HIV Transmission Impact of AIDS on life expectancy in five African countries,

Transcription

1 Reginal HIV and AIDS statistics and features, 26 AIDS at 25 Epidemilgy and Clinical Management Sub-Saharan Africa Middle East & Nrth Africa Suth and Suth-East Asia East Asia Latin America Caribbean Eastern Eurpe & Central Asia Western & Central Eurpe Nrth America Oceania TOTAL Adults & children living with HIV 24.7 millin [ millin] 46 [27 76 ] 7.8 millin [ millin] 75 [ millin] 1.7 millin [ millin] 25 [19 32 ] 1.7 millin [ millin] 74 [58 97 ] 1.4 millin [ millin] 81 [5 17 ] 39.5 millin [ millin] Adults & children newly infected with HIV 2.8 millin [ millin] 68 [41 22 ] 86 [ millin] 1 [56 3 ] 14 [1 41 ] 27 [2 41 ] 27 [17 82 ] 22 [18 33 ] 43 [34 65 ] 71 [ ] 4.3 millin [ millin] Adult (15 49) prevalence [%] 5.9% [5.2% 6.7%].2% [.1%.3%].6% [.4% 1.%].1% [<.2%].5% [.4% 1.2%] [.9% 1.7%].9% [.6% 1.4%].3% [.2%.4%].8% [.6% 1.1%].4% [.2%.9%] 1.% [.9% - 1.2%] Adult & child deaths due t AIDS 2.1 millin [ millin] 36 [2 6 ] 59 [39 85 ] 43 [26 64 ] 65 [51 84 ] 19 [14 25 ] 84 [58 12 ] 12 [ <15 ] 18 [11 26 ] 4 [23 66] 2.9 millin [ millin] 12/6 e AIDS Epidemic Update December 26 Table 1b Increase in reprted HIV cases in the Russian Federatin and Ukraine, Reprted HIV cases in the Russian Federatin Russian Federatin Newly reprted cases Cumulative (previus years) Reprted HIV cases in Ukraine Ukraine Newly reprted cases Cumulative (previus years) Surces: Russian Federal AIDS Centre; Ukranian AIDS Centre and Ministry f Health f Ukraine 26 Reprt n the glbal AIDS epidemic Fig 2.12 Bld transfusin injectin drug use Sexual Intercurse hetersexual male t male Perinatal intrapartum breast feeding HIV Transmissin Impact f AIDS n life expectancy in five African cuntries, Life 5 expectancy 45 at birth (years) Btswana Suth Africa Swaziland Zambia Zimbabwe Surce: United Natins Ppulatin Divisin (24). Wrld Ppulatin Prspects: The 24 Revisin, database. 26 Reprt n the glbal AIDS epidemic Fig 4.1

2 TB ntificatin rate in 2 African cuntries* versus HIV prevalence in sub-saharan Africa, TB ntificatin 12 rate per 1,1 ppulatin % Adult HIV prevalence (15-49) TB ntificatin rate HIV prevalence Cnsistently reprting each year: Algeria, Angla, Btswana, Camern, Cmrs, Cng, Côte d'ivire, Demcratic Republic f Cng, Ghana, Guinea, Kenya, Malawi, Mauritius, Mzambique, Nigeria, Senegal, Suth Africa, Uganda, United Republic f Tanzania, Zimbabwe Surces: Wrld Health Organizatin (26), Glbal TB database; UNAIDS (26) 26 Reprt n the glbal AIDS epidemic Fig 4.5 Peple in sub-saharan Africa n antiretrviral treatment as percentage f thse in need, Surce: WHO/UNAIDS (25). Prgress n glbal access t HIV antiretrviral therapy: An update n 3 by Reprt n the glbal AIDS epidemic Fig 7.2

3 HIV Prevalence and Mrtality in NYC Prbability f AIDS ver 3 years Prbability f AIDS within 3 years 1% 8% 6% 4% 2% 32.6% 32.6% 42.9% 9.5% 64.4% 85.5% 16.1% 16.1% 4.1% 4.1% 8.1% 8.1% 8.1% 2.% 2.% 3.7% 3.2% 2.% %.% > 11K 41-11K 14-41K 3-14K < 3K HIV-1 RNA cncentratin (cpies/ml) < > 75 CD4 cunt Plasma HIV-1 RNA Level After Acute HIV-1 Infectin Predicts Disease Curse HIV-1 RNA in Plasma (cpies/ml) Detectin threshld Patients with AIDS 5 years after infectin 62% 49% 26% Years After Infectin Reprinted with permissin frm H. Science. 1996;272: % Frequency f HIV Nn-Prgressrs San Francisc City Clinic Chrt 489 HIV+ Gay men with knwn sercnversin date. 13% develped AIDS by 5 years; 51% develped AIDS by 1 years. 89% had died, develped AIDS r had CD4<5 by 1 years. [Rutherfrd et al. BMJ. 199; 31: ]

