Refresher Course For  J2J Fellows XVIII International AIDS Conference Vienna, Austria  Presenter: Bob Meyers, NPF & J2J
Why are we doing this? To make sure that all J2J participants in Cape Town are on a  level playing field , with all other ...
We will look at HIV/AIDS  in three ways. As a … <ul><li>Medical/Scientific Issue </li></ul><ul><li>Public Health Issue </l...
Some basic definitions <ul><li>HIV  – Human Immunodeficiency Virus </li></ul><ul><li>AIDS  – Acquired Immune Deficiency Sy...
HIV/AIDS As A Medical/Scientific Issue
What Does AIDS Do  In the Body? <ul><li>AIDS is a disease of the immune system </li></ul><ul><li>The immune system is a  n...
What Does AIDS Do  In the Body? <ul><li>HIV primarily attacks one type of cell that is crucial to the immune system: The C...
AIDS is caused by HIV,  the Human Immunodeficiency Virus  Courtesy of Anthony S. Fauci, National Institute of Allergy and ...
In many ways HIV acts like most other viruses And the immune system treats it  like any other virus
Video from Howard Hughes Medical Institute <ul><li>http://www.hhmi.org/biointeractive/disease/hiv_life_cycle.html </li></ul>
Scroll through the following PPTs on your own, or Jump to # 53
But in a few crucial ways HIV differs from other viruses <ul><li>When the immune system responds after HIV attacks it, HIV...
The immune system is a  network  of organs and cells <ul><li>Mucosal barriers: Vagina, rectum, mouth.  </li></ul><ul><li>L...
Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
The immune system is complex and interactive <ul><li>Immune-system cells  detect  invading viruses and bacteria </li></ul>...
Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
The CD4+ T-helper Cell <ul><li>“ CD4+” means that the cell displays (“expresses”) a molecule on its surface called “CD4”. ...
HIV replicates in CD4 cells. Amount of virus produced determines disease course Slide (slightly adapted) courtesy of Bruce...
New research suggests that … <ul><li>This time frame may be a matter of HOURS, not days </li></ul><ul><ul><li>Which could ...
Typical Course of HIV infection Graph courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
Relationship Between CD4 and Plasma HIV viral load <ul><li>AIDS is like a train heading toward a crash </li></ul><ul><li>V...
CD4 Count  in Phases of HIV Infection 5-14 days Incubation CD4 cell count 1-4 mo. 4-10 years 1-2 years Primary Presymptoma...
The level of HIV in the blood predicts disease course Amount of Virus in Blood Rapid Progression Slow Progression Slide (s...
Immune system detects HIV  and sounds the alarm
At the cellular level… <ul><li>Macrophages and dendritic cells “eat” HIV </li></ul><ul><ul><li>“ Macrophage” comes from “m...
Function of the CD4 T Cell Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antigen Presenting Cel...
HIV prefers to infect  activated   CD4 T-cells <ul><li>93-99% of HIV infects activated CD4 cells, which are HIV’s favorite...
Function of the CD4 T Cell after infection Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antige...
(Pause) Why are we spending so much time on this science stuff?
So everyone will know how complex this is And so you will be able refute anyone who denies that HIV  causes AIDS
How antibodies work <ul><li>Antibodies work by binding to particular fragments of HIV as the virus floats in the blood or ...
Antibodies try to snare HIV Slide (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard ...
But HIV eludes antibodies <ul><li>HIV is sheathed in an “envelope” </li></ul><ul><ul><li>The envelope is the most mutable ...
Killer T-cells  are “big guns” in viral infections <ul><li>Antibodies snare free-floating virus </li></ul><ul><li>But viru...
This is one scientific reason that  HIV is so difficult to stop once it is in the body  …  and why AIDS is so difficult to...
HIV replicates mainly in lymph tissue, the immune-system stronghold Images from The National Cancer Institute, http://news...
Site of HIV Production and Storage Photos and slide (slightly adapted) courtesy of Timothy Schacker, University of Minneso...
HIV in the lymph nodes <ul><li>The lymph nodes normally trap viruses in the lymphoid “germinal centers” and cleanse the vi...
Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
HIV destroys the lymph nodes <ul><li>HIV causes persistent lymph-node swelling, or “lymphadenopathy,” one of the signs of ...
