1. HIV
Where do we go from here?
Matt Berni
Kristina Krull
Mike Vaughan
HSC5320
Chronic Disease Prevention
Dr. McInnis
2. Introduction
Human Immunodeficiency Virus
• Gradually attacks immune system
• Many different strains exist
• Two main types
Acquired Immune Deficiency Syndrome
• Last stage of HIV infection
• Body can no longer defend itself
• Fatal without treatment
23. Antiretroviral Treatment
Goal is to decrease viral load (amount of HIV in a sample of
blood)
Antiretroviral Treatment (ART)
• Combination of medicines taken daily
• Prevent HIV from multiplying (reduces amount of HIV in blood)
• Increases ability of immune system to fight off infections
• Reduces risk of transferring HIV
31. Research Evidence
Predictors and Evolution of Antiretroviral Therapy Adherence
Among Perinatally HIV-Infected Adolescents in Brazil
Jose Cote , R.N. Ph.D. Philippe Delmas, R.N. Ph.D. Regina Celia
de Menezes Succi, Ph. D. Eliana Galano, Ph. D. Patricia Auger,
M.Sc. Helene Sylvain, R.N. Ph.D. Sebastien Colson, R.N. Ph.D.
Daisy Maria Machado, Ph.D
32. Purpose
Better understand the evolution and predictors of medication
adherence among PIY youths during a 1 year longitudinal study
in São Paulo, Brazil
33. Methods
Identify factors that play a role in medication adherence (95% of
prescribed pills taken in last 7 days) through questionnaires
• Self-efficacy
• Stress and Depression
• Symptoms
• Social Support
35. Conclusion
Initiatives to better support young adults to adhere to
treatment are needed
Increase adherence by helping patients overcome barriers of
treatment
Young adults adhering to treatment are crucial in determining
future trajectory of disease
36. Research Study 2
Utilization of contraceptives by persons living with HIV in
Eastern Uganda: a cross sectional study
Richard Ekorinyang
37. Purpose
Determine the rate of contraceptive use and associated
factors among persons receiving HIV care and treatment
in Eastern Uganda
38. Methods
• Cross sectional study across 4 hospitals in Eastern Uganda.
• 87 men aged 15-54 were interviewed.
• 213 women aged 15-49 were interviewed.
39. Results
Rate of contraceptive use among respondents was 62.1%.
Condoms were most popular, used by 44% of respondents.
Higher proportion of females were more likely to use condoms
with partners than males were.
40. Conclusion
The rate of contraception use among people living with HIV in
Eastern Uganda is higher than that in the Ugandan general
population.
41. Research Study 3
Housing Status, Medical Care, and Health Outcomes Among
People Living with HIV/AIDS: A Systematic Review
Angela A. Aidala, Michael G. Wilson, Virginia Shubert, David
Gogolishvili, Jason Globerman, Sergio Rueda, Anne K. Bozak,
Maria Caban, & Sean B. Rourke
42. Purpose
Relates importance of housing status for HIV prevention for use in the future
development and implementation of health promotion programs
44. Outcomes
Worse housing status was independently associated with worse outcomes
Individual patient and healthcare system characteristics were controlled for
45. Conclusion
Supports importance of addressing housing needs of people living with HIV as
a necessary component to achieve prevention goals & reduce disparities
53. References
Bangsberg, D. R., Moss, A. R., & Deeks, S. G. (2004). Paradoxes of adherence and drug resistance to HIV antiretroviral
therapy. Journal of Antimicrobial Chemotherapy, 53(5), 696–699. https://doi.org/10.1093/jac/dkh162
Leng, S. X., & Margolick, J. B. (2015). Understanding Frailty, Aging, and Inflammation in HIV Infection. Current HIV/AIDS
Reports, 12(1), 25–32. https://doi.org/10.1007/s11904-014-0247-3
Kahana, S. Y., Jenkins, R. A., Bruce, D., Fernandez, M. I., Hightow-Weidman, L. B., & Bauermeister, J. A. (2016). Structural
determinants of antiretroviral therapy use, HIV care attendance, and viral suppression among adolescents and young
adults living with HIV. PLoS ONE, 11(4), 1–20. https://doi.org/10.1371/journal.pone.0151106
Mataftsi, M., Skoura, L., & Sakellari, D. (2011). HIV infection and periodontal diseases: An overview of the post-HAART era.
