might arise during sessions.
Getting started
First, practitioners are advised to familiarize themselves with the format, content and tone of the program. This can be accomplished by first reading the following:
Chapter 1 of the Practitioners’ Guide
Educational Handout #1 (“Recovery Strategies”)
Practitioner Guidelines for Educational Handout #1 (“Recovery Strategies”)
It is optimal for practitioners to read the remaining educational handouts and accompanying practitioners’ guidelines before beginning to work with people. Practitioners are advised to review specific handouts and guidelines prior to addressing these particular topic areas with people.
Preparing For Sessions
The first session is usually spent on orientation, using the “Orientation Sheet” (see Appendix 1) as a guide. The second (and sometimes third) session is spent on getting to know the person better, using the ”Knowledge and Skills Inventory” (see Appendix 2) as a guide. This inventory is focused on the person’s positive attributes rather than their problems or “deficits.” It is important to gather information in a friendly, low- key manner, using a conversational tone. The remaining sessions are focused on helping people to learn and practice the information and strategies in the educational handouts and to set and pursue their personal goals. Each session should be documented, using the “Progress Note for Illness Management and Recovery” (Appendix 3). The format of the progress note helps practitioners to keep track of the person’s personal goals, the kinds of interventions provided (motivational, educational, cognitive-behavioral), the specific evidence-based skill(s) that are taught (coping skills, relapse prevention skills and behavioral tailoring skills) and the homework that is agreed upon.
Before beginning each educational handout, the practitioner is encouraged to review the contents of the handout and the practitioner guidelines of the same title in the Practitioners’ Guide. Most educational handouts will require two to four sessions to put the important principles into practice. Preparation for sessions is most effective when practitioners review the educational handout and the corresponding practitioners’ guidelines side-by-side, noting the goals of the handout, the specific topic headings, the probe questions, the checklists, etc. As noted above, sessions should be recorded on the form “Progress Note for Illness Management and Recovery” (Appendix 3). Although for many people it is most helpful to go through the handouts in the order they are listed, it is important to tailor the program to respond to individual needs. For example, when a person is very distressed by the symptoms he or she is experiencing, it would be preferable to address this problem early in the program using Educational Handout #8, “Coping with Problems and Symptoms. ” Practitioners need to be responsive to people’s concerns and use their clinical judgment regarding the order and pacing of handouts.
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Importance of Recovery
There is widespread acceptance of the importance of recovery as a guiding vision for helping people who experience psychiatric symptoms to achieve personal success in their lives. The term recovery means different things to different individuals. Each person is free to define it in his or her terms. For some individuals, recovery means no longer having any symptoms or signs of a mental illness. For others, recovery means taking on challenges, enjoying the pleasures life has to offer, pursuing personal dreams and goals, and learning how to cope with or grow past one’s mental illness despite symptoms or setbacks.
Regardless of the personal understanding each individual develops about recovery, the overriding message is one of hope and optimism. The recovery vision is at the heart of the Illness Management and Recovery Toolkit. Through learning information about mental illness and its treatment, developing skills for reducing relapses, dealing with stress, and coping with symptoms, people can become empowered to manage their own illness, to find their own goals for recovery, and to assume responsibility for directing their own treatment. People who experience psychiatric symptoms are not passive recipients of treatment, and the goal is not to make them “comply” with treatment recommendations. Rather, the focus of Illness Management and Recovery is providing people with the information and skills they need in order to make informed decisions about their own treatment.
Broadly speaking, the goals of Illness Management and Recovery are to:
Instill hope that change is possible
Develop a collaborative relationship with a treatment team
Help people establish personally meaningful goals to strive towards
Teach information about mental illness and treatment options
Develop skills for reducing relapses, dealing with stress, and coping with symptoms
Provide information about where to obtain needed resources
Help people develop or enhance their natural supports for managing their illness and pursuing goals
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Importance of Helping People Set and Pursue Personal Goals
Being able to set and pursue personal goals is an essential part of recovery. At the same time that information and skills are being taught in the Illness Management and Recovery Program, people are also helped to define what recovery means to them and to identify what goals and dreams are important to them. The first educational handout, “Recovery Strategies,” contains specific information about setting goals. However, throughout the entire program, practitioners help people set meaningful personal goals and follow up regularly on those goals. As people gain more mastery over their psychiatric symptoms, they gain more control over their lives and become better able to realize their vision of recovery. In each session of the program, practitioners should follow up on the participants’ progress towards their goals. “Goals Set in the Illness Management and Recovery Program” (Appendix 5) helps practitioners to keep track of a person’s goals. Another form, “Step-By-Step Problem-Solving and Goal Achievement” (Appendix 6) is useful for helping a person plan the steps for achieving a goal (or solving a problem).
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Logistics
The content and teaching methods used in the Illness Management and Recovery Program are derived from multiple studies of professionally based illness management training programs for people who have experienced psychiatric symptoms. Information is taught using a combination of motivational, educational, and cognitive-behavioral teaching principles. Critical information is summarized in educational handouts that are written for people who experience psychiatric symptoms but are also suitable for distribution to anyone with a professional or caring relationship with a person who experiences psychiatric symptoms (such as a case manager or a family member).
The information and skills taught in Illness management and Recovery are organized into nine topic areas: recovery strategies, practical facts about mental illness, the stress-vulnerability model, building social support, using medication effectively, reducing relapses, coping with stress, coping with problems and symptoms, and getting your needs met in the mental health system. There are educational handouts and practitioners’ guidelines for each topic area.
Each topic is taught using a combination of motivational, educational, and cognitive behavioral methods. Also, in order to help people apply the information and skills that they learn in the sessions to their day-to-day lives, the practitioner and the person collaborate to develop homework assignments at the end of each session. These homework assignments are tailored to the individual, to help him or her practice strategies in “the real world.” Because developing and enhancing natural supports is a goal of Illness Management and Recovery, people are encouraged to identify significant others with whom they can share the handout materials and who may support them in applying newly acquired skills or completing homework.
The amount of time required to teach Illness Management and Recovery depends on a variety of factors, including people’s prior knowledge and level of skills, the problem areas that they would like to work on, and the presence of either cognitive difficulties or severe symptoms that may slow the learning process. In general, between three and six months of weekly sessions of 45 to 60 minutes may be required to teach Illness Management and Recovery. Following the completion of the nine topic areas, people may also benefit from either booster sessions or participation in support groups aimed at using and expanding skills.
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The Illness Management and Recovery Program consists of a series of weekly sessions where mental health practitioners help people who have experienced psychiatric symptoms to develop personalized strategies for managing their mental illness and moving forward in their lives. The program can be provided in an individual or group format, and generally lasts between three and six months. In the sessions, practitioners work collaboratively with people, offering a variety of information, strategies, and skills that people can use to further their own recovery. There is a strong emphasis on helping people set and pursue personal goals and helping them put strategies into action in their everyday lives.
