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  • 1. HIV AND HPV
  • 2. HIV/AIDS • AIDS: acquired immunodeficiency syndrome • Syndrome: a collection of symptoms • Opportunistic infections • caused by HIV (HIV-1): human immunodeficiency virus • HIV causes AIDS by directly causing the death of CD4+ Tcells (immune cells that fight infections) or interfering with the cells' normal functions, and by triggering other events that deteriorate a person's immune system (Ois)
  • 3. AIDS considered an “emerging disease” • HIV mutated in 1930s from a form exclusive to apes to one that could live in humans. • Such diseases that move from one species to another are known as zoonoses. Ebola and tuberculosis are both examples of other zoonoses. Where did HIV come from? •
  • 4. HIV/AIDS • HIV is a virus • All viruses unable to multiply outside a host cell, and therefore, are classified as intracellular, obligate parasites • Most often causes some type of cell damage or death • Many viruses exist within host at a low enough level that the host is not aware of this • Since viruses‟ survival depends entirely on host, most viruses tend to cause mild infections • Death in host = death of virus • this is not the usual mode of action for most viruses because their existence would cease to be • Exceptions human immunodeficiency virus, ebola virus, pandemic influenza • HIV is lentivirus, a class of retroviruses • Unlike other retroviruses, which typically bud from infected cell for a long period of time, HIV can lyze cell or lie dormant for many years, especially in resting T4 (CD4) lymphocytes; • while HIV may disappear from cells of circulation, viral replication and budding continues to occur in other tissues. • recrudescence of viral production occurs that ultimately destroys the cell.
  • 5. Short hx • AIDS 1st described in 1981 by physicians in U.S.- saw healthy patients become sickly and develop opportunistic infections and cancers • described AIDS in the medical literature. • Public health officials (PHOs) started with this information and amassed additional data about the patients, hoping to identify a cause for the new disease. • By mid-1982, epidemiologists had data demonstrating that AIDS was transmissible. A virus was suspect. • 1983, a candidate retrovirus isolated and in 1984, it was demonstrated to be causative pathogen. • This retrovirus destroyed helper T-cells, the master cells of the body‟s immune response.
  • 6. 1984-95 • Intensive research period to learn how HIV worked • HIV found to mutate 1,000 times faster than influenza virus, thus dashing hopes for making a traditional vaccine • Antiviral drugs tested; AZT rapidly approved as 1st anti-AIDS drug1987 • Public fear of AIDS and hostility towards people with AIDS reached their zenith • PHOs had to deal with epidemic of fear as well as biological epidemic. • 1988-95 • Congress increased funding for AIDS research across U.S. • Surgeon General C. Everett Koop mailed a brochure, “Understanding AIDS,” to every household in the U.S. so that citizens would know facts about AIDS instead of believing rumors. • World Health Organization‟s AIDS Programme began functioning
  • 7. 1995-2006 • With introduction of first protease inhibitor drug in 1995, Highly Active Anti-Retroviral Therapy (HAART) transformed AIDS into a chronic disease. • epidemiological focus of epidemic shifted to developing countries and marginalized populations in U.S. • 2006, universal screening guidelines for HIV infection aimed to make AIDS a routinely reported disease in U.S. • 2013 UN agency reports „dramatic‟ progress on reducing new HIV infections
  • 8. 8 HIV/AIDS Key driver of change in public health • Enormous impact because • no biological control mechanism • enormous cost • many are vulnerable • Effect on other infectious disease programs • TB surveillance and control programs were successful public health interventions, until HIV/AIDS epidemic reversed this achievement • rise in active cases • Effect on maternal child health programs and reproductive health programs • Changes to program planning and infrastructure due to: • use of antiretroviral drugs for treatment • prophylactic treatment for exposed babies • breast feeding
  • 9. HIV/AIDS epidemiology • 2.3 million adults and children newly infected with HIV in 2012, • represents 33 % reduction in annual new cases compared to 2001. • new HIV infections among children fell 52 % to 260,000 in 2012. • greater access to antiretroviral TX led to a 30 per cent drop in AIDS-related deaths from the peak in 2005. • In the U.S., deaths typically through Pneumocystis carinii • In other parts of the world, it is TB • > 90% of new HIV infections are in developing countries. • In Africa (mostly sub Saharan), > 24 million people with HIV infection and about 1 million new cases of AIDS per year • .
