CLAUDINE HENNESSEY & THEUNIS HURTER
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1 HIV/AIDS/TB CLAUDINE HENNESSEY & THEUNIS HURTER
2 KEY TERMS Do these sound familiar? What strange terms do you hear in the clinics? Any others to add?? HIV AIDS Viral Load & suppression CD4 count Regimen Adherence Monitoring Resistance HAART Enrolment Criteria
3 History of HIV 3 Originated in non-human primates in Sub-Saharan Africa Transferred to humans during the late 19th or early 20th century Chimpanzee Hunter theory: virus transmitted from a chimpanzee to a human when a bush meat hunter was bitten or cut while hunting or butchering an animal
4 First cases : British printer (possible AIDS death) 4 Sailor in the navy oldest documented possible case Symptoms included: shortness of breath, extreme fatigue, rapid weight loss, night sweats and high fever 1959: Congolese man One of earliest documented HIV-1 infections discovered in a preserved blood sample 1960: Congolese woman discovered in a preserved lymph node biopsy 1969: Robert R. Suspected to be a prostitute Died from aggressive Kaposi s sarcoma Later tests on stored blood showed HIV infection 1969: Arvid Noe Sailor, wife and 9 year old daughter died of AIDS
5 Can one person start an pandemic? Gaëtan Dugas, 5 so-called "Patient Zero flight attendant who had over 2,500 sexual partners across North America At least 40 of the 248 people diagnosed with AIDS by April 1982 were thought to have had sex either with him or with someone who had. Dugas refused to stop having unprotected sex after being diagnosed, and informed some of his sex partners that he had the "gay cancer" and perhaps they would get it too. TRUE or FALSE?
6 Difference between HIV & AIDS HIV the patient is infected with the Human Immunodeficiency Virus and can be unaware of being infected for a period of 4-8 or more years. The virus that causes AIDS 6 AIDS Acquired Immune Deficiency Syndrome: according the SA guidelines it is when the CD4 cell count drops below 200 and/or the patient has severe opportunistic diseases
7 What is HIV? 7 2 Types: HIV-1 (worldwide): Most common and pathogenic has 3 sub-groups, each of them with many sub-types, but clinically identical. HIV-2 (Localised in West-Africa): has lower pathogenicity and lower MTCT risk.
8 What Is Viral Load? The HIV viral load is simply a measure of the quantity of virus in a drop (ml) of a patient s blood In general, the higher the viral load, the faster CD4 cells are destroyed Over time, viral load increases as more and more viruses are produced
9 What is CD4? Cell in body that fights off infection - police Virus enters your body - criminal CD4 attacks that virus police arrest the criminal Virus dies criminal goes to jail HIV enters your body- criminal Enters CD4 cells criminal fights the police in the police station 9 Other viruses enter the body (TB, Pneumonia) other criminals end up running wild Police (CD4) are busy fighting the criminals (HIV) TB, PNEUMONIA (OTHER CRIMINALS) OVER TAKE THE BODY... Goal of HIV/ARV care: to increase the number of CD4 cells in the body
10 CD4 cells have specialized receptors on their surface. LOCK Once HIV gets into bloodstream, it is able to locate CD4 cells and attaches to CD4 receptors. KEY What is a CD4??? HIV and the immune System HIV has protein spikes around its periphery that fit perfectly into CD4 receptors. Right key CD4
11 Plasma HIV RNA Natural history of HIV infection 10,000,000 1,000, ,000 10,000 1, Primary Infectio n Seroconversio n ARS Viral Load Intermediate Stage CD4 Cells Danger Zone AIDS 1, Weeks 5-10 Years to AIDS Survival with Natural History of HIV Infection AIDS 1 year 11 CD4 Cell Count
12 The HIV Life Cycle
13 Video..\..\..\..\Cider Documents\CIDER\TIER.net training documents\hiv training videos\hiv Replication 3D Medical Animation - YouTube.flv 13
14 Why are multiple drugs needed? RT inhibitors (NRTI/NNRTI) Tenofovir TDF Zidovudine AZT Lamivudine 3TC Didanosine ddi Stavudine d4t Abacavir ABC Nevirapine NVP Efavirenz EFV Emtricitabine FTC PI s Ritonavir RTV Saquinavir SQV Lopinavir/r LPV/r
15 Goals of HAART 15 Decrease viral load Less virus = lower risk of opportunistic infections Question: What would be considered virological success? Decrease in viral load to lower than detectable limit (LDL) Allow the immune system to (partially) recover Question: What would be considered immunological success? Increase in CD4
16 Goals of HAART 16 increase quality of life Work or school/university possible increase survival and duration of infection-free life Life expectancy identical to a HIV- person
17 Goals of HAART 17 limit transmission theoretically no more virus in body fluids BUT, practically, not always true! Less persons with high viral load = less chance of new infections
18 Efficiency of HAART Before HAART: 85% of patients would be dead 3 years after AIDS diagnosis. Now: 85% of patients are still alive 3 years after AIDS diagnosis (if starting HAART at AIDS diagnosis, even more if they started before AIDS diagnosis)
19 Aim of ART 5. Increase in quality of life 1. Suppressed viral replication (VL) 4. Fewer opportunistic infections. Healthy person living with AIDS 2. Immune system recovery 3. Increase in CD4 count
20 Treating HIV 20 Prevention / treatment of opportunistic infections and cancers Specific antiviral treatment Support (psychological, social, etc ) Not just giving ARV s Adherence counseling Prevention of HIV transmission Immune boosters? Prevention and treatment of nutritional deficiencies (vitamins A, B, Fe, )
21 HAART 21 Highly Active Antiretroviral Treatment Combination (3 or more ARVs) HAART is a lifelong treatment Adherence is most important
22 ART enrolment Criteria South Africa
23 Does ART work? Photographs by: David Walton Copyright 2003 Partners In Health Before HAART After 1 year on HAART
24 What is adherence? 24
25 Adherence 25 Means the ability to 1. Take the right dose of medication 2. At the right time 3. At the right frequency 4. For the duration of treatment 5. Monitoring any adverse events, drug and/or dietary restrictions
26 Is Adherence Important? Prevents resistance to drugs developing 2 nd line therapy more complicated & more expensive Limited options in case of treatment failure After 1 st line, 2 nd line then what? 26
27 Timing is everything. Keeping drug levels in the safety zone International AIDS Society.Top HIV Med. 2003;11:
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