Part 1: HIV in 2008 and HIV Treatment Trends

  • 4,138 views
Uploaded on

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

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.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
  • HIV
    Are you sure you want to
    Your message goes here
No Downloads

Views

Total Views
4,138
On Slideshare
0
From Embeds
0
Number of Embeds
3

Actions

Shares
Downloads
142
Comments
1
Likes
2

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1.
      • 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.
      • The speaker is Bill Whittaker, NAPWA Health, Treatments and Research portfolio co-convenor.
      • For more presentations from this event, visit the sponsor organisations’ websites:
  • 2. HIV Treatment and Health Update 25 November 2008 Part 1 HIV in 2008 and HIV Treatment Trends
  • 3. .2 HIV in 2008 – Facts & Figures A global view of HIV infection 33 million people [ 30–36 million ] living with HIV
  • 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. Over 7400 new HIV infections a day in 2007
    • More than 96% are in low and middle income countries
    • About 1000 are in children under 15 years
    • About 6300 are in adults aged 15 years and older
    • of whom:
      • almost 50% are among women
      • about 45% are among young people (15-24)
      • Access to high quality treatment & care remains out of reach for most people with HIV in the world
  • 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.
    • Around 19,000 Australian’s currently living with HIV infection.
    • 1000 new HIV infections annually, an increase of around 50% since 1999.
    HIV in 2008 – Facts & Figures
  • 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.
    • Australian AIDS related deaths continue to decline – halved from 141 in 1999 to 67 in 2007.
    • Approx 13,000 of 19,000 Australians with HIV taking treatment – around 70%.
    • Australian HIV positive population is across a widening spectrum of age.
    HIV in 2008 – Facts & Figures
  • 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. Source: NCHECR Age distribution MSM with HIV in Australia Estimated number of MSM living with HIV HIV in 2008 – Facts & Figures
  • 12. Major Shifts – 18 months
    • 5 major HIV scientific conferences.
    • Important HIV research findings presented + published.
    • New life expectancy estimates for people with HIV
    • More news about the impact of living long term living with HIV infection.
    • Important changes in HIV treatment and care.
    • An avalanche of new information which challenges both doctors and treatment activists to keep on top of.
    • Much of the news is good, but some is not so good.
  • 13. Major Shifts – 18 months
    • New debates emerging about HIV and treatment.
    • Shift away from using the term AIDS – non classical AIDS is now the biggest problem – “HIV disease, HIV related”.
    • Move to earlier HIV antiviral treatment
    • New treatment options
    • Pill count down on one side, but could be going up on the other.
    • Good results for rescue situations.
    • Cardiovascular (heart) links to HIV and treatment .
    • Health delivery for HIV – long term – choice, gps.
  • 14.
    • Shift in how the experience of HIV living is being talked about……….
    • Changed focus: from surviving AIDS – to making HIV part of “ long term, more normal living ” .
    • Simplistic clinical categorizations of HIV positive people as either “ well or sick ”.
    • Lived experience is different for everyone.
    • Variety of experiences of living with HIV –
    Major Shifts – 18 months
      • “ Living well’
      • “ Living well – isolated/disconnected”
      • “ Living long, but not well”
      • “ Doing it tough – in trouble”
  • 15. HIV & AIDS 1981 to 1996
  • 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.
    • Early years of HIV Treatment (88-95) gave most people only 1 or 2 years of extra life.
    • More potent drugs and protease inhibitors arrived in 1995
    • Dramatic increase in life expectancy since 1996.
    • Why???
          • Overwhelmingly it’s HIV treatment impact + treatment improvement.
          • Better adherence and less treatment breaks.
          • Scientific and clinical advances (viral load and resistance tests).
    Life Expectancy
  • 18.
    • The Antiretroviral Therapy Cohort Collaboration.
    • Large multi-national study of life expectancy in 43,355 HIV+ taking HIV treatment between 1996 and 2005.
    • Key findings:
    Life Expectancy
      • marked decrease in deaths and potential years of life lost from HIV.
      • corresponding increases in life expectancy.
      • 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.
      • “ These figures are startling and will surely help doctors raise the hopes and expectations of patients during discussion of life choices and goals.”
  • 19.
    • Among HIV positive people starting treatment, life expectancy varies a lot between different groups –
      • Starting HIV Treatment at a low CD4 T cell count is estimated to shave an extra 10 to 20 years off life expectancy.
      • Life expectancy influenced by other factors, particularly age, lifestyle, family history.
    • A large gap still remains in life expectancy between the general population, and the HIV positive population.
    • Even in the best scenarios with the most recent experience with HIV Treatment, about 10 years is shaved off a normal lifespan.
    • 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.
    Life Expectancy There’s always a qualification……
  • 20.  
  • 21.
    • HIV treatment has greatly increased life expectancy for many.
    • So HIV+ people are now aging while receiving HIV treatment.
    • Are at risk of developing chronic diseases associated with advancing age (hypertension, heart problems, diabetes, bone disease, etc) that rest of population experiences.
    • Issues of mental health and cognitive function (brain).
    • Suggestions that HIV infection “compresses” the aging process, perhaps accelerating other health problems.
    Impact of long-term living with HIV
  • 22.
    • “HIV and ageing” – a hot research topic.
    • Why? - long-term HIV living is a recent phenomenon – not a lot is known.
    • We’re not just talking about reaching old age – we’re talking about the impact of living with HIV over time .
    • So the impact of HIV and ageing applies if you're 20, 40 or 60 now.
    Impact of long-term living with HIV
  • 23.
    • Death is increasingly due to serious non-AIDS illnesses, such as cardiovascular disease, cancers, end-stage liver, and kidney disease.
    • Uncontrolled HIV could cause a good proportion of these problems – in addition to traditional risk factors (lifestyle, family history)?
    • Studies are finding that HIV viral load and CD4 count levels are associated with risk of developing cancers and other illnesses.
    Impact of long-term living with HIV
  • 24.
    • So keeping a high CD4 count and undetectable viral load may be important to help prevent other illnesses such as cancers.
    • So earlier HIV treatment? (more shortly)
    • Growing research focus on understanding the link between HIV and other illnesses – strategies to manage them (bone disease)
    Impact of long-term living with HIV
  • 25.
      • For more presentations from this event, visit
      • www. napwa .org.au
      • or
      • www.acon.org.au