Part 1: HIV in 2008 and HIV Treatment Trends

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A presentation from the 2008 HIV Health and Treatments Update forum held in Sydney on 25 Nov 2008.

Part 1: an overview of HIV in 2008 and treatment trends, presented by Bill Whittaker.

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  • Part 1: HIV in 2008 and HIV Treatment Trends

    1. 1. <ul><ul><li>The following slides and audio are taken from a public HIV health and treatments update forum held in Sydney, Australia on 25 November 2008. The slides and audio have been edited for presentation on the web. </li></ul></ul><ul><ul><li>The speaker is Bill Whittaker, NAPWA Health, Treatments and Research portfolio co-convenor. </li></ul></ul><ul><ul><li>For more presentations from this event, visit the sponsor organisations’ websites: </li></ul></ul>
    2. 2. HIV Treatment and Health Update 25 November 2008 Part 1 HIV in 2008 and HIV Treatment Trends
    3. 3. .2 HIV in 2008 – Facts & Figures A global view of HIV infection 33 million people [ 30–36 million ] living with HIV
    4. 4. Global summary of the HIV epidemic Total 33 million [30 – 36 million] Adults 30.8 million [28.2 – 34.0 million] Women 15.5 million [14.2 – 16.9 million] Children under 15 years 2.0 million [1.9 – 2.3 million] Total 2.7 million [2.2 – 3.2 million] Adults 2.3 million [1.9 – 2.8 million] Children under 15 years 370 000 [330 000 – 410 000] Total 2.0 million [1.8 – 2.3 million] Adults 1.8 million [1.6 – 2.1 million] Children under 15 years 270 000 [250 000 – 290 000] Number of people living with HIV in 2007 People newly infected with HIV in 2007 AIDS deaths in 2007
    5. 5. Over 7400 new HIV infections a day in 2007 <ul><li>More than 96% are in low and middle income countries </li></ul><ul><li>About 1000 are in children under 15 years </li></ul><ul><li>About 6300 are in adults aged 15 years and older </li></ul><ul><li>of whom: </li></ul><ul><ul><li>almost 50% are among women </li></ul></ul><ul><ul><li>about 45% are among young people (15-24) </li></ul></ul><ul><ul><li>Access to high quality treatment & care remains out of reach for most people with HIV in the world </li></ul></ul>
    6. 6. Diagnoses of HIV infection and AIDS 1 in Australia 1 AIDS diagnoses adjusted for reporting delays. Source: State and Territory Health Depts & NCHECR
    7. 7. <ul><li>Around 19,000 Australian’s currently living with HIV infection. </li></ul><ul><li>1000 new HIV infections annually, an increase of around 50% since 1999. </li></ul>HIV in 2008 – Facts & Figures
    8. 8. 12.9% 54% 4.1% 21.4% 5.6% Where we live Estimated % of people living with HIV infection in 2007 by State/Territory 1% 0.7% 0.7% Source: State/Territory Health Depts
    9. 9. <ul><li>Australian AIDS related deaths continue to decline – halved from 141 in 1999 to 67 in 2007. </li></ul><ul><li>Approx 13,000 of 19,000 Australians with HIV taking treatment – around 70%. </li></ul><ul><li>Australian HIV positive population is across a widening spectrum of age. </li></ul>HIV in 2008 – Facts & Figures
    10. 10. Clinical Infectious Diseases 2008 47(4):542–553 Age distribution of HIV positive people in USA Estimated number of people living with HIV HIV in 2008 – Facts & Figures
    11. 11. Source: NCHECR Age distribution MSM with HIV in Australia Estimated number of MSM living with HIV HIV in 2008 – Facts & Figures
    12. 12. Major Shifts – 18 months <ul><li>5 major HIV scientific conferences. </li></ul><ul><li>Important HIV research findings presented + published. </li></ul><ul><li>New life expectancy estimates for people with HIV </li></ul><ul><li>More news about the impact of living long term living with HIV infection. </li></ul><ul><li>Important changes in HIV treatment and care. </li></ul><ul><li>An avalanche of new information which challenges both doctors and treatment activists to keep on top of. </li></ul><ul><li>Much of the news is good, but some is not so good. </li></ul>
    13. 13. Major Shifts – 18 months <ul><li>New debates emerging about HIV and treatment. </li></ul><ul><li>Shift away from using the term AIDS – non classical AIDS is now the biggest problem – “HIV disease, HIV related”. </li></ul><ul><li>Move to earlier HIV antiviral treatment </li></ul><ul><li>New treatment options </li></ul><ul><li>Pill count down on one side, but could be going up on the other. </li></ul><ul><li>Good results for rescue situations. </li></ul><ul><li>Cardiovascular (heart) links to HIV and treatment . </li></ul><ul><li>Health delivery for HIV – long term – choice, gps. </li></ul>
    14. 14. <ul><li>Shift in how the experience of HIV living is being talked about………. </li></ul><ul><li>Changed focus: from surviving AIDS – to making HIV part of “ long term, more normal living ” . </li></ul><ul><li>Simplistic clinical categorizations of HIV positive people as either “ well or sick ”. </li></ul><ul><li>Lived experience is different for everyone. </li></ul><ul><li>Variety of experiences of living with HIV – </li></ul>Major Shifts – 18 months <ul><ul><li>“ Living well’ </li></ul></ul><ul><ul><li>“ Living well – isolated/disconnected” </li></ul></ul><ul><ul><li>“ Living long, but not well” </li></ul></ul><ul><ul><li>“ Doing it tough – in trouble” </li></ul></ul>