Lymph tissue in HIV-negative  and HIV-positive people HIV-negative person Upper left-hand corner: round germinal center su...
The consequences of HIV infection <ul><li>As HIV slowly wins the battle, the immune system can no longer repel some infect...
Antiretroviral drugs (ARVs) attack HIV itself <ul><li>They stop HIV from replicating, but they  do not   eradicate  HIV fr...
Antiretroviral drugs (ARVs) block HIV’s assault on the CD4 T-cell Resting CD4 Cell Activated CD4 Cell Macrophage, Dendriti...
Lymph nodes in HIV-negative, HIV-positive, and ARV-treated patients HIV-negative person Upper left-hand corner:  Round “ge...
Without ARVs, many non-HIV “OIs” can be cured or prevented cheaply <ul><li>Tuberculosis </li></ul><ul><li>Pneumocystis Car...
(This ends Mark’s brilliant review of HIV/AIDS)
So why is there no  vaccine against,  or a cure for,  HIV/AIDS?
Unfortunately, these are some  of the responses …  <ul><li>The virus is incredibly complex and operates in a way rarely se...
So until medicine and science can give us the answer … We have to look at ways to  prevent  HIV infections & AIDS
HIV/AIDS As A   Public Health Issue
Some basic definitions <ul><li>HIV  – Human Immunodeficiency Virus </li></ul><ul><li>AIDS  – Acquired Immune Deficiency Sy...
Some basic definitions <ul><li>HIV  – Human Immunodeficiency Virus </li></ul><ul><li>AIDS  – Acquired Immune Deficiency Sy...
A very informal way of looking at HIV transmission … <ul><li>You have to do something </li></ul><ul><li>Or have something ...
Vulnerable People <ul><li>Women </li></ul><ul><ul><li>Especially in male-dominant cultures </li></ul></ul><ul><ul><li>In w...
Transmission <ul><li>Unprotected sexual contact </li></ul><ul><li>IV drug use </li></ul><ul><li>Unsafe clinical environmen...
Vulnerable Groups  <ul><li>Local communities </li></ul><ul><li>National defense </li></ul><ul><li>Migrant workers </li></u...
If there is infection, these are possible movements of HIV <ul><li>IDU or Sex worker </li></ul><ul><li>  or Unknowingly  <...
Until we have a vaccine or a cure … We have to focus on prevention
Personal Prevention <ul><li>Condoms – Male or female </li></ul><ul><li>Microbicides </li></ul><ul><li>Limited sexual partn...
Societal Prevention <ul><li>Developing of new drugs </li></ul><ul><ul><li>Distribution of those drugs </li></ul></ul><ul><...
Medicine & Public Health   Compared for the Benefit of Journalists
Medicine  Public Health <ul><li>Primary focus on individual </li></ul><ul><li>Diagnosis & treatment  </li></ul><ul><li>Med...
Leading Causes of Death  In the United States <ul><li>In the Year 1900 </li></ul><ul><li>Influenza </li></ul><ul><li>Pneum...
Each of the following pictures can be viewed … <ul><li>as a story of an  individual   </li></ul><ul><li>Or as the story of...
And if you’re going to view them  as both, then you need two more basic definitions …
Some basic definitions <ul><li>HIV  – Human Immunodeficiency Virus </li></ul><ul><li>AIDS  – Acquired Immune Deficiency Sy...
Journalism Practice
In the next four days we’re going to look at a lot of issues, both as journalists and as concerned citizens...
… But right now I want to briefly discuss this question – do we as journalists have a special obligation to cover HIV/AIDS?
I believe that AIDS is curable… <ul><li>Despite all the failed vaccine trials </li></ul><ul><li>Despite the failed scienti...
HIV/AIDS is curable … through  education
Journalists are  educators… <ul><li>We research difficult situations </li></ul><ul><li>We show people what we have learned...
Because we are educators,  and  given … <ul><li>The size of the epidemic </li></ul><ul><li>The potential for its growth </...
And the fact that print, or broadcast & online journalists cover everything from …. <ul><li>Poor people </li></ul><ul><li>...
Then I think we can educate many segments of the population about what we know.
And I think that is why  we came here …
Thank you!
Acknowledgements <ul><li>Mark Schoofs, The Wall Street Journal </li></ul><ul><li>Anthony S. Fauci & Greg Folkers, National...
