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Preventative health for PLHIV:  some key issues Sean Slavin Assistant Director
Context  <ul><li>‘ Prevention’: changes in meaning over time </li></ul><ul><ul><li>transmission prevention </li></ul></ul>...
Diagnoses of  HIV infection   and AIDS in Australia Source: State and Territory health authorities
HIV viral load and CD4+cell count by year 1 Source: Australian HIV Observational Database 1 Dashed lines indicate the year...
Clinical Infectious Diseases 2008 47(4):542–553 Age distribution of HIV positive MSM in Australia Thanks John Murray – NCH...
Multiple co-morbidities: HIV versus controls Guaraldi G et al. CROI 2010. Abstract 727  Comorbidities analysed: hypertensi...
“ Prevention” has a broader meaning among PLHIV <ul><li>Heart / vascular system, liver, kidneys, psycho-social, bones, bra...
Aetiology & Consequences <ul><li>HIV disease (various theories re. mechanisms) </li></ul><ul><li>Rx (still much to learn a...
Problems with prevention <ul><li>Treatment  as  prevention </li></ul><ul><ul><li>Rx lowers VL and reduces transmission ris...
CVD risks – what we can influence
A cautionary note <ul><li>Health reform is moving fast – increasing role for primary health care to reduce reliance on hos...
Conclusion: HIV+ health and the national prevention agenda <ul><li>There is some overlap </li></ul><ul><li>Lifestyle risks...
 
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Preventative health for PLHIV: some key issues - Sean Slavin

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Presentation from the AFAO National Symposium on Prevention, held in Sydney, Thursday 27 May, 2010.

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Preventative health for PLHIV: some key issues - Sean Slavin

  1. 1. Preventative health for PLHIV: some key issues Sean Slavin Assistant Director
  2. 2. Context <ul><li>‘ Prevention’: changes in meaning over time </li></ul><ul><ul><li>transmission prevention </li></ul></ul><ul><ul><li>HIV disease prevention </li></ul></ul><ul><li>More PLHIV, living longer, thus the median age of PLHIV rising. </li></ul><ul><li>Observational studies increasingly emphasise risks of non-AIDS morbidity and mortality </li></ul>
  3. 3. Diagnoses of HIV infection and AIDS in Australia Source: State and Territory health authorities
  4. 4. HIV viral load and CD4+cell count by year 1 Source: Australian HIV Observational Database 1 Dashed lines indicate the years of retrospective data collection.
  5. 5. Clinical Infectious Diseases 2008 47(4):542–553 Age distribution of HIV positive MSM in Australia Thanks John Murray – NCHECR / UNSW Estimated number of people living with HIV
  6. 6. Multiple co-morbidities: HIV versus controls Guaraldi G et al. CROI 2010. Abstract 727 Comorbidities analysed: hypertension, Type 2 Diabetes Mellitus, Cardiovascular disease and osteoporosis Guaraldi G, CROI 2010 Abstract727
  7. 7. “ Prevention” has a broader meaning among PLHIV <ul><li>Heart / vascular system, liver, kidneys, psycho-social, bones, brain </li></ul><ul><li>Risk factors – being HIV+ - also lifestyle, family history, social context. </li></ul><ul><li>Many of these are the same as for the general population, although they may work in slightly different ways </li></ul><ul><li>What do we do? </li></ul><ul><ul><li>A number of scientific questions need to be answered through research </li></ul></ul><ul><ul><li>Lifestyle change is probably a step in the right direction but not a complete solution </li></ul></ul>
  8. 8. Aetiology & Consequences <ul><li>HIV disease (various theories re. mechanisms) </li></ul><ul><li>Rx (still much to learn about long term effects) </li></ul><ul><li>Lifestyle risks (elevated among PLHIV) </li></ul><ul><li>Specific co-morbidities esp. brain, bone, vascular, liver, kidney </li></ul><ul><li>&/or </li></ul><ul><li>A non-specific acceleration of senescence </li></ul>
  9. 9. Problems with prevention <ul><li>Treatment as prevention </li></ul><ul><ul><li>Rx lowers VL and reduces transmission risk </li></ul></ul><ul><li>Public health </li></ul><ul><ul><li>Prioritises populations over individuals </li></ul></ul><ul><ul><ul><li>Need to emphasise health and human rights of individuals </li></ul></ul></ul><ul><ul><li>Individuals responsible for population health </li></ul></ul><ul><ul><ul><li>Need a political agenda around social context that goes beyond the homilies </li></ul></ul></ul>
  10. 10. CVD risks – what we can influence
  11. 11. A cautionary note <ul><li>Health reform is moving fast – increasing role for primary health care to reduce reliance on hospitals </li></ul><ul><li>A place for community based health promotion </li></ul><ul><li>Even good GPs time poor and often prefer a drug intervention and increasingly being asked to squeeze more into a 15min consult. </li></ul>
  12. 12. Conclusion: HIV+ health and the national prevention agenda <ul><li>There is some overlap </li></ul><ul><li>Lifestyle risks can and should be reduced but this isn’t a silver bullet for non-AIDS morbidities </li></ul><ul><li>Remain cognisant of: </li></ul><ul><ul><li>social determinants – poverty, stigma </li></ul></ul><ul><ul><li>Confounding conditions – mental health esp. </li></ul></ul><ul><li>Health not universal good – social identity </li></ul><ul><li>Critical relationship with social contexts and particular behaviours that includes things like pleasure, quality of life, social identity </li></ul>

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