    15. 15. HIV & AIDS 1981 to 1996
    16. 16. HIV & AIDS 1981 to 1996 “ Before 1996, doctors who saw patients with HIV had to give bad news almost daily. We tried to restore hope by telling patients the cold hard facts that only 50% would progress to AIDS or death within 10 years. But at the same time we were often acknowledging to ourselves that the tell-tale clinical features of immune deficiency had already appeared and the inevitable demise would surely be sooner rather than later.” Dr David Cooper 2008
    17. 17. <ul><li>Early years of HIV Treatment (88-95) gave most people only 1 or 2 years of extra life. </li></ul><ul><li>More potent drugs and protease inhibitors arrived in 1995 </li></ul><ul><li>Dramatic increase in life expectancy since 1996. </li></ul><ul><li>Why??? </li></ul><ul><ul><ul><ul><li>Overwhelmingly it’s HIV treatment impact + treatment improvement. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Better adherence and less treatment breaks. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Scientific and clinical advances (viral load and resistance tests). </li></ul></ul></ul></ul>Life Expectancy
    18. 18. <ul><li>The Antiretroviral Therapy Cohort Collaboration. </li></ul><ul><li>Large multi-national study of life expectancy in 43,355 HIV+ taking HIV treatment between 1996 and 2005. </li></ul><ul><li>Key findings: </li></ul>Life Expectancy <ul><ul><li>marked decrease in deaths and potential years of life lost from HIV. </li></ul></ul><ul><ul><li>corresponding increases in life expectancy. </li></ul></ul><ul><ul><li>bottom line - a 20-year-old starting HIV treatment can expect to live for another 43 years on average, whereas a 35-year-old can expect 32 more years of life. </li></ul></ul><ul><ul><li>“ These figures are startling and will surely help doctors raise the hopes and expectations of patients during discussion of life choices and goals.” </li></ul></ul>
    19. 19. <ul><li>Among HIV positive people starting treatment, life expectancy varies a lot between different groups – </li></ul><ul><ul><li>Starting HIV Treatment at a low CD4 T cell count is estimated to shave an extra 10 to 20 years off life expectancy. </li></ul></ul><ul><ul><li>Life expectancy influenced by other factors, particularly age, lifestyle, family history. </li></ul></ul><ul><li>A large gap still remains in life expectancy between the general population, and the HIV positive population. </li></ul><ul><li>Even in the best scenarios with the most recent experience with HIV Treatment, about 10 years is shaved off a normal lifespan. </li></ul><ul><li>But this absolutely remarkable turnaround in life expectancy is to be celebrated – the task now is to extend the quantity and quality of life further. </li></ul>Life Expectancy There’s always a qualification……
    20. 21. <ul><li>HIV treatment has greatly increased life expectancy for many. </li></ul><ul><li>So HIV+ people are now aging while receiving HIV treatment. </li></ul><ul><li>Are at risk of developing chronic diseases associated with advancing age (hypertension, heart problems, diabetes, bone disease, etc) that rest of population experiences. </li></ul><ul><li>Issues of mental health and cognitive function (brain). </li></ul><ul><li>Suggestions that HIV infection “compresses” the aging process, perhaps accelerating other health problems. </li></ul>Impact of long-term living with HIV
    21. 22. <ul><li>“HIV and ageing” – a hot research topic. </li></ul><ul><li>Why? - long-term HIV living is a recent phenomenon – not a lot is known. </li></ul><ul><li>We’re not just talking about reaching old age – we’re talking about the impact of living with HIV over time . </li></ul><ul><li>So the impact of HIV and ageing applies if you're 20, 40 or 60 now. </li></ul>Impact of long-term living with HIV
    22. 23. <ul><li>Death is increasingly due to serious non-AIDS illnesses, such as cardiovascular disease, cancers, end-stage liver, and kidney disease. </li></ul><ul><li>Uncontrolled HIV could cause a good proportion of these problems – in addition to traditional risk factors (lifestyle, family history)? </li></ul><ul><li>Studies are finding that HIV viral load and CD4 count levels are associated with risk of developing cancers and other illnesses. </li></ul>Impact of long-term living with HIV
    23. 24. <ul><li>So keeping a high CD4 count and undetectable viral load may be important to help prevent other illnesses such as cancers. </li></ul><ul><li>So earlier HIV treatment? (more shortly) </li></ul><ul><li>Growing research focus on understanding the link between HIV and other illnesses – strategies to manage them (bone disease) </li></ul>Impact of long-term living with HIV
    24. 25. <ul><ul><li>For more presentations from this event, visit </li></ul></ul><ul><ul><li>www. napwa .org.au </li></ul></ul><ul><ul><li>or </li></ul></ul><ul><ul><li>www.acon.org.au </li></ul></ul>

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