Materials for Providing the Illness Management and Recovery Program
In the Practitioners’ Workbook (this document) there are two sets of materials for Illness Management and Recovery: the Practitioners’ Guide (Chapters 1-10) and Educational Handouts. The educational handouts contain practical information and strategies that people can use in the recovery process. The handouts are not meant to stand alone. Practitioners are expected to help people select and put into practice the knowledge and strategies that are most helpful to themselves as individuals. The following topics are covered in nine educational handouts:
Recovery Strategies
Practical Facts about Schizophrenia/Bipolar Disorder/ Depression
The Stress-Vulnerability Model and Strategies for Treatment
Building Social Support
Using Medication Effectively
Reducing Relapses
Coping with Stress
Coping with Problems and Symptoms
Getting Your Needs Met in the Mental Health System
Chapter 1 of the Practitioners’ Guide contains overall strategies for conducting the program, and Chapters 2-10 contain practitioner guidelines for using each of the educational handouts to conduct sessions. The guidelines contain specific suggestions for using motivational, educational, and cognitive behavioral techniques to help people use strategies from the handouts in their daily lives. They also provide tips for developing homework assignments and for dealing with problems that might arise during sessions.
Getting started
First, practitioners are advised to familiarize themselves with the format, content and tone of the program. This can be accomplished by first reading the following:
Chapter 1 of the Practitioners’ Guide
Educational Handout #1 (“Recovery Strategies”)
Practitioner Guidelines for Educational Handout #1 (“Recovery Strategies”)
It is optimal for practitioners to read the remaining educational handouts and accompanying practitioners’ guidelines before beginning to work with people. Practitioners are advised to review specific handouts and guidelines prior to addressing these particular topic areas with people.
Preparing For Sessions
The first session is usually spent on orientation, using the “Orientation Sheet” (see Appendix 1) as a guide. The second (and sometimes third) session is spent on getting to know the person better, using the ”Knowledge and Skills Inventory” (see Appendix 2) as a guide. This inventory is focused on the person’s positive attributes rather than their problems or “deficits.” It is important to gather information in a friendly, low- key manner, using a conversational tone. The remaining sessions are focused on helping people to learn and practice the information and strategies in the educational handouts and to set and pursue their personal goals. Each session should be documented, using the “Progress Note for Illness Management and Recovery” (Appendix 3). The format of the progress note helps practitioners to keep track of the person’s personal goals, the kinds of interventions provided (motivational, educational, cognitive-behavioral), the specific evidence-based skill(s) that are taught (coping skills, relapse prevention skills and behavioral tailoring skills) and the homework that is agreed upon.
Before beginning each educational handout, the practitioner is encouraged to review the contents of the handout and the practitioner guidelines of the same title in the Practitioners’ Guide. Most educational handouts will require two to four sessions to put the important principles into practice. Preparation for sessions is most effective when practitioners review the educational handout and the corresponding practitioners’ guidelines side-by-side, noting the goals of the handout, the specific topic headings, the probe questions, the checklists, etc. As noted above, sessions should be recorded on the form “Progress Note for Illness Management and Recovery” (Appendix 3). Although for many people it is most helpful to go through the handouts in the order they are listed, it is important to tailor the program to respond to individual needs. For example, when a person is very distressed by the symptoms he or she is experiencing, it would be preferable to address this problem early in the program using Educational Handout #8, “Coping with Problems and Symptoms. ” Practitioners need to be responsive to people’s concerns and use their clinical judgment regarding the order and pacing of handouts.
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Importance of Recovery
There is widespread acceptance of the importance of recovery as a guiding vision for helping people who experience psychiatric symptoms to achieve personal success in their lives. The term recovery means different things to different individuals. Each person is free to define it in his or her terms. For some individuals, recovery means no longer having any symptoms or signs of a mental illness. For others, recovery means taking on challenges, enjoying the pleasures life has to offer, pursuing personal dreams and goals, and learning how to cope with or grow past one’s mental illness despite symptoms or setbacks.
Regardless of the personal understanding each individual develops about recovery, the overriding message is one of hope and optimism. The recovery vision is at the heart of the Illness Management and Recovery Toolkit. Through learning information about mental illness and its treatment, developing skills for reducing relapses, dealing with stress, and coping with symptoms, people can become empowered to manage their own illness, to find their own goals for recovery, and to assume responsibility for directing their own treatment. People who experience psychiatric symptoms are not passive recipients of treatment, and the goal is not to make them “comply” with treatment recommendations. Rather, the focus of Illness Management and Recovery is providing people with the information and skills they need in order to make informed decisions about their own treatment.
Broadly speaking, the goals of Illness Management and Recovery are to:
Instill hope that change is possible
Develop a collaborative relationship with a treatment team
Help people establish personally meaningful goals to strive towards
Teach information about mental illness and treatment options
Develop skills for reducing relapses, dealing with stress, and coping with symptoms
Provide information about where to obtain needed resources
Help people develop or enhance their natural supports for managing their illness and pursuing goals
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Importance of Helping People Set and Pursue Personal Goals
Being able to set and pursue personal goals is an essential part of recovery. At the same time that information and skills are being taught in the Illness Management and Recovery Program, people are also helped to define what recovery means to them and to identify what goals and dreams are important to them. The first educational handout, “Recovery Strategies,” contains specific information about setting goals. However, throughout the entire program, practitioners help people set meaningful personal goals and follow up regularly on those goals. As people gain more mastery over their psychiatric symptoms, they gain more control over their lives and become better able to realize their vision of recovery. In each session of the program, practitioners should follow up on the participants’ progress towards their goals. “Goals Set in the Illness Management and Recovery Program” (Appendix 5) helps practitioners to keep track of a person’s goals. Another form, “Step-By-Step Problem-Solving and Goal Achievement” (Appendix 6) is useful for helping a person plan the steps for achieving a goal (or solving a problem).
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Logistics
The content and teaching methods used in the Illness Management and Recovery Program are derived from multiple studies of professionally based illness management training programs for people who have experienced psychiatric symptoms. Information is taught using a combination of motivational, educational, and cognitive-behavioral teaching principles. Critical information is summarized in educational handouts that are written for people who experience psychiatric symptoms but are also suitable for distribution to anyone with a professional or caring relationship with a person who experiences psychiatric symptoms (such as a case manager or a family member).
The information and skills taught in Illness management and Recovery are organized into nine topic areas: recovery strategies, practical facts about mental illness, the stress-vulnerability model, building social support, using medication effectively, reducing relapses, coping with stress, coping with problems and symptoms, and getting your needs met in the mental health system. There are educational handouts and practitioners’ guidelines for each topic area.
