Content Information
Disease Information
Overview
Also known as: HIV/AIDS, Acquired Immune Deficiency Syndrome (AIDS)
Responsibilities
- Hospital: Report cases, deaths of persons with HIV/AIDS, and births by HIV-infected women by mail or phone
- Lab: Report results of positive HIV detection tests, cultures, viral loads (any level, including less than the detectable limits of the test), and CD4+ cell counts (any level) by mail or secure electronic transmission.
- Physician: Report all new patients and HIV diagnoses, AIDS diagnoses, and deaths of persons with HIV/AIDS (from any cause) by mail or phone.
- Local Public Health Agency (LPHA): Follow-up generally not required
Iowa HHS
HIV Reporting: (515) 242-5141
A. Agent
The human immunodeficiency virus is an RNA retrovirus of the lentivirus subgroup, meaning that it contains RNA as its inner core of nucleic acid. Two types of HIV have been identified: type 1 (HIV-1) and type 2 (HIV-2). Although the two types are distinct, they produce similar symptoms and disease. Type 1 predominates in the United States, and it is the most pathogenic. HIV targets and destroys CD4+ T-lymphocyte (helper or T4) cells, leaving a person vulnerable to attack by other organisms and agents, including cancer. Acquired Immune Deficiency Syndrome (AIDS) indicates the late manifestation of HIV infection, in which severe immunosuppression is present. A diagnosis of AIDS occurs when the CD4+ cell count falls below 200 cells/microliter or 14% of total lymphocytes, or when one of 26 indicator diseases is diagnosed.
B. Clinical Description
Symptoms of recent HIV infection, called acute retroviral syndrome, are present in 80 – 90% of people with primary HIV infection. The syndrome is characterized by flu-like symptoms that may include fever, malaise, lymphadenopathy, pharyngitis, headache, night sweats, myalgia, and rash. These may last for 1-2 weeks. Symptoms of advanced HIV disease are variable but may include wasting, candidiasis, persistent generalized lymphadenopathy, pneumococcal and other bacterial pneumonia, Kaposi’s sarcoma, and oral hairy leukoplakia.
Onset of acute retroviral syndrome occurs 2 – 3 weeks after viral transmission, with seroconversion and recovery occurring shortly thereafter. Symptoms of advanced disease occur, on average, 8 – 10 years after infection (without treatment), but this may range from a few months to over 15 years.
Advanced disease includes increased risk of opportunistic infections and conditions, including active tuberculosis, Pneumocystis jiroveci (formerly P. carinii) pneumonia, cervical cancer, B-cell lymphoma, disseminated histoplasmosis and coccidioidomycosis, and progressive multifocal leukoencephalopathy. Co-infection with other sexually transmitted diseases or viral hepatitis can substantially alter the course of the illness, shortening the time to diagnosis of AIDS.
C. Reservoirs
Common reservoirs: Humans are the only known reservoir.
D. Modes of Transmission
Spread is person to person through sexual contact; the sharing of HIV-contaminated needles, syringes, and injection paraphernalia; transfusion of infected blood or its components; transplantation of infected tissues or organs; or breastfeeding. Infants may become infected before, during, or after birth to an infected mother. Less than one-fourth of infants carried by infected mothers become infected. With treatment of the mother and newborn infant, this can be lowered considerably. HIV is not transmitted by casual contact, kissing, mosquitoes, or items in the environment.
E. Incubation period
The incubation period is highly variable. Antibodies can generally be detected 3 weeks to 3 months after infection. Without effective treatment, approximately 50% of infected adults will develop AIDS within 10 years. The incubation time for infants is shorter than in adults.
F. Period of Communicability or Infectious Period
The period of communicability begins shortly after transmission and continues throughout life. Epidemiological studies indicate that transmission potential is highest shortly after infection and during late stages of disease. The presence of other STDs can increase infectiousness.
G. Epidemiology
In 2013, CDC estimates that 1.2 million people are living with HIV infection and 1 in 6 people are unaware they are infected. By the end of 2012, over 1.1 million AIDS cases and over 636,000 deaths among persons with AIDS had been reported to CDC for the United States and its dependent areas. HIV infection (without an AIDS diagnosis) is now reportable by name in all 50 states. CDC estimates that approximately 50,000 persons become infected with HIV in the United States each year, and this has been relatively stable since 1990. Globally, 35.3 million people were living with HIV/AIDS in 2012 and approximately 2.3 million people become newly infected with HIV each year.
Iowa averages approximately 115 HIV diagnoses and 75 AIDS diagnoses per year.
H. Bioterrorism Potential
None.
I. Additional Information
Consent and Education Requirements for HIV testing (Iowa Code 141A.6)
Prior to undergoing an HIV test, information concerning testing and any means of obtaining additional information regarding HIV infection and risk reduction shall be made available to the subject of the test.
Testing of Adults
If an individual signs a general consent form for the performance of medical tests or procedures, the signing of an additional consent form for the specific purpose of consenting to an HIV-related test is not required during the time in which the general consent form is in effect. If an individual has not signed a general consent form for the performance of medical tests and procedures or the consent form is no longer in effect, a health care provider shall obtain oral or written consent prior to performing an HIV-related test. If an individual is unable to provide consent, the individual’s legal guardian may provide consent. If the individual’s legal guardian cannot be located or is unavailable, a health care provider may authorize the test when the test results are necessary for diagnostic purposes to provide appropriate urgent medical care.
Testing of minors
Minors have the legal capacity to act and give consent for diagnosis and treatment of sexually transmitted diseases, including HIV, without the consent of a parent, custodian, or guardian (see Iowa Code 139A.35).
Before undergoing an HIV test, however, a minor must be informed that the legal guardian will be notified by the testing facility if the test is confirmed as positive. Minors must give written consent for HIV testing and treatment services (see Iowa Code 141A.7 (3). The consent form should indicate that the minor understands that his or her legal guardian will be notified if the test is confirmed as positive.
Surveillance Case Definitions
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
References
Bartlett, J.G., and J.E. Gallant. Medical Management of HIV Infection, 2012. Johns Hopkins University, 2001. www.mmhiv.com/
Centers for Disease Control and Prevention. HIV/AIDS website
Centers for Disease Control and Prevention. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings, MMWR 2006; 55(No.RR-14); 1-17.
www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
Heymann, D.L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC, American Public Health Association, 2015.
World Health Organization. HIV/AIDS website. www.who.int/hiv/en/
Additional Resources
HIV/AIDS Program web site, Iowa HHS.