What should we Know about AIDS

Abstract

Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS) have been around in America since the 1970s. Since then, the effect of this disease on funeral service has been a part of many precautions that have been put into place. HIV and AIDS is a highly infectious disease that can be transmitted via bodily fluids and blood. While the main way this disease is spread is through sexual contact and sharing of needles, as an embalmer we come into contact with the body fluids, so we are therefore at a higher risk of infection. There are ways for people to get tested and treated for this disease but there is no cure. While there is treatment this does not mean the person can no longer pass on the infection, so as the embalmer this is an example of why we have universal precautions and special additional methods to ensure our safety and the preservation of the descendant infected with this disease. 

HIV/AIDS and its Effects on Funeral Service

HIV/AIDS arose in the United States around the 1970s. In this paper the origin, symptoms, treatment, diagnoses will be discussed. Most importantly the implications this disease has on the embalmer will be discussed. Since HIV/AIDS is an infectious disease spread by contact of bodily fluids this causes concern for professionals in our field. It's important to be knowledgeable about different diseases so that you as the embalmer can take the precautions needed. While this paper gives lots of useful information, it's important to always remember the number one rule of always practicing universal precautions from first removal until disposition and even in the preparatory room afterwards.

Scientific Name of the Disease

HIV stands for Human immunodeficiency virus and has two types, HIV-1 and HIV-2.  The pathogen HIV causes the disease AIDS. AIDS stands for Acquired immunodeficiency syndrome. This type of immunological disease is caused by a retrovirus. A virus comes in many different types but the main similarity is that they infect a host cell inside the body and use it to continuously reproduce more infected cells. A retrovirus is a special type of virus because unlike most viruses it does not contain DNA wrapped in a protein but instead RNA. The cells that this virus targets are the T cells in the immune system; the virus mutates the T cells and then continues to reproduce this mutated cell. This slight difference with the retrovirus is that it allows the virus to reproduce these mutated cells quickly and they become more resistant to treatments (Mullins, 2006).

Origin of HIV/AIDS

The CDC website has an article about the origin of the virus. It's thought that HIV started in African from a Chimpanzee, this Chimpanzee was infected with a different type of the virus called, simian immunodeficiency virus. Through a mutation it's believed that the virus became communicable to humans. Once our human population in Africa became infected it wasn't long before we started to see it in other parts of the world. The virus is believed to have appeared in Africa in the 1800s and was first diagnosed in America about the 1970s (HIV/AIDS, n.d.).

Symptoms of HIV/AIDS

Due to the progression of HIV to AIDS and the many other opportunistic pathogens associated with this virus there can be many different symptoms that may appear in people diagnosed with HIV or AIDS. There are three stages of the disease as it progresses from HIV to AIDS. Stage 1, acute HIV infection, symptoms typically appear 2 to 4 weeks after the initial infection of the virus. As the body naturally reacts to the virus infection, flu like symptoms may appear. These symptoms do not always appear in every case. This can be dangerous because during this first stage of the disease the infected person is very contagious, so if you are a person that does show these symptoms you may not know that anything is wrong for a while. In addition to the symptoms not appearing, tests may show up with a false negative, even though you can still have and spread the virus. Stage 2 is called the clinical latency (inactivity/dormancy) stage. Again this stage does not always present symptoms, especially if the person is actively being treated. Even though the virus is dormant the person may still be able to spread the virus to others. If a person is actively being treated they may stay in this stage for many years. The treatment keeps the HIV in the blood low so that the immune system is not as badly affected. It's once the HIV has progressed to a point where the immune system is very low that it can no longer fight off infections that the disease progresses to AIDS. The symptoms specifically associated with AIDS include: chills, fever, sweats, swollen lymph glands, weakness and weight loss. This is in addition to the low T Cell count (HIV/AIDS, n.d.). It's at this point where people start to acquire the opportunistic pathogens because the body's immune system cannot control fighting them off any more. This means that the symptoms associated become much worse as well as a result of the other diseases the person may now have.

Treatments for HIV/AIDS

While there is no cure for the disease there is fairly successful treatment available. The treatment used and recommended today by the CDC is antiretroviral therapy (ART). ART is a combination of drugs taken by HIV patients. What this drug does is it lowers the amount of the HIV virus in the blood. Lowering the amount of the virus allows people to live longer lives even with the disease (HIV/AIDS, n.d.). The main side effects of the ART medication shouldn't cause serve differences in the body in regards to post mortem effect.

Post Mortem Effects of HIV/AIDS

        The post mortem effect of this disease really varies from case to case. With proper treatment patients affected are able to live for a long time with minimal problems. In this case, the living and post mortem effects may be unnoticeable. Other patients may have progressed further in the disease making them more susceptible to opportunistic pathogens due to their low immune system.  Mentioned later is all of the other diseases are associated with HIV/AIDS.

Diagnoses and Testing for HIV/AIDS

To find out if you are infected with HIV finding a testing center or purchasing an at home testing kit from your pharmacy is the first place to start. Since symptoms are not always present when first contracted, it's important if you are sexually active or in a medical health professions to get regularly tested at your local doctors office. There are three different types of tests available they are: nucleic acid test (NAT), antigen/antibody tests, and antibody tests. The NAT test looks for the virus in the blood and the antigen/antibody tests look for HIV antigens and antibodies that the body would be naturally producing if infected with HIV (HIV/AIDS, n.d.). Tests either use blood or saliva and there are tests that can be done at a medical facility or at home. It is always recommended and in your best interest to follow up with your medical doctor.