Each topic is taught using a combination of motivational, educational, and cognitive behavioral methods. Also, in order to help people apply the information and skills that they learn in the sessions to their day-to-day lives, the practitioner and the person collaborate to develop homework assignments at the end of each session. These homework assignments are tailored to the individual, to help him or her practice strategies in “the real world.” Because developing and enhancing natural supports is a goal of Illness Management and Recovery, people are encouraged to identify significant others with whom they can share the handout materials and who may support them in applying newly acquired skills or completing homework.
The amount of time required to teach Illness Management and Recovery depends on a variety of factors, including people’s prior knowledge and level of skills, the problem areas that they would like to work on, and the presence of either cognitive difficulties or severe symptoms that may slow the learning process. In general, between three and six months of weekly sessions of 45 to 60 minutes may be required to teach Illness Management and Recovery. Following the completion of the nine topic areas, people may also benefit from either booster sessions or participation in support groups aimed at using and expanding skills.
March 31, 2010
Prevention Initiatives and Priority Programs Development Branch
Prevention Initiatives and Priority Programs Development Branch
The Prevention Initiatives and Priority Programs Development Branch is part of the Division of Prevention, Traumatic Stress, and Special Programs at the Center for Mental Health Services (CMHS). CMHS is leading the effort to transform mental health systems and the way mental health services are perceived, accessed, delivered, and financed. A major way that the Prevention Initiatives and Priority Programs Development Branch (PIPPDB) supports transformation is through their grants and other programs that promote mental health for children, youth, and families and prevent mental and behavioral disorders for those who are at-risk.
PIPPDB currently has projects that focus on:
Youth Violence Prevention
The interdepartmental Safe Schools/Healthy Students Initiative (SS/HS) is designed to prevent school violence and foster the healthy development of children. The SS/HS Initiative is an unprecedented collaborative grant program supported by three federal agencies – the U.S. Departments of Health and Human Services, Education, and Justice. The SS/HS Initiative seeks to develop real-world knowledge about what works best to promote safe and healthy environments in which America’s children can learn and develop. It is a unique Federal program designed to prevent violence and substance abuse in our Nation’s youth, schools, and communities.
Complementing SS/HS is PIPPDB’s Youth Violence Prevention Program that provides support for grantees to form and expand on community collaborations dedicated to the prevention of youth violence, substance abuse, suicide, and other mental health and behavioral problems.
Targeted Capacity Expansion grants for the Prevention Early Intervention Grant Program aim to develop mental health prevention and early intervention services targeted to infants, toddlers, preschool, and school-age children, and/or adolescents in both mental health settings and other settings that serve this population.
PIPPDB has also developed the 15+ Make Time to Listen, Take Time to Talk campaign based on the premise that parents who talk with their children about what is happening in their lives are better able to guide their children and this can be instrumental in building a healthier and safer environment for children. The initiative has been adapted to address the prevention of bullying and the climate of fear created by bullying through a national education and dissemination project.
Suicide Prevention
Recent reports by the Institute of Medicine and the World Health Organization have revealed the magnitude and impact of suicide, citing it as the cause of death for 30,000 Americans annually and over one million people worldwide. These reports, as well as the President’s New Freedom Commission Report and the Surgeon General’s National Strategy for Suicide Prevention, call for aggressive efforts to reduce the loss of life and suffering related to suicide.
The Branch supports several key initiatives designed to improve public and professional awareness of suicide as a preventable public health problem and to enhance the capabilities of the systems that promote prevention and recovery, including:
Cooperative Agreements for State-Sponsored Youth Suicide Prevention and Early Intervention Program. Three-year grants to support States and tribes in developing and implementing statewide or tribal youth suicide prevention and early intervention strategies, grounded in public/private collaboration.
Campus Suicide Prevention Grants. Three-year grants to institutions of higher education to enhance services for students with mental and behavioral health problems that can lead to school failure, depression, substance abuse, and suicide attempts.
Cooperative Agreement for the Suicide Prevention Resource Center (SPRC). Funds the continuation of a Federal Suicide Technical Assistance Center to provide guidance to State, tribal, and local grantees in the implementation of the suicide prevention strategy; create standards for data collection; and collect, evaluate, and disseminate data related to specific suicide prevention programs.
Networking and Certifying Suicide Prevention Hotlines. This grant provides funding to manage a toll-free national suicide prevention hotline network utilizing a life affirming number which routes calls from anywhere in the United States to a network of local crisis centers that can link callers to local emergency, mental health and social service resources.
Linking Adolescents at Risk to Mental Health Services Grant Program. This initiative is one of SAMHSA's Service-to-Science Grants programs. The purpose of the Adolescents at Risk program is to evaluate voluntary school-based programs that focus on identification and referral of high school youth who are at risk for suicide or suicide attempts. Eligible applicants are local educational agencies or nonprofit entities in conjunction with local educational agencies.
Collectively, these initiatives will further awareness of suicide, will promote suicide prevention and intervention efforts, and will reduce the numbers of lives lost and disrupted by suicide.
The Prevention Initiatives and Priority Programs Development Branch is part of the Division of Prevention, Traumatic Stress, and Special Programs at the Center for Mental Health Services (CMHS). CMHS is leading the effort to transform mental health systems and the way mental health services are perceived, accessed, delivered, and financed. A major way that the Prevention Initiatives and Priority Programs Development Branch (PIPPDB) supports transformation is through their grants and other programs that promote mental health for children, youth, and families and prevent mental and behavioral disorders for those who are at-risk.
PIPPDB currently has projects that focus on:
Youth Violence Prevention
The interdepartmental Safe Schools/Healthy Students Initiative (SS/HS) is designed to prevent school violence and foster the healthy development of children. The SS/HS Initiative is an unprecedented collaborative grant program supported by three federal agencies – the U.S. Departments of Health and Human Services, Education, and Justice. The SS/HS Initiative seeks to develop real-world knowledge about what works best to promote safe and healthy environments in which America’s children can learn and develop. It is a unique Federal program designed to prevent violence and substance abuse in our Nation’s youth, schools, and communities.
Complementing SS/HS is PIPPDB’s Youth Violence Prevention Program that provides support for grantees to form and expand on community collaborations dedicated to the prevention of youth violence, substance abuse, suicide, and other mental health and behavioral problems.
Targeted Capacity Expansion grants for the Prevention Early Intervention Grant Program aim to develop mental health prevention and early intervention services targeted to infants, toddlers, preschool, and school-age children, and/or adolescents in both mental health settings and other settings that serve this population.
PIPPDB has also developed the 15+ Make Time to Listen, Take Time to Talk campaign based on the premise that parents who talk with their children about what is happening in their lives are better able to guide their children and this can be instrumental in building a healthier and safer environment for children. The initiative has been adapted to address the prevention of bullying and the climate of fear created by bullying through a national education and dissemination project.