Oral Diseases, 17(1), 13–25. https://doi.org/10.1111/j.1601-0825.2010.01727.x
Webel, A. R., Barkley, J., Longenecker, C. T., Mittelsteadt, A., Gripshover, B., & Salata, R. A. (2015). A Cross-Sectional
Description of Age and Gender Differences in Exercise Patterns in Adults Living With HIV. Journal of the Association of Nurses
in AIDS Care, 26(2), 176–186. https://doi.org/10.1016/j.jana.2014.06.004
Widman, L., Golin, C. E., Noar, S. M., Massey, J., & Prinstein, M. J. (2016). PROJECTHEARTFORGIRLS . COM : DEVELOPMENT OF
A WEB-BASED HIV / STD PREVENTION PROGRAM FOR ADOLESCENT GIRLS EMPHASIZING SEXUAL COMMUNICATION SKILLS,
28(5), 365–377.
Zanoni, B. C., & Mayer, K. H. (2014). The adolescent and young adult HIV cascade of care in the United States: exaggerated
health disparities. AIDS Patient Care and STDs, 28(3), 128–35. https://doi.org/10.1089/apc.2013.0345
54. References
Aidala, A. A., Wilson, M. G., Shubert, V., Gogolishvili, D., Globerman, J., Rueda, S., … Rourke, S. B. (2016). Housing status,
medical care, and health outcomes among people living with HIV/AIDS: A systematic review. American Journal of Public
Health, 106(1), e1–e23. https://doi.org/10.2105/AJPH.2015.302905
CDC. (2016, September 26). HIV and AIDS in the United States by geographic distribution. Retrieved November 2, 2016, from
http://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html
Côté, J., Delmas, P., de Menezes Succi, R. C., Galano, E., Auger, P., Sylvain, H., & ... Machado, D. M. (2016). Predictors and evolution
of antiretroviral therapy adherence among perinatally HIV-infected adolescents in Brazil. Journal Of Adolescent Health, 59(3),
305-310. doi:10.1016/j.jadohealth.2016.05.004
HIV and AIDS in the United States of America (USA). (2015, May 1). Retrieved November 1, 2016, from
http://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/usa
Overview of HIV treatments. (2015, August 13). Retrieved November 9, 2016, from AIDS.gov, https://www.aids.gov/hiv-aids-
basics/just-diagnosed-with-hiv-aids/treatment-options/overview-of-hiv-treatments/
Ekorinyang, R. (2015). Utilization of contraceptives by persons living with HIV in Eastern Uganda: A cross sectional study.
Reproductive Health, 12(1). doi:10.1186/s12978-015-0030-y
Editor's Notes
MV -
Dramatic
We all know of the HIV/AIDS epidemic but we don’t hear about it as much as we did a generation ago...
Source:
KK
Often a sexually transmitted Infectious disease
HIV mutates frequently
If left untreated, it can take around 10 to 15 years for AIDS to develop, which is when HIV has severely damaged the immune system.
Human Immunodeficiency Virus
–Virus that attacks T cells (CD4 cells)
•WBC important for orchestrating immune response
CD4 levels get lower and lower until they can’t launch an immune response
–Spread: contact mucus membrane and bodily fluid, sex, needles, mother to baby
AIDS is a syndrome caused by the HIV virus.4 It is when a person’s immune system is too weak to fight off many infections, and develops when the HIV infection is very advanced. This is the last stage of HIV infection where the body can no longer defend itself and may develop various diseases, infections and if left untreated, death.
.
AIDS is also referred to as advanced HIV infection or late-stage HIV.
Source:http://www.lshtm.ac.uk/newsevents/news/2016/hiv_infections_stagnating.html
MB
Global epidemic - NOTE LOCATION & Percentages
Globally - 5th leading cause of death
MB
MV
This is a huge problem globally, the US only accounts for 4% cases worldwide
Source:http://www.cdc.gov/hiv/group/msm/bmsm.html
MV
All ages - pay attention to subset of Male Diagnoses according to race/ethnicity (2014)
Mv
More than 50 percent of new HIV infections occur as a result of the 21 percent of people who have HIV but do not know it.
United States - All Races, Both sexes Ages 24-45 8th leading cause of death
Source:https://www.drugabuse.gov/publications/research-reports/hivaids/who-risk-hiv-infection-which-populations-are-most-affected
Mb
Nearly 75 percent of new HIV infections occur in men.
More than half occur in gay and bisexual men, regardless of race or ethnicity.