NPF: AIDS 2010 Refresher for Vienna Journalists
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  • AIDS is caused by HIV. HIV is a member of a family of viruses called retroviruses. You’ll learn more about the virus in the course, “Basic Science of HIV/AIDS” taught by Laurie. In this course, you will learn how HIV works in the body and the consequences of that.
  • GALT = Gut Associated Lympoid Tissue. It is lymph tissue that is located in the gut and intestines.
  • Inside those organs, many different types of cells are interacting with one another to orchestrate a complex attack against any invading virus or bacteria. This slide illustrates some of those kinds of cells, as they attempt to fight off an HIV infection. The arrows indicate messenger molecules that the cells secrete. They use these molecules to communicate with each other and organize their attack. Some of these molecules also directly inhibit viruses such as HIV
  • The electron-microscope photograph in Slide 3, showing HIV budding from a T-cell, depicts one new virus emerging from an infected cell. But HIV replicates at a very high rate, generating between 10 billion and one trillion new viruses per day in an infected person. The immune system tries to keep up. During the long asymptomatic phase of HIV infection, an infected person generates about a billion new CD4 cells every day to make up for those HIV has killed. Most HIV replication takes place in lymphatic tissues, and it damages those tissues. As HIV replicates, it mutates often, making it hard for the immune system to keep recognizing it.
  • This is a very important slide. It shows what happens to the amount of virus in the body during a typical case of HIV, and what happens to the amount of CD4 cells, the ones that HIV targets. The amount of virus is called viral load (or sometimes viral burden). The test or “assay” that measures it is called usually called a PCR test (a similar test is called “branch DNA.) The PCR test measures “copies” of HIV RNA in a milliliter of plasma. CD4 counts are measured by a different kind of test, which counts the number of such cells in a milliliter of blood. At first, HIV surges, but then the immune system fights back and suppresses it. It stays at this “steady state” for years. During this time, HIV and the immune system are locked in a pitched battle.Eventually, HIV wins and the amount of virus in the body, called “viral load,” rises. It typically takes about 10 years for HIV to run its course and kill the patient. That gives HIV a tremendous advantage, because it has 10 years to spread from that patient to other people. For HIV, keeping the host alive for a long time is one of its main advantages. Just the opposite is happening to CD4 cells. They decline at first, then level off for many years. But during this time their number slowly dwindles. Then, when HIV virual load surges, CD4 drops. What is the patient feeling? During primary infection, the paitent may feel flu-like symptoms. Then during the long steady state, he usually experiences very few symptoms. But as the level of CD4 drops, he gets prone to more and more “opportunistic infections” such as TB and pneumonia. These finally kill him.
  • GALT = Gut Associated Lympoid Tissue. It is lymph tissue that is located in the gut and intestines.
  • These are photographs of HIV-infected human lymph tissue. The tissue has been chemically stained so that HIV shows up as bright “stars” or dots. The second slide is a close-up, showing HIV+ cells. The assay technique is to put a radioactive probe that binds to to HIV RNA. Then the solution is coated with an photopgraphic emulsion. Silver grains cluster at the radio probes, allowing scientists to literally count the silver grains to see how many cells are infected.
  • This is an even more complex version of the earlier slide. It shows how complex the interactions are between the known elements of the immune system. This slide should remind us that there is always more going on than we, or the scientists, know.
  • Women are at risk from men who feel their masculinity is challenged if a woman uses protection Rape has been used as an instrument of war and domination Sex work in many countries is an economic necessity, because education and jobs are forbidden to women; women are also at risk for kidnapping and forced participation in sex work.
  • It doesn’t matter whether the contact is being men and women, or men and men, or women and women. HIV is spread through blood and body fluids from a positive-person entering the body of an uninfected person. People using intravenous drugs often share the same needle. Infected blood from one person is likely to be transferred to the second person. Use of previously unused needles is an effective preventive; a common disinfectant commonly used in non-medical environments is to sterilize the needle in bleach before reusing. Blood products and body fluids are common in clinical environments and protections must always be taken. A single dose of Navirapine can prevent mother-to-child transmission, especially when taken with other drugs.There has never been any valid scientific data that the Navirapine is risky or harmful, despite allegations about that in South Africa several years ago.