Suicide Prevention
Recent reports by the Institute of Medicine and the World Health Organization have revealed the magnitude and impact of suicide, citing it as the cause of death for 30,000 Americans annually and over one million people worldwide. These reports, as well as the President’s New Freedom Commission Report and the Surgeon General’s National Strategy for Suicide Prevention, call for aggressive efforts to reduce the loss of life and suffering related to suicide.
The Branch supports several key initiatives designed to improve public and professional awareness of suicide as a preventable public health problem and to enhance the capabilities of the systems that promote prevention and recovery, including:
Cooperative Agreements for State-Sponsored Youth Suicide Prevention and Early Intervention Program. Three-year grants to support States and tribes in developing and implementing statewide or tribal youth suicide prevention and early intervention strategies, grounded in public/private collaboration.
Campus Suicide Prevention Grants. Three-year grants to institutions of higher education to enhance services for students with mental and behavioral health problems that can lead to school failure, depression, substance abuse, and suicide attempts.
Cooperative Agreement for the Suicide Prevention Resource Center (SPRC). Funds the continuation of a Federal Suicide Technical Assistance Center to provide guidance to State, tribal, and local grantees in the implementation of the suicide prevention strategy; create standards for data collection; and collect, evaluate, and disseminate data related to specific suicide prevention programs.
Networking and Certifying Suicide Prevention Hotlines. This grant provides funding to manage a toll-free national suicide prevention hotline network utilizing a life affirming number which routes calls from anywhere in the United States to a network of local crisis centers that can link callers to local emergency, mental health and social service resources.
Linking Adolescents at Risk to Mental Health Services Grant Program. This initiative is one of SAMHSA's Service-to-Science Grants programs. The purpose of the Adolescents at Risk program is to evaluate voluntary school-based programs that focus on identification and referral of high school youth who are at risk for suicide or suicide attempts. Eligible applicants are local educational agencies or nonprofit entities in conjunction with local educational agencies.
Collectively, these initiatives will further awareness of suicide, will promote suicide prevention and intervention efforts, and will reduce the numbers of lives lost and disrupted by suicide.
February 07, 2010
HIV and AIDS Online Continuing Education CEUs
Click link below for
HIV and AIDS Online Continuing Education CEUsHIV and AIDS
Description
Differentiate between HIV and AIDS
Identify causes
Learn epidemiology
Learn the historical framework related to the development of HIV/AIDS
Become familiar with the impact HIV/AIDS on culture
Identify and recognize common stigmas associated with HIV/AIDS
Increase familiarity with the relationship between HIV/AIDS and mental health
Increase familiarity with the relationship between HIV/AIDS and substance abuse
Develop the ability to identify the characteristics and method of assessment and treatment of people who live with HIV/AIDS.
HIV and AIDS Online Continuing Education CEUsHIV and AIDS
Description
Differentiate between HIV and AIDS
Identify causes
Learn epidemiology
Learn the historical framework related to the development of HIV/AIDS
Become familiar with the impact HIV/AIDS on culture
Identify and recognize common stigmas associated with HIV/AIDS
Increase familiarity with the relationship between HIV/AIDS and mental health
Increase familiarity with the relationship between HIV/AIDS and substance abuse
Develop the ability to identify the characteristics and method of assessment and treatment of people who live with HIV/AIDS.
January 26, 2010
HIV AND AIDS Continuing Education Units CEUS
HIV AND AIDS Continuing Education Units CEUS
7 Hours/CEU’s
Click here for full course text
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material
may be transmitted or reproduced in any form, or by any means, mechanical or
electronic without written permission of Aspira Continuing Education.
1. Differentiate between HIV and AIDS
2. Identify causes
3. Learn epidemiology
4. Learn the historical framework related to the development of
HIV/AIDS
5. Become familiar with the impact HIV/AIDS on culture
6. Identify and recognize common stigmas associated with HIV/AIDS
7. Increase familiarity with the relationship between HIV/AIDS and
mental health
8. Increase familiarity with the relationship between HIV/AIDS and
substance abuse
9. Develop the ability to identify the characteristics and method of
assessment and treatment of people who live with HIV/AIDS.
Table of Contents:
1. Definitions
2. Causes
3. Epidemiology
4. History
5. Stigma
6. HIV/AIDS and Mental Health
7. HIV/AIDS and Substance Abuse
8. Cognitive Disorders
9. Summary
10. References
1. Definitions
Human immunodeficiency virus (HIV) is a lentivirus (a member of the
retrovirus family) that can lead to acquired immunodeficiency syndrome
(AIDS), a condition in humans in which the immune system begins to fail,
leading to life-threatening opportunistic infections. Previous names for the
virus include human T-lymphotropic virus-III (HTLV-III),
lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus
(ARV). Infection with HIV occurs by the transfer of blood, semen, vaginal
fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present
as both free virus particles and virus within infected immune cells. The four
major routes of transmission are unprotected sexual intercourse,
contaminated needles, breast milk, and transmission from an infected mother
to her baby at birth (Vertical transmission). Screening of blood products for
HIV has largely eliminated transmission through blood transfusions or
infected blood products in the developed world (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).HIV infection in humans is now pandemic. As
of January 2006, the Joint United Nations Program on HIV/AIDS (UNAIDS) and the
World Health Organization (WHO) estimate that AIDS has killed more than 25 million people
since it was first recognized on December 1, 1981. It is estimated that about 0.6 percent of the world's population is infected with HIV. In 2005 alone, AIDS claimed an estimated 2.4–3.3
million lives, of which more than 570,000 were children. A third of these deaths are occurring in sub-Saharan Africa, retarding economic growth
and increasing poverty. According to current estimates, HIV is set to infect 90 million people in Africa, resulting in a minimum estimate of 18 million orphans.
Antiretroviral treatment reduces both the mortality and the morbidity of HIV
infection, but routine access to antiretroviral medication is not available in
all countries. HIV primarily infects vital cells in the human immune system
such as helper T cells (specifically CD4+ T cells), macrophages, and
Human immunodeficiency virus Scanning electron micrograph of HIV-1 (in green) budding
from cultured lymphocyte. Multiple round bumps on cell surface represent sites of
assembly and budding of virions.
dendritic cells. HIV infection leads to low levels of CD4+ T cells through
three main mechanisms: firstly, direct viral killing of infected cells;
secondly, increased rates of apoptosis in infected cells; and thirdly, killing of
infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected
cells. When CD4+ T cell numbers decline below a critical level, cellmediated
immunity is lost, and the body becomes progressively more
susceptible to opportunistic infections (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Eventually most HIV-infected individuals develop AIDS (Acquired
Immunodeficiency Syndrome). These individuals mostly die from
opportunistic infections or malignancies associated with the progressive
failure of the immune system. Without treatment, about 9 out of every 10
persons with HIV will progress to AIDS after 10-15 years. Many people
deteriorate much sooner. Treatment with anti-retrovirals increases the life
expectancy of people infected with HIV. Even after HIV has progressed to
diagnosable AIDS, the average survival time with antiretroviral therapy (as
of 2005) is estimated to be more than 5 years. Without antiretroviral therapy,
death normally occurs within a year. It is hoped that current and future
treatments may allow HIV-infected individuals to achieve a life expectancy
approaching that of the general public (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Acquired immune deficiency syndrome or acquired immunodeficiency
syndrome (AIDS) is a set of symptoms and infections resulting from the
damage to the human immune system caused by the human
immunodeficiency virus (HIV). This condition progressively reduces the
effectiveness of the immune system and leaves individuals susceptible to
opportunistic infections and tumors. HIV is transmitted through direct
contact of a mucous membrane or the bloodstream with a bodily fluid
containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and
breast milk (Appay V, Sauce D (January 2008). "Immune activation and
inflammation in HIV-1 infection: causes and consequences". J. Pathol.)