4 Explaining the variability f HIV disease Viral Factrs Nef deletin Nn-clade B subtypes? Hst Factrs Chemkine c-receptrs Immune respnse Gender? Envirnmental Factrs Infectin, diet?, stress? AIDS Restrictin Genes S. O Brien, G. Nelsn. Nature Genetics 24;36:565 HIV C-receptrs Early indicatrs f HIV Infectin CD4 necessary but nt sufficient fr infectin. Beta chemkine receptrs act as HIV c-receptrs. CXCR4 (lymphcyte) CCR5 (macrphage) Hmzygus CCR5 deletin fund in <1%. MACS High risk chrt: N HIV+ amng thse hmzygus fr deletin. 3.6% f HIV Negative were hmzygus. Amng persistently HIV Neg: : up t 33% were hmzygus. Effect f C-receptr Heterzygsity Key features f OIs in AIDS HIV causes prfund defect mstly restricted t T cell- based immunity (restricted range f pathgens) OIs usually reflect reactivatin f latent infectins. Reinfectin may ccur (eg( eg: : tuberculsis) Chrnic suppressin needed after acute treatment. Immune recnstitutin with anti-retrviral therapy may reverse OI susceptibility (but may als trigger an inflammatry respnse t active OIs)

5 Pneumcystis pneumnia in AIDS Cmmnest life threatening cmplicatin f AIDS in U.S. Subacute illness (fever, cugh, dyspnea). Diffuse interstitial infiltrate n x-ray. x Additin f crticsterids t antimicrbials cuts mrtality in severe disease 5%. Fully preventable with trimethprim-sulfa. Cryptcccal disease in AIDS Ubiquitus sil fungus. Initial assymptmatic pneumnia. Reactivatin in advanced HIV disease (CD4<1). Meningitis cmmnest presentatin but wide disseminatin frequent. CD4 cunt predicts risk f PCP CMV disease in AIDS Cmmn viral infectin (5% adult serprevalence). Reactivatin at CD4<5 Retinitis cmmnest. Other sites: Cln, CNS. CNS txplasmsis Prtzn parasite; cats shed cysts; ; farm animals incidental hsts; humans infected frm cysts, uncked meat. Cmmnest cause f fcal CNS disease in AIDS. Serum IgG antibdy reliable marker f past infectin. Reactivatin in AIDS assciated with CD4<1. Disseminated Mycbacterium-avium avium cmplex (MAC) disease in AIDS Cmmn in envirnment (water). Lcal lung disease knwn prir t AIDS. Widespread visceral disseminatin in AIDS. Diagnsis by bld culture. Absence f inflammatin in tissue sites.

6 Prphylaxis f Opprtunistic Infectins Pathgen Indicatin Regimen PCP CD4<2 Trimethprim-sulfa MAC IRIS simulating TB r Lung cancer Tx MAC TB CD4<1 and IgG+ CD4<5 +PPD (5mm) Trimethprim-sulfa r Dapsne +Pyrimethamine Clarithr/Azithrmycin INH (9 mnths) OI Guidelines Nvember, 21 Cmparisn f Indicatins t Discntinue Primary and Secndary Prphylaxis CNS crypt IRIS Agent PCP Tx. MAC Recmmendatin 1 CD 4 > 2 X 3 mnths 2 CD 4 > 2 X 3 mnths 1 CD 4 > 2 X 3 mnths 2 CD 4 > 2 X 6 mnths + initial Rx + asymptmatic 1 CD 4 > 1 X 3 mnths 2 CD 4 > 1 X 6 mnths + 12 m Rx + asymptmatic 12/28 3/13 Immune Recnstitutin with HIV Therapy Fcal MAC adenitis Inflammatry flare f CMV retinitis Wrsening f previusly stable hepatitis Develpment f cavitary TB