Transmission of HIV/AIDS

HIV is considered to be an STI, a sexually transmitted disease, meaning it can be spread through sexual contact. The virus can enter at the vaginal opening, penis, rectum or orally. Sexual contact is not the only way that the virus can spread, any contact with infected blood; this can be through physical contact of wounds, blood transfusions and most commonly in drug users. HIV can also be spread from mother to child during birth or from breast milk, but this is less common (Mullins, 2006). Drug use is one of the most common ways that the virus is spread; this is from using contaminated needles that are shared. This is important for embalmers to note because in the event of a needle-stick injury the virus can be spread very easily.

Opportunistic Pathogens associated with HIV/AIDS

Patients that are diagnosed with AIDS are susceptible to opportunistic infections due to the diseases effect on the immune system. Having a suppressed immune system makes the body more susceptible to infections. Similar to how the elderly are often at a greater risk. Most often the parts of the body that get infectious are the central nervous system, the mouth, lungs, kidney, large intestine, small intestine and the skin. The central nervous system can contact disease such as Meningitis, Encephalitis, and AIDS dementia. Diseases seen in the mouth are Herpes labiallis and Thrush. Disease seen in the lung is pneumonia. In the Kidneys, AID nephropathy. In the large intestine is Colitis and Procitis. The small intestine mal-absorption is often seen. Dermatitis, Folliculitis and Impetigo are infections on the skin. Lymphoma and Kaposi's sarcoma are also diseases seen (Mullins, 2006). Many of these disease can be life threating when the are a secondary infection of HIV/AIDS, because the immune system is suppressed these infections are more difficult for the body to fight off.  The normal T cell count can be around 10 when the normal count is typically around 1,000 T Cells (Muller, 2006).

Precautions for the Embalmer

As discussed in the textbook, Embalming History, Theory and Practice, every embalming should follow the Blood-borne Pathogen Rule. This rule has three parts, universal precautions, engineering controls and work practice controls (Mayer, 2012). Universal precautions mean that you treat every single case in the preparatory room as if it is an infectious disease case. While embalmer by law are supposed to be notified of an infectious case, that does not always mean they are aware. Proper personal protective equipment such as gloves, ventilation mask, face shield, arm covers, smock, shoe covers and a hair net and important for the embalmer to have. Protecting your skin from direct contact is very important. Disinfecting, sterilizing your tools and workspace prevents any body fluids from contaminating the work area. Disposing of sharps in the correct container (handling them with care) and other materials in the biohazard container will help with stick injuries and contamination. Don't forget about during the removal too, wear your personal protective equipment and dispose of it correctly.  The threat to embalmers is not AIDS itself, although the infection can be spread through need-stick injuries. The threat to embalmers is the potential of spreading and contracting opportunistic infections (Mullins, 2006).

In a conversation with two embalmers, Mr. Gilbert and Mr. Omatis I asked if either of them had ever embalmed an infectious disease case and what advice they would have. Mr. Gilbert and Mr. Omatis both expressed to be how important universal precautions were and how as long as they are followed that rule not much in the methods used is very different. Mr. Gilbert mentioned that he is sure to wear extra protection if he knows it's in infectious case, particularly a face mask and a face shield, he said that sometimes he will even double glove (Gilbert, 2018). Mr. Omatis had a similar response but also told me how he has almost encountered two needle stick injuries while embalming an AIDS case. Mr. Omatis told me, You'll never feel your heart drop to your stomach so fast when you almost poke yourself with the needle or the trocar, especially if it's an autopsy case. Mr. Omatis expressed the importance of taking your time and doing procedures the correct way to avoid any skin puncturing injuries. It's very important before the embalmer starts the embalming process to complete a pre-embalming analysis. The embalming analysis will be notes taken about the conditions of the body before the embalming preparations are started. Because there are so many infections and diseases that appear with AIDS, the conditions of a decedent with AIDS may have vary widely.

By properly completing the pre-embalming analysis the embalmer can make note of what special precautions must take place and what extra steps might be needed. There are certain methods of drainage that the embalmer may consider to use to minimize exposure to the blood and to minimize the airborne pathogens. The two methods that may be considered are using a drain tube or direct heart drainage. The center of drainage come from the right atrium of the heart, the method of direct heart drainage is taking the drainage during embalming directly from the right atrium. The method of direct heart drainage is a good technique for infectious cases because it will minimize the exposure of the blood to the air, therefore creating a safer environment for the embalmer. This method is done by inserting a trocar into the right atrium, where the aspirator can be turned on slightly to start the movement of blood out of the body, then can be turned off. The blood will exit the heart through the trocar, through the tube attached to the trocar and into a bottle or the drain. Using a drain tube is a similar technique because it will keep the drainage of blood contained in a tube, and into the drain to minimize exposure.  There are a variety of drain tubes that can be used for different areas of the body (Mayer, 2012).

Special Methods used in Embalming

In the text book, Embalming History, Theory, and Practice, embalming treatments that are recommended for a contagious disease case it says use solutions a little stronger than normal (2-3%); run plenty of volume; avoid personal contact with first drainage'; run volume and increased strengths depending on other body conditions (Mayer 2012).  A higher index and higher solution will make sure to fixate the proteins to help stop microbial growth. The reason to avoid contact with the first drainage is because that will be the most infectious of the blood; other drainage would have come into contact with the arterial fluids.

        HIV and AIDS is an important disease to be knowledgeable about in funeral service. From its origin, the transmission and the embalming implications there is a lot to be aware of. Because this disease is an infectious disease spread by body fluids and blood, the funeral director and embalmer should know how to treat the body for both personal protection and so that the body is preserved in the best way possible to prevent other infection and to help the family view their loved one before final disposition.  The most important aspect to remember is to always follow universal precautions and take your time to analysis and preform the correct procedures.

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