This transmission can involve anal, vaginal or oral sex, blood transfusion,
contaminated hypodermic needles, exchange between mother and baby
during pregnancy, childbirth, or breastfeeding, or other exposure to one of
the above bodily fluids (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived
with the disease worldwide, and it killed an estimated 2.1 million people,
including 330,000 children. Over three-quarters of these deaths occurred in
sub-Saharan Africa, retarding economic growth and destroying human
capital. Genetic research indicates that HIV originated in west-central
Africa during the late nineteenth or early twentieth century. AIDS was first
recognized by the U.S. Centers for Disease Control and Prevention in 1981
and its cause, HIV, identified in the early 1980s (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Although treatments for AIDS and HIV can slow the course of the disease,
there is currently no vaccine or cure. Antiretroviral treatment reduces both
the mortality and the morbidity of HIV infection, but these drugs are
expensive and routine access to antiretroviral medication is not available in
all countries. Due to the difficulty in treating HIV infection, preventing
infection is a key aim in controlling the AIDS epidemic, with health
organizations promoting safe sex and needle-exchange programs in attempts
to slow the spread of the virus (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
2. Causes
AIDS is the most severe acceleration of infection with HIV. HIV is a
retrovirus that primarily infects vital organs of the human immune system
such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells.
It directly and indirectly destroys CD4+ T cells. Once HIV has killed so
many CD4+ T cells that there are fewer than 200 of these cells per microliter
(μL) of blood, cellular immunity is lost. Acute HIV infection progresses
over time to clinical latent HIV infection and then to early symptomatic HIV
infection and later to AIDS, which is identified either on the basis of the
amount of CD4+ T cells remaining in the blood, and/or the presence of
certain infections (Appay V, Sauce D, January 2008. "Immune activation
and inflammation in HIV-1 infection: causes and consequences". J. Pathol).
Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.
In the absence of antiretroviral therapy, the median time of progression from
HIV infection to AIDS is nine to ten years, and the median survival time
after developing AIDS is only 9.2 months. However, the rate of clinical
disease progression varies widely between individuals, from two weeks up
to 20 years. Many factors affect the rate of progression. These include
factors that influence the body's ability to defend against HIV such as the
infected person's general immune function. Older people have weaker
immune systems, and therefore have a greater risk of rapid disease
progression than younger people. Poor access to health care and the
existence of coexisting infections such as tuberculosis also may predispose
people to faster disease progression. The infected person's genetic
inheritance plays an important role and some people are resistant to certain
strains of HIV. An example of this is people with the homozygous CCR5-
Δ32 variation are resistant to infection with certain strains of HIV. HIV is
genetically variable and exists as different strains, which cause different
rates of clinical disease progression (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Sexual transmission
Sexual transmission occurs with the contact between sexual secretions of
one person with the rectal, genital or oral mucous membranes of another.
Unprotected receptive sexual acts are riskier than unprotected insertive
sexual acts, and the risk for transmitting HIV through unprotected anal
intercourse is greater than the risk from vaginal intercourse or oral sex.
However, oral sex is not entirely safe, as HIV can be transmitted through
both insertive and receptive oral sex. Sexual assault greatly increases the risk
of HIV transmission as protection is rarely employed and physical trauma to
the vagina occurs frequently, facilitating the transmission of HIV. Other
sexually transmitted infections (STI) increase the risk of HIV transmission
and infection, because they cause the disruption of the normal epithelial
barrier by genital ulceration and/or microulceration; and by accumulation of
pools of HIV-susceptible or HIV-infected cells (lymphocytes and
macrophages) in semen and vaginal secretions. Epidemiological studies
from sub-Saharan Africa, Europe and North America suggest that genital
ulcers, such as those caused by syphilis and/or chancroid, increase the risk of
becoming infected with HIV by about fourfold. There is also a significant
although lesser increase in risk from STIs such as gonorrhea, Chlamydial
infection and trichomoniasis, which all cause local accumulations of
lymphocytes and macrophages (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Transmission of HIV depends on the infectiousness of the index case and the
susceptibility of the uninfected partner. Infectivity seems to vary during the
course of illness and is not constant between individuals. An undetectable
plasma viral load does not necessarily indicate a low viral load in the
seminal liquid or genital secretions. However, each 10-fold increase in the
level of HIV in the blood is associated with an 81% increased rate of HIV
transmission. Women are more susceptible to HIV-1 infection due to
hormonal changes, vaginal microbial ecology and physiology, and a higher
prevalence of sexually transmitted diseases. People who have been infected
with one strain of HIV can still be infected later on in their lives by other,
more virulent strains. Infection is unlikely in a single encounter. High rates
of infection have been linked to a pattern of overlapping long-term romantic
relationships. This allows the virus to quickly spread to multiple partners
who in turn infect their partners. A pattern of serial monogamy or occasional
casual encounters is associated with lower rates of infection. HIV spreads
readily through heterosexual sex in Africa, but less so elsewhere. One
possibility being researched is that schistosomiasis, which affects up to 50
per cent of women in parts of Africa, damages the lining of the vagina
(Mastro TD, de Vincenzi I, 1996. "Probabilities of sexual HIV-1
transmission).
Exposure to blood-borne pathogens
(CDC poster from 1989 highlighting the threat of AIDS associated with drug use)
This transmission route is particularly relevant to intravenous drug users,
hemophiliacs and recipients of blood transfusions and blood products.
Sharing and reusing syringes contaminated with HIV-infected blood
represents a major risk for infection with HIV. Needle sharing is the cause
of one third of all new HIV-infections in North America, China, and Eastern
Europe. The risk of being infected with HIV from a single prick with a
needle that has been used on an HIV-infected person is thought to be about 1
in 150. Post-exposure prophylaxis with anti-HIV drugs can further reduce
this risk. This route can also affect people who give and receive tattoos and
piercings. Universal precautions are frequently not followed in both sub-
Saharan Africa and much of Asia because of both a shortage of supplies and
inadequate training. The WHO estimates that approximately 2.5% of all HIV
infections in sub-Saharan Africa are transmitted through unsafe healthcare
injections. Because of this, the United Nations General Assembly has urged
the nations of the world to implement precautions to prevent HIV
transmission by health workers. The risk of transmitting HIV to blood
transfusion recipients is extremely low in developed countries where
improved donor selection and HIV screening is performed. However,
according to the WHO, the overwhelming majority of the world's population
does not have access to safe blood and between 5% and 10% of the world's
HIV infections come from transfusion of infected blood and blood products
(Source: The World Health Organization).