  • 10. HIV/AIDS epidemiology • Of adult infections, 40% are in women and 15% in individuals of 15-25 years of age. • Perinatal infection resulting in a large # of children being born with HIV. • 30-50% of mother to child transmissions of HIV results from breast feeding and about a ¼ of babies born to HIV-infected mothers are themselves infected. • Reduced through HAART Figure 1. Prenatal Antiretroviral Therapy and Impact on Perinatal HIV Transmission
  • 11. HIV Transmission • Sexual Transmission • Blood Transmission • Mother to Child
  • 12. HIV/AIDS Risk Groups • Paid/commercial sex workers (CSWs) • Men who have sex with men (MSM) • Injecting drug users (IDUs) • Prisoners • Any sexually active person who does not assume she/he is at risk and take preventive measures • Women • HIV/AIDS Mother-to-child transmission • Risk of • • • • acquiring HIV during delivery without intervention: 15% to 30% HIV transmission during delivery if the mother is taking ARVs: <2% acquiring HIV from breastfeeding without intervention: 25% to 45% HIV transmission during breastfeeding if the mother is taking ARVs: much lower
  • 13. Testing for HIV • Antibody tests: Once infected, takes 3-6 months for enough antibodies to be formed for screening tests to be positive • If test negative, person should be retested in 6 months • ELISA (also called EIA) • Western blot or indirect immunofluorescence assay (IFA). • Rapid assessment tests • PCR tests. • Once positive additional tests may be done for • CD4 count. Important because healthy person's CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when CD4 count becomes < 200. • Viral load. measures amount of virus in blood; people with higher viral loads generally fare more poorly than do those with a lower viral load. • Drug resistance. determines whether strain of HIV will be resistant to certain anti-HIV medications and which ones work better
  • 14. The Course of the disease From HIV Infection to AIDS Acute infection (acute retroviral syndrome) • Initially, HIV infection produces a mild disease • . This is not seen in all patients. • In period immediately after infection, virus titer rises (about 4 to 11 days after infection) and continues at a high level over a period of a few weeks. • Mononucleosis-like symptoms (fever, rash, swollen lymph glands but none of these are lifethreatening. • may mimic the flu • result is an initial fall in the number of CD4+ cells but the numbers quickly return to near normal.
  • 15. The Course of the disease From HIV Infection to AIDS • No other symptoms may occur until enough CD4 cells have been destroyed by HIV • With loss of CD4 cells, the immune system cannot protect • When CD4 count reaches 200 – person considered to have AIDS • Without therapy, time from infection to AIDS = approximately 8-10 years • Despite possible co-factors associated with lifestyle, HIV infected persons progress to AIDS at a remarkably similar rate • Antiretroviral therapy can prolong this time span • Some people naturally have not progressed from HIV infection to AIDS • Referred to as long-term nonprogressors
  • 16. Preventive interventions for HIV/AIDS • Safe sex, including condom use • Unused needles for drug users • Male circumcision • Treatment of other sexually transmitted infections (STIs) • Safe, screened blood supplies • Antiretrovirals (ARVs) in pregnancy to prevent mother-to- child transmission (MTCT) and after occupational exposure
  • 17. Treatment Interventions for HIV/AIDS • Antitretroviral drugs (ARVs) • Highly active antiretroviral therapy (HAART): combination of antiretroviral drugs that are used as medications to control retroviruses • Extend years between infection and onset of clinical AIDS • Extend years between onset of AIDS and death • works against HIV by using drugs in combination to suppress HIV replication as many times as possible. • problems for HIV replication, keeps HIV offspring low, and reduces the possibility of HIV mutating. • must be used in combination to suppress HIV for long periods of time • Treatment of opportunistic infections (OIs) • Palliative care (pain management)
  • 18. High Costs of HIV Medication Cause 'Terrible Dilemma' in Mozambique • • 10:30 • In Mozambique, where 1 in 8 adults is living with HIV, the number of patients on antiretroviral drugs has expanded thanks to international AIDS funding, but a debate is emerging over whether foreign donors can continue to fund an ever-expanding pool of patients.
  • 19. Role of Advocacy and Activism • International response to epidemic • U.S. PEPFAR program • Global Fund to treat AIDS, TB, and Malaria • Bill and Melinda Gates Foundation • World Bank 20
  • 20. HIV/AIDS Critical Challenges • Developing a vaccine to prevent the 2.6 million new infections per year • Cost-effective approaches to prevention in different settings • Universal treatment for all those who are eligible • Management of TB and HIV coinfection