Male to male
Male to female
KK
Draw attention to Southeastern US
5 States in the US make up half of new HIV diagnosis - TX, CA, FLA, LA, GA, NY, Washington DC. MD,
KK
MV
Source:
MV
Chimpanzees in Central Africa infected with Simean Immundofeficiency Virus transmitted to humans and mutated into HIV
Humans hunted these chimps for meat and came in contact with infected blood
MV
Set up HIV and AIDS epidemic was first diagnosed in the US in 1981
Source: https://aidsinfo.nih.gov/education-materials/fact-sheets/19/46/the-stages-of-hiv-infection
KK
Diagnosed through blood tests detecting the presence or absence of HIV antibodies (3 stages of HIV infection) ~ CD4 count drops too low
CD4 Cells - (T-cell) - lymphocyte produced by thymus gland, actively participates in the immune response, important part of the immune system,
HIV attacks and killls CD4 cells, loss of CD4 cells makes it hard for the body to fight off infections
HIV is the virus, damages the immune system by killing CD4 cells
AIDS is the last stage of HIV infection, as HIV infection advances to AIDS the amount of HIV in the body increases and the number of CD4 cells decreases
HIV medicines can stop HIV infection from progressing to AIDS, without HIV medicines, HIV advances to AIDS in about 10-12 years
KK
Great Study on the Immune Response by Defranco, Lockely, & Robertson
Example of how AIDS onsets with Decreasing CD4 count
KK
There is no cure for HIV infection. However, effective treatment with antiretroviral drugs can control the virus so that people with HIV can enjoy healthy and productive lives.
Treatment gives patients a nearly-normal life expectancy, but many living with HIV don’t have access to these treatments
Source:http://www.avert.org/hiv-transmission-prevention
MB
4 fluids (semen, blood, vaginal fluids, breast milk) - that each transmit different amounts of the virus
Must come in contact with a mucous membrane
Source: http://www.avert.org/hiv-transmission-prevention
MB
Viruses cannot survive on surfaces
KK
3 Stages of Infection
Acute = flu like symptoms
Chronic = dormant symptoms
AIDS = opportunistic diseases
MV
In the U.S. we have it under 1%, now what?
Focus on ART coverage
MV
There are other treatment strategies but ART is by far the most effective therapy
Source: http://www.avert.org/about-hiv-aids/how-infects-body
KK
HIV virus cannot reproduce on its own - so it must hijack nucleus of an T-cell
KK
Type of Drug used is going to depend on stage of HIV infection
Binding and fusion - Fusion or Entry Inhibitors.
Reverse transcription and integration- NRTIs, NNRTIs and Integrase Inhibitors.
Transcription and translation
Assembly, budding and maturation- Protease Inhibitors.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors (PIs)
Fusion inhibitors
CCR5 antagonists (CCR5s) (also called entry inhibitors)
Integrase strand transfer inhibitors (INSTIs)
Daily regimen determined between patient and doctor based on person’s individual nee
KK
KK
Source: http://addictionnomore.com/hiv_prevention
MB
Testing only requires small sample of blood & sample of oral fluids
Abstinence
Condoms
PrEP (Pre Exposure Prophylaxis)
Daily HIV medications to prevent infection
HIV Negative with an HIV Positive partner
PEP (Post Exposure Prophylaxis)
HIV medication immediately after potential exposure (within 3 days)
Less risky sexual behaviors
MB
MV
The purpose of this study to better understand the evolution and predictors of medication adherence among youths born with HIV in Sao Paulo Brazil.
These 4 factors were measured based upon short questionnaires for each topic
At baseline adherence was 63.06%
At end adherence was 68.98%
What they found was the patients that were most adherent to their medication were the same patients that responded well to their medication
Patients need to be diligent about their treatment, social support programs need to be created to help those who aren’t taking their medication
MB
Picture from cdc.gov/hiv
KK
American Journal of Public Health (January 2016)~ out of Columbia University
Peer Reviewed
Focuses on association between housing status and health outcomes with people with HIV
to address prevention goals and reduce racial disparities
Housing Status and stability affects all of this!
Lack of stable, secure, adequate housing is a significant barrier
Source:https://www.healthypeople.gov/2020/topics-objectives/topic/hiv
KK
Linking to and staying in treatment.
Increasing the availability of ongoing HIV prevention interventions.
Providing prevention services for their partners.
Addressing dispartities culturally relevant for African American Community
Budget Sequestration 2014 on domestic HIV/AIDS programming
Socioeconomic disparity is a big challenge
7.3% cut to the funding of these programs (foundation for AIDS research & National Minority AIDS Council) will impact research grants, households receiving assistance and people enrolled in drug assistance programs
Source:CDC Fact Sheet Dec. 2013 (Hall et al., 2013)
KK
Current State of affairs
We want earlier treatment Interventions*******
Source: International AIDS Society 2015
KK
Global needs to reach 2020 target goals
Source:http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/november/20141118_PR_WAD2014report
MB
Ideal Goals to reach toward for the next decade from UNAIDS (Joint United Nations Programs on HIV/AIDS)
MV
100% Preventable and/or Treatable STI
Young adults adhering to treatment are crucial in determining future trajectory of disease….Hammer home primary prevention***Its really those that have HIV need to go get checked before they spread it….It is up to those w/ it to be diligent in their treatment