Perinatal transmission
The transmission of the virus from the mother to the child can occur in utero
during the last weeks of pregnancy and at childbirth. In the absence of
treatment, the transmission rate between a mother and her child during
pregnancy, labor and delivery is 25%. However, when the mother takes
antiretroviral therapy and gives birth by caesarean section, the rate of
transmission is just 1%. The risk of infection is influenced by the viral load
of the mother at birth, with the higher the viral load, the higher the risk.
Breastfeeding also increases the risk of transmission by about 4 % (Source:
The World Health Organization).
Misconceptions
A number of misconceptions have arisen surrounding HIV/AIDS. Three of
the most common are that AIDS can spread through casual contact, that
sexual intercourse with a virgin will cure AIDS, and that HIV can infect
only homosexual men and drug users. Other misconceptions are that any act
of anal intercourse between gay men can lead to AIDS infection, and that
open discussion of homosexuality and HIV in schools will lead to increased
rates of homosexuality and AIDS (Source: The World Health
Organization).
Pathophysiology
The pathophysiology of AIDS is complex, as is the case with all syndromes.
Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes.
This weakens the immune system and allows opportunistic infections. T
lymphocytes are essential to the immune response and without them, the
body cannot fight infections or kill cancerous cells. The mechanism of CD4+
T cell depletion differs in the acute and chronic phases.
During the acute phase, HIVinduced
cell lysis and killing of
infected cells by cytotoxic T cells
accounts for CD4+ T cell
depletion, although apoptosis may
also be a factor. During the
chronic phase, the consequences
of generalized immune activation
coupled with the gradual loss of
the ability of the immune system
to generate new T cells appear to
account for the slow decline in
CD4+ T cell numbers.
Although the symptoms of
immune deficiency characteristic
of AIDS do not appear for years
after a person is infected, the bulk
of CD4+ T cell loss occurs during
the first weeks of infection,
especially in the intestinal
mucosa, which harbors the
majority of the lymphocytes
found in the body. The reason for
the preferential loss of mucosal
CD4+ T cells is that a majority of
mucosal CD4+ T cells express the
CCR5 coreceptor, whereas a
small fraction of CD4+ T cells in
the bloodstream do so.
HIV seeks out and destroys CCR5
expressing CD4+ cells during
acute infection. A vigorous
immune response eventually
controls the infection and initiates
the clinically latent phase.
However, CD4+ T cells in mucosal tissues remain depleted throughout the
infection, although enough remain to initially ward off life-threatening
infections (Source: The World Health Organization).
Estimated per act risk for acquisition
of HIV by exposure route.
Exposure Route
Estimated infections
per 10,000 exposures
to an infected source
Blood Transfusion 9,000
Childbirth 2,500
Needle-sharing injection drug use 67
Percutaneous needle stick 30
Receptive anal intercourse* 50
Insertive anal intercourse* 6.5
Receptive penile-vaginal intercourse* 10
Insertive penile-vaginal intercourse* 5
Receptive oral intercourse*§ 1
Insertive oral intercourse*§ 0.5
* assuming no condom use
§ source refers to oral intercourse
performed on a man
Continuous HIV replication results in a state of generalized immune
activation persisting throughout the chronic phase. Immune activation,
which is reflected by the increased activation state of immune cells and
release of proinflammatory cytokines, results from the activity of several
HIV gene products and the immune response to ongoing HIV replication.
Another cause is the breakdown of the immune surveillance system of the
mucosal barrier caused by the depletion of mucosal CD4+ T cells during the
acute phase of disease.
This results in the systemic exposure of the immune system to microbial
components of the gut’s normal flora, which in a healthy person is kept in
check by the mucosal immune system. The activation and proliferation of T
cells that results from immune activation provides fresh targets for HIV
infection. However, direct killing by HIV alone cannot account for the
observed depletion of CD4+ T cells since only 0.01-0.10% of CD4+ T cells
in the blood are infected. A major cause of CD4+ T cell loss appears to
result from their heightened susceptibility to apoptosis when the immune
system remains activated. Although new T cells are continuously produced
by the thymus to replace the ones lost, the regenerative capacity of the
thymus is slowly destroyed by direct infection of its thymocytes by HIV.
Eventually, the minimal number of CD4+ T cells necessary to maintain a
sufficient immune response is lost, leading to AIDS (Source: The World
Health Organization).
7 Hours/CEU’s
Click here for full course text
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material
may be transmitted or reproduced in any form, or by any means, mechanical or
electronic without written permission of Aspira Continuing Education.
1. Differentiate between HIV and AIDS
2. Identify causes
3. Learn epidemiology
4. Learn the historical framework related to the development of
HIV/AIDS
5. Become familiar with the impact HIV/AIDS on culture
6. Identify and recognize common stigmas associated with HIV/AIDS
7. Increase familiarity with the relationship between HIV/AIDS and
mental health
8. Increase familiarity with the relationship between HIV/AIDS and
substance abuse
9. Develop the ability to identify the characteristics and method of
assessment and treatment of people who live with HIV/AIDS.
Table of Contents:
1. Definitions
2. Causes
3. Epidemiology
4. History
5. Stigma
6. HIV/AIDS and Mental Health
7. HIV/AIDS and Substance Abuse
8. Cognitive Disorders
9. Summary
10. References
1. Definitions
Human immunodeficiency virus (HIV) is a lentivirus (a member of the
retrovirus family) that can lead to acquired immunodeficiency syndrome
(AIDS), a condition in humans in which the immune system begins to fail,
leading to life-threatening opportunistic infections. Previous names for the
virus include human T-lymphotropic virus-III (HTLV-III),
lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus
(ARV). Infection with HIV occurs by the transfer of blood, semen, vaginal
fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present
as both free virus particles and virus within infected immune cells. The four
major routes of transmission are unprotected sexual intercourse,
contaminated needles, breast milk, and transmission from an infected mother
to her baby at birth (Vertical transmission). Screening of blood products for
HIV has largely eliminated transmission through blood transfusions or
infected blood products in the developed world (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).HIV infection in humans is now pandemic. As
of January 2006, the Joint United Nations Program on HIV/AIDS (UNAIDS) and the
World Health Organization (WHO) estimate that AIDS has killed more than 25 million people
since it was first recognized on December 1, 1981. It is estimated that about 0.6 percent of the world's population is infected with HIV. In 2005 alone, AIDS claimed an estimated 2.4–3.3
million lives, of which more than 570,000 were children. A third of these deaths are occurring in sub-Saharan Africa, retarding economic growth
and increasing poverty. According to current estimates, HIV is set to infect 90 million people in Africa, resulting in a minimum estimate of 18 million orphans.