  • Communities are made up of individuals and when enough individuals are challenged by HIV/AIDS communities can suffer in unexpected ways: Lack of factory workers, or miners, or soldiers, or farm workers or teachers or students. Think about what happens to children whose parents die from AIDS and they are raised by grandparents, or raised on the streets. This is a prescription for ccrime and civic unrest.
  • Adult male circumcision – it has been shown to be effective about 50 – 60 % of the time with HIV-negative heterosexual circumcised populations. The implementation needs to be done carefully: all the instruments need to be sterile, the medical worker needs to be trained, the patient needs to avoid sexual intercourse for at least six weeks after surgery, and local customs and traditions need to be observed. For more information go to the NPF website, www.nationalpress.org and search the words “male circumcision.” Also go to the World Health Organization website.
  • T This slide is modified by a chart designed by Harvey Fineberg when he was Dean of the Harvard School of Public Health. I have shortened it and modified it for talks to journalists. The idea here is to show the differences between medicine and public health, at least as practiced in the U.S. On the left are subjects that we care about for OUR personal health – or MY personal health. That’s on the bottom right you can see that the doctor comes to my bedside. On the right are subjects that are important to a social view of health of all people in a society. The doctor doesn’t come to my bedside, but he or she may go into the fields to find out why I am sick. his slide is modified by a chart designed by Harvey Fineberg when he was Dean of the Harvard School of Public Health. I have shortened it and modified it for talks to journalists. The idea here is to show the differences between medicine and public health, at least as practiced in the US.
  • REGARDING DEATHS IN THE U.S., WE HAVE A 100-YEAR COMPARISON HERE, ON THE LEFT, DEATHS 100 YEARS AGO, ON THE RIGHT, CAUSES OF DEATH TODAY. ON THE LEFT, DISEAS THAT SPREAD THROUGH THE AIR, WATER, OVERCROWDING, OR THAT REFLECT PERSONAL HEALTH PROBLEMS LIKE HEART PROBLEMS, ETC. CANCERS ARE AT THE BOTTOM OF THE 100 YEAR LIST. BUT CURRENTLY, PERSONAL BEHAVIORS ARE BEHIND THE MAIN CAUSES OF DEATH. CANCERS ARE AT THE TOP OF THE LIST, AND MOST U.S. CANCERS ARE RELATED TO TOBACCO USE. Diet, lack of exercise, motor vehicle crashes… this is all public health – and a source of great stories
  • PERRISKY PERSONAL BEHAVIORS. Noticed I didn’t say “risky sexual behaviors,” because we approaching an area where these behaviors start to overlap. And the next series of pictures gives us a change to fully explore some issues of journalism ethics as well. These are teenage heroin users in the U.S. In light of common journalism practice in the U.S., as well as U.S. laws, we can ask whether these girls have given their permission to be photographed. EVEN THEY HAVE GIVEN THEIR PERMISSION, are they legally old enough to do so? And even if they have, should the picture have been taken? As drug addicts, what are they at risk for, besides the addition? It is common for groups that shoot up together to share needles, whatevere is in one person’s blood may well be passed on to the others. To calm the addiction they will need more drugs, and to get drugs they will need money. To get money the will probably rob, steal, and turn to sex work. Sex work exposes them to sexually transmitted diseases, like HIV/AIDS – but also gonorrhea, sythillis, and a wide variety of other health problems. AND THE LARGEST QUESTION OF ALL FOR JOURNALISTS IS – WHAT ARE KIDS THIS AGE DOING SHOOTING DRUGS? SONAL BEHAVIORS
  • THESE ARE MEN WHO HAVE SEX WITH MEN. UNPROTECTED SEX, OR SEX WITH MANY SEX PARTNERS, PUTS THEM AT RISK. IF THEY HAVE UNPROTECTED SEX WITH WOMEN, SUCH AS WIVES OR GIRLFRIENDS – AND THE WOMEN DON’T KNOW THAT THEIR MALE PARTRNERS ALSO HAVE SEX WITH OTHER MEN --THAT COULD PLACE THOSE UNSUSPECTING WOMEN AT RISK. Question for journalists – do we need to print the men’s names? Did they know they were bering photographed? What if they need they were bei9ng photographed, but thought it was for a vanity magazine, for good-looking men, and they see their picture in a story about HIV/AIDS? PERSONAL CHOICE – OR SOCIAL CIRCUMSTANCE – OR ECONOMIC NECESSITY? Sex workers in Thailand. PRIVACY QUESTION: what about the guy on the left? Is he just walking by? Or is he a client? And to run his name or picture do we need to get his permission?
