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Clinical laboratory personnel performs routine tests to diagnose, treat, and prevent various diseases. Duties included collecting and analyzing blood samples, tissue samples, and bodily fluids. Because of this, laboratory personnel are at increased risk of exposure to Human Immunodeficiency Virus (HIV) and other bloodborne pathogens. Intended for people working in clinical laboratories, this activity addresses the Florida requirement for continuing education in HIV. This activity improves clinical laboratory personnel’s knowledge of HIV etiology, transmission, prevention, and treatment. It also describes the Florida laws related to HIV testing, reporting, and confidentiality. The activity highlights the role of interprofessional teams in reducing the risk of occupational exposure to HIV. Objectives: Describe the human immunodeficiency virus (HIV) structure. Outline HIV modes of transmission in the healthcare setting. Identify practices that prevent HIV exposure. Explain the impact of HIV testing on current Florida laws. Access free multiple choice questions on this topic.

HIV is transmitted through exposure to infected blood, semen, vaginal fluid, or breast milk.[1] The virus targets cells with CD4+ receptors, including T-cells.[2] These cells comprise parts of the immune system that allow the body to fend off infections.[3] Infection with HIV triggers T-cell destruction, decreasing cell-mediated immunity, which can lead to various opportunistic infections and cancer.[2] From days to weeks after exposure to the virus, early symptoms of HIV infection may include fever, sore throat, enlarged lymph nodes, weight loss, myalgia, or rash. Then, an infected person can become asymptomatic while the virus continues to replicate, and the number of CD4+ T-cells progressively decreases. Once the CD4+ count drops below a certain level, there is a significant increase in risk for infections that can become life-threatening, defining the Acquired Immunodeficiency Syndrome (AIDS) stage of HIV infection. Without treatment, the time from the start of infection to AIDS-related death is estimated to be about 11 years.[4] However, when started early, Antiretroviral treatment (ART) has enabled people with HIV to live with chronic infection as long as those without the disease.[2] Retrovirus HIV belongs to the retrovirus family with complex genomes and capsid core particles.[5] Retroviruses are positive-sense RNA viruses that can reverse transcribe their genome, inserting it into the host cell.[6] Through reverse transcription, single-stranded viral RNA is transformed into double-stranded DNA, which can incorporate itself into the host cell’s DNA and replicate.[4] Basic Structure HIV consists of two primary components: the capsid and the genome. The conical capsid encloses the viral RNA genome, giving it shape and protection. The genome carries genetic information.[7] Capsid The capsid protects the genome, transfers the viral genome between cells, and interacts with host factors to further viral replication.[7] The shape of the capsid is elastic; it starts as an immature sphere and transitions into a mature cone.[6] Envelope For the virus to enter a cell, its envelope must fuse with the host cell’s membrane. The viral envelope consists of glycoproteins gp120 and gp41, forming spikes that allow for attachment. These glycoproteins recognize the host cell’s surface receptors CD4+, CCR5, and CXCR4.[4] Proteins Involved in Adsorption

The capsid protects the genome, transfers the viral genome between cells, and interacts with host factors to further viral replication.[7] The shape of the capsid is elastic; it starts as an immature sphere and transitions into a mature cone.[6] Envelope For the virus to enter a cell, its envelope must fuse with the host cell’s membrane. The viral envelope consists of glycoproteins gp120 and gp41, forming spikes that allow for attachment. These glycoproteins recognize the host cell’s surface receptors CD4+, CCR5, and CXCR4.[4] Proteins Involved in Adsorption Adsorption occurs when HIV binds and enters a cell through fusion. The spikes on the HIV envelope consist of gp120 and gp41. Gp120 binds CD4 receptors and either CCR5 or CXCR4 on the host cell, allowing HIV entry into the cell. Gp41 promotes the fusion of HIV and the host cell membrane. CXCR4 presents on T-cells and many other cells, and CCR5 presents mainly on macrophages.[4] The Function of HIV Genes Every retrovirus encodes three essential structural genes: gag, pol, and env. The gag gene determines the structural core proteins, creating the capsid; pol encodes for enzymes necessary for viral replication, including reverse transcriptase; and env encodes the glycoproteins of the viral envelope. The HIV-1 genome also encodes six other regulatory genes that modulate replication: tat, rev, vif, vpx, vpr, nef.[4][6] Mutations Because HIV consists of two RNA molecules, genetic mutations are likely, as point mutations can occur on either molecule. The high frequency of mutations allows the virus to escape from the body’s immune system.[4][5] There are two genetically different strains of HIV: HIV-1 and HIV-2. HIV-1 makes up most infections worldwide, and HIV-2 is primarily restricted to Western Africa. HIV-1 has been divided into groups M, N, O, and P. The M group dominates the HIV pandemic. Thus, this group has been further divided into nine subtypes A-D, F-H, J, and K. Subtype B predominates in North America.[8]

Healthcare workers should work together to recognize workplace hazards, including exposure to HIV. Together, they can develop protocols to mitigate these threats and create programs to promote health and safety in the laboratory. Though training and understanding HIV prevention is critical to avoid transmission, accidents and exposure to bloodborne pathogens will occur. Knowledge of exposure, treatment, and postexposure prophylaxis is of vital importance. By using safety-engineered medical devices, the number of needlestick injuries has decreased.[29] [Level 1] Nurses, technicians, and phlebotomists collect and screen tissues and blood samples. Laboratory personnel ensures safe testing and handling of these products. Physicians, pharmacists, and advanced care providers work in the coordination of care and information. Communication throughout the levels of the healthcare team is critical for patient care and healthcare workers’ safety. Coordinating care amongst all interprofessional team members can improve health and safety measures.