Antiretroviral treatment reduces both the mortality and the morbidity of HIV
infection, but routine access to antiretroviral medication is not available in
all countries. HIV primarily infects vital cells in the human immune system
such as helper T cells (specifically CD4+ T cells), macrophages, and
Human immunodeficiency virus Scanning electron micrograph of HIV-1 (in green) budding
from cultured lymphocyte. Multiple round bumps on cell surface represent sites of
assembly and budding of virions.
dendritic cells. HIV infection leads to low levels of CD4+ T cells through
three main mechanisms: firstly, direct viral killing of infected cells;
secondly, increased rates of apoptosis in infected cells; and thirdly, killing of
infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected
cells. When CD4+ T cell numbers decline below a critical level, cellmediated
immunity is lost, and the body becomes progressively more
susceptible to opportunistic infections (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Eventually most HIV-infected individuals develop AIDS (Acquired
Immunodeficiency Syndrome). These individuals mostly die from
opportunistic infections or malignancies associated with the progressive
failure of the immune system. Without treatment, about 9 out of every 10
persons with HIV will progress to AIDS after 10-15 years. Many people
deteriorate much sooner. Treatment with anti-retrovirals increases the life
expectancy of people infected with HIV. Even after HIV has progressed to
diagnosable AIDS, the average survival time with antiretroviral therapy (as
of 2005) is estimated to be more than 5 years. Without antiretroviral therapy,
death normally occurs within a year. It is hoped that current and future
treatments may allow HIV-infected individuals to achieve a life expectancy
approaching that of the general public (Appay V, Sauce D, January 2008.
"Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Acquired immune deficiency syndrome or acquired immunodeficiency
syndrome (AIDS) is a set of symptoms and infections resulting from the
damage to the human immune system caused by the human
immunodeficiency virus (HIV). This condition progressively reduces the
effectiveness of the immune system and leaves individuals susceptible to
opportunistic infections and tumors. HIV is transmitted through direct
contact of a mucous membrane or the bloodstream with a bodily fluid
containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and
breast milk (Appay V, Sauce D (January 2008). "Immune activation and
inflammation in HIV-1 infection: causes and consequences". J. Pathol.)
This transmission can involve anal, vaginal or oral sex, blood transfusion,
contaminated hypodermic needles, exchange between mother and baby
during pregnancy, childbirth, or breastfeeding, or other exposure to one of
the above bodily fluids (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived
with the disease worldwide, and it killed an estimated 2.1 million people,
including 330,000 children. Over three-quarters of these deaths occurred in
sub-Saharan Africa, retarding economic growth and destroying human
capital. Genetic research indicates that HIV originated in west-central
Africa during the late nineteenth or early twentieth century. AIDS was first
recognized by the U.S. Centers for Disease Control and Prevention in 1981
and its cause, HIV, identified in the early 1980s (Appay V, Sauce D, January
2008. "Immune activation and inflammation in HIV-1 infection: causes and
consequences". J. Pathol).
Although treatments for AIDS and HIV can slow the course of the disease,
there is currently no vaccine or cure. Antiretroviral treatment reduces both
the mortality and the morbidity of HIV infection, but these drugs are
expensive and routine access to antiretroviral medication is not available in
all countries. Due to the difficulty in treating HIV infection, preventing
infection is a key aim in controlling the AIDS epidemic, with health
organizations promoting safe sex and needle-exchange programs in attempts
to slow the spread of the virus (Appay V, Sauce D, January 2008. "Immune
activation and inflammation in HIV-1 infection: causes and consequences".
J. Pathol).
2. Causes
AIDS is the most severe acceleration of infection with HIV. HIV is a
retrovirus that primarily infects vital organs of the human immune system
such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells.
It directly and indirectly destroys CD4+ T cells. Once HIV has killed so
many CD4+ T cells that there are fewer than 200 of these cells per microliter
(μL) of blood, cellular immunity is lost. Acute HIV infection progresses
over time to clinical latent HIV infection and then to early symptomatic HIV
infection and later to AIDS, which is identified either on the basis of the
amount of CD4+ T cells remaining in the blood, and/or the presence of
certain infections (Appay V, Sauce D, January 2008. "Immune activation
and inflammation in HIV-1 infection: causes and consequences". J. Pathol).
Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.
In the absence of antiretroviral therapy, the median time of progression from
HIV infection to AIDS is nine to ten years, and the median survival time
after developing AIDS is only 9.2 months. However, the rate of clinical
disease progression varies widely between individuals, from two weeks up
to 20 years. Many factors affect the rate of progression. These include
factors that influence the body's ability to defend against HIV such as the
infected person's general immune function. Older people have weaker
immune systems, and therefore have a greater risk of rapid disease
progression than younger people. Poor access to health care and the
existence of coexisting infections such as tuberculosis also may predispose
people to faster disease progression. The infected person's genetic
inheritance plays an important role and some people are resistant to certain
strains of HIV. An example of this is people with the homozygous CCR5-
Δ32 variation are resistant to infection with certain strains of HIV. HIV is
genetically variable and exists as different strains, which cause different
rates of clinical disease progression (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Sexual transmission
Sexual transmission occurs with the contact between sexual secretions of
one person with the rectal, genital or oral mucous membranes of another.
Unprotected receptive sexual acts are riskier than unprotected insertive
sexual acts, and the risk for transmitting HIV through unprotected anal
intercourse is greater than the risk from vaginal intercourse or oral sex.
However, oral sex is not entirely safe, as HIV can be transmitted through
both insertive and receptive oral sex. Sexual assault greatly increases the risk
of HIV transmission as protection is rarely employed and physical trauma to
the vagina occurs frequently, facilitating the transmission of HIV. Other
sexually transmitted infections (STI) increase the risk of HIV transmission
and infection, because they cause the disruption of the normal epithelial
barrier by genital ulceration and/or microulceration; and by accumulation of
pools of HIV-susceptible or HIV-infected cells (lymphocytes and
macrophages) in semen and vaginal secretions. Epidemiological studies
from sub-Saharan Africa, Europe and North America suggest that genital
ulcers, such as those caused by syphilis and/or chancroid, increase the risk of
becoming infected with HIV by about fourfold. There is also a significant
although lesser increase in risk from STIs such as gonorrhea, Chlamydial
infection and trichomoniasis, which all cause local accumulations of
lymphocytes and macrophages (Mastro TD, de Vincenzi I, 1996.
Probabilities of sexual HIV-1 transmission).