  • PERSONPERSONAL CHOICE – OR SOCIAL CIRCUMSTANCE – OR ECONOMIC NECESSITY? Sex workers in Thailand. PRIVACY QUESTION: what about the guy on the left? Is he just walking by? Or is he a client? And to run his name or picture do we need to get his permission?
  • Yes! All of these are reasons why news organizations have an ethical and moral responsibility to cover HIV/AIDS.
  • NPF: AIDS 2010 Refresher for Vienna Journalists

    1. 1.
    2. 2. Refresher Course For J2J Fellows XVIII International AIDS Conference Vienna, Austria Presenter: Bob Meyers, NPF & J2J
    3. 3. Why are we doing this? To make sure that all J2J participants in Cape Town are on a level playing field , with all other J2Jers and all other journalists.
    4. 4.
    5. 5. We will look at HIV/AIDS in three ways. As a … <ul><li>Medical/Scientific Issue </li></ul><ul><li>Public Health Issue </li></ul><ul><li>Medicine & Public Health compared for the benefit of journalists </li></ul>
    6. 6. Some basic definitions <ul><li>HIV – Human Immunodeficiency Virus </li></ul><ul><li>AIDS – Acquired Immune Deficiency Syndrome </li></ul><ul><li>Medicine – a focus on the individual </li></ul><ul><li>Public health – a focus on populations </li></ul><ul><li>Incidence – the number of new cases arising in a given population in a given time </li></ul><ul><li>Prevalence – the proportion of people with HIV at a specific point in time; expressed as a %. </li></ul>
    7. 7. HIV/AIDS As A Medical/Scientific Issue
    8. 8. What Does AIDS Do In the Body? <ul><li>AIDS is a disease of the immune system </li></ul><ul><li>The immune system is a network of cells and organs throughout the body </li></ul><ul><li>HIV destroys the immune system. </li></ul>
    9. 9. What Does AIDS Do In the Body? <ul><li>HIV primarily attacks one type of cell that is crucial to the immune system: The CD4 T-helper cell </li></ul><ul><li>After exposure the body cannot fight off infections, and so it succumbs to “opportunistic infections” such as TB, pneumonia, etc., which is why AIDS is a syndrome. </li></ul>
    10. 10. AIDS is caused by HIV, the Human Immunodeficiency Virus Courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
    11. 11. In many ways HIV acts like most other viruses And the immune system treats it like any other virus
    12. 12. Video from Howard Hughes Medical Institute <ul><li>http://www.hhmi.org/biointeractive/disease/hiv_life_cycle.html </li></ul>
    13. 13. Scroll through the following PPTs on your own, or Jump to # 53
    14. 14. But in a few crucial ways HIV differs from other viruses <ul><li>When the immune system responds after HIV attacks it, HIV turns the immune system counter-attack to its own advantage </li></ul><ul><li>This allows HIV to persist in the body for years and finally destroy the immune system </li></ul>
    15. 15. The immune system is a network of organs and cells <ul><li>Mucosal barriers: Vagina, rectum, mouth. </li></ul><ul><li>Lymphatic vessels: </li></ul><ul><li>the immune system’s bloodstream </li></ul><ul><li>Lymph nodes & GALT: cleansing centers </li></ul><ul><li>Thymus, spleen, bone marrow etc. </li></ul>Images from The National Cancer Institute, http://newscenter.cancer.gov/sciencebehind/immune/immune00.htm
    16. 16. Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
    17. 17. The immune system is complex and interactive <ul><li>Immune-system cells detect invading viruses and bacteria </li></ul><ul><li>Immune system cells mobilize each other by: </li></ul><ul><ul><li>Direct cell-to-cell contact </li></ul></ul><ul><ul><li>Excreting messenger molecules such as “cytokines” </li></ul></ul><ul><li>Immune system cells destroy invading viruses by: </li></ul><ul><ul><li>Excreting “antibodies” that snare free-floating virus </li></ul></ul><ul><ul><li>Killing the body’s own cells that have been infected </li></ul></ul><ul><ul><li>Excreting molecules such as “chemokines” that interfere with viral replication </li></ul></ul>
    18. 18. Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
    19. 19. The CD4+ T-helper Cell <ul><li>“ CD4+” means that the cell displays (“expresses”) a molecule on its surface called “CD4”. HIV attaches to this molecule and, like a lock and key, uses it to enter the cell. </li></ul><ul><li>“ Helper” means that this cell “helps” other parts of the immune system do their job. If the immune system is an orchestra, this cell is the conductor. </li></ul><ul><li>“ T” is short for “Thymus-derived” and is a type of immune cell. There are other T-cells, such as killer T-cells. </li></ul>
    20. 20. HIV replicates in CD4 cells. Amount of virus produced determines disease course Slide (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center 2-3 Days New virus assembly
    21. 21. New research suggests that … <ul><li>This time frame may be a matter of HOURS, not days </li></ul><ul><ul><li>Which could be one factor in failure of recent vaccine trials </li></ul></ul><ul><ul><ul><ul><li>Inserted by Bob Meyers, 2008 </li></ul></ul></ul></ul>
    22. 22. Typical Course of HIV infection Graph courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
    23. 23. Relationship Between CD4 and Plasma HIV viral load <ul><li>AIDS is like a train heading toward a crash </li></ul><ul><li>Viral load indicates the speed of the train </li></ul><ul><li>CD4 count indicates the distance to the crash </li></ul>
    24. 24. CD4 Count in Phases of HIV Infection 5-14 days Incubation CD4 cell count 1-4 mo. 4-10 years 1-2 years Primary Presymptomatic AIDS Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota
    25. 25. The level of HIV in the blood predicts disease course Amount of Virus in Blood Rapid Progression Slow Progression Slide (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center One year
    26. 26. Immune system detects HIV and sounds the alarm
    27. 27.
    28. 28. At the cellular level… <ul><li>Macrophages and dendritic cells “eat” HIV </li></ul><ul><ul><li>“ Macrophage” comes from “macro” for big and “phage” for eat. So macrophages are “Big Eaters,” or scavenger cells </li></ul></ul><ul><li>These scavenger cells cut up the virus into fragments called “antigens” or “epitopes” </li></ul><ul><li>They “present” these viral fragments to other cells, including CD4+ T-cells </li></ul><ul><ul><li>Each CD4+ T-cell can recognize only one epitope </li></ul></ul><ul><ul><li>When it meets its particular epitope, the CD4 T-cell clones itself into an army of identical cells </li></ul></ul><ul><li>These “activated” cells stimulate other immune-system cells, such as B-cells, which make antibodies, and killer T-cells, which kill infected cells </li></ul>
    29. 29. Function of the CD4 T Cell Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antigen Presenting Cell Promote B-cell Antibody Response (also called “ Humoral” response ) Promote Killer T-cells (also called “CTL” short for “Cytotoxic T-Lymphocyte”) Secrete ß Chemokines Rantes Mip 1 alpha Mip 1 ß Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota
    30. 30. HIV prefers to infect activated CD4 T-cells <ul><li>93-99% of HIV infects activated CD4 cells, which are HIV’s favorite “food” </li></ul><ul><ul><li>HIV occasionally infects unactivated or “resting” CD4 cells, where for years it can hide from the immune system </li></ul></ul><ul><li>By activating CD4 cells to mobilize a counterattack, the immune system is actually “feeding” HIV </li></ul>
    31. 31. Function of the CD4 T Cell after infection Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antigen Presenting Cell Promote B-cell Antibody Response (also called “ Humoral” response ) Promote Killer T-cells (also called “CTL” short for “Cytotoxic T-Lymphocyte”) Secrete ß Chemokines Rantes Mip 1 alpha Mip 1 ß Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota
    32. 32. (Pause) Why are we spending so much time on this science stuff?
    33. 33. So everyone will know how complex this is And so you will be able refute anyone who denies that HIV causes AIDS
    34. 34. How antibodies work <ul><li>Antibodies work by binding to particular fragments of HIV as the virus floats in the blood or lymph. </li></ul><ul><li>These fragments are called “epitopes.” </li></ul><ul><li>When the antibody binds to the epitope, it “neutralizes” the virus, rendering it harmless. </li></ul>Graphic (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center
    35. 35. Antibodies try to snare HIV Slide (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center New virus assembly B cell
    36. 36. But HIV eludes antibodies <ul><li>HIV is sheathed in an “envelope” </li></