Transmission of HIV depends on the infectiousness of the index case and the
susceptibility of the uninfected partner. Infectivity seems to vary during the
course of illness and is not constant between individuals. An undetectable
plasma viral load does not necessarily indicate a low viral load in the
seminal liquid or genital secretions. However, each 10-fold increase in the
level of HIV in the blood is associated with an 81% increased rate of HIV
transmission. Women are more susceptible to HIV-1 infection due to
hormonal changes, vaginal microbial ecology and physiology, and a higher
prevalence of sexually transmitted diseases. People who have been infected
with one strain of HIV can still be infected later on in their lives by other,
more virulent strains. Infection is unlikely in a single encounter. High rates
of infection have been linked to a pattern of overlapping long-term romantic
relationships. This allows the virus to quickly spread to multiple partners
who in turn infect their partners. A pattern of serial monogamy or occasional
casual encounters is associated with lower rates of infection. HIV spreads
readily through heterosexual sex in Africa, but less so elsewhere. One
possibility being researched is that schistosomiasis, which affects up to 50
per cent of women in parts of Africa, damages the lining of the vagina
(Mastro TD, de Vincenzi I, 1996. "Probabilities of sexual HIV-1
transmission).
Exposure to blood-borne pathogens
(CDC poster from 1989 highlighting the threat of AIDS associated with drug use)
This transmission route is particularly relevant to intravenous drug users,
hemophiliacs and recipients of blood transfusions and blood products.
Sharing and reusing syringes contaminated with HIV-infected blood
represents a major risk for infection with HIV. Needle sharing is the cause
of one third of all new HIV-infections in North America, China, and Eastern
Europe. The risk of being infected with HIV from a single prick with a
needle that has been used on an HIV-infected person is thought to be about 1
in 150. Post-exposure prophylaxis with anti-HIV drugs can further reduce
this risk. This route can also affect people who give and receive tattoos and
piercings. Universal precautions are frequently not followed in both sub-
Saharan Africa and much of Asia because of both a shortage of supplies and
inadequate training. The WHO estimates that approximately 2.5% of all HIV
infections in sub-Saharan Africa are transmitted through unsafe healthcare
injections. Because of this, the United Nations General Assembly has urged
the nations of the world to implement precautions to prevent HIV
transmission by health workers. The risk of transmitting HIV to blood
transfusion recipients is extremely low in developed countries where
improved donor selection and HIV screening is performed. However,
according to the WHO, the overwhelming majority of the world's population
does not have access to safe blood and between 5% and 10% of the world's
HIV infections come from transfusion of infected blood and blood products
(Source: The World Health Organization).
Perinatal transmission
The transmission of the virus from the mother to the child can occur in utero
during the last weeks of pregnancy and at childbirth. In the absence of
treatment, the transmission rate between a mother and her child during
pregnancy, labor and delivery is 25%. However, when the mother takes
antiretroviral therapy and gives birth by caesarean section, the rate of
transmission is just 1%. The risk of infection is influenced by the viral load
of the mother at birth, with the higher the viral load, the higher the risk.
Breastfeeding also increases the risk of transmission by about 4 % (Source:
The World Health Organization).
Misconceptions
A number of misconceptions have arisen surrounding HIV/AIDS. Three of
the most common are that AIDS can spread through casual contact, that
sexual intercourse with a virgin will cure AIDS, and that HIV can infect
only homosexual men and drug users. Other misconceptions are that any act
of anal intercourse between gay men can lead to AIDS infection, and that
open discussion of homosexuality and HIV in schools will lead to increased
rates of homosexuality and AIDS (Source: The World Health
Organization).
Pathophysiology
The pathophysiology of AIDS is complex, as is the case with all syndromes.
Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes.
This weakens the immune system and allows opportunistic infections. T
lymphocytes are essential to the immune response and without them, the
body cannot fight infections or kill cancerous cells. The mechanism of CD4+
T cell depletion differs in the acute and chronic phases.
During the acute phase, HIVinduced
cell lysis and killing of
infected cells by cytotoxic T cells
accounts for CD4+ T cell
depletion, although apoptosis may
also be a factor. During the
chronic phase, the consequences
of generalized immune activation
coupled with the gradual loss of
the ability of the immune system
to generate new T cells appear to
account for the slow decline in
CD4+ T cell numbers.
Although the symptoms of
immune deficiency characteristic
of AIDS do not appear for years
after a person is infected, the bulk
of CD4+ T cell loss occurs during
the first weeks of infection,
especially in the intestinal
mucosa, which harbors the
majority of the lymphocytes
found in the body. The reason for
the preferential loss of mucosal
CD4+ T cells is that a majority of
mucosal CD4+ T cells express the
CCR5 coreceptor, whereas a
small fraction of CD4+ T cells in
the bloodstream do so.
HIV seeks out and destroys CCR5
expressing CD4+ cells during
acute infection. A vigorous
immune response eventually
controls the infection and initiates
the clinically latent phase.
However, CD4+ T cells in mucosal tissues remain depleted throughout the
infection, although enough remain to initially ward off life-threatening
infections (Source: The World Health Organization).
Estimated per act risk for acquisition
of HIV by exposure route.
Exposure Route
Estimated infections
per 10,000 exposures
to an infected source
Blood Transfusion 9,000
Childbirth 2,500
Needle-sharing injection drug use 67
Percutaneous needle stick 30
Receptive anal intercourse* 50
Insertive anal intercourse* 6.5
Receptive penile-vaginal intercourse* 10
Insertive penile-vaginal intercourse* 5
Receptive oral intercourse*§ 1
Insertive oral intercourse*§ 0.5
* assuming no condom use
§ source refers to oral intercourse
performed on a man
Continuous HIV replication results in a state of generalized immune
activation persisting throughout the chronic phase. Immune activation,
which is reflected by the increased activation state of immune cells and
release of proinflammatory cytokines, results from the activity of several
HIV gene products and the immune response to ongoing HIV replication.
Another cause is the breakdown of the immune surveillance system of the
mucosal barrier caused by the depletion of mucosal CD4+ T cells during the
acute phase of disease.
This results in the systemic exposure of the immune system to microbial
components of the gut’s normal flora, which in a healthy person is kept in
check by the mucosal immune system. The activation and proliferation of T
cells that results from immune activation provides fresh targets for HIV
infection. However, direct killing by HIV alone cannot account for the
observed depletion of CD4+ T cells since only 0.01-0.10% of CD4+ T cells
in the blood are infected. A major cause of CD4+ T cell loss appears to
result from their heightened susceptibility to apoptosis when the immune
system remains activated. Although new T cells are continuously produced
by the thymus to replace the ones lost, the regenerative capacity of the
thymus is slowly destroyed by direct infection of its thymocytes by HIV.
Eventually, the minimal number of CD4+ T cells necessary to maintain a
sufficient immune response is lost, leading to AIDS (Source: The World
Health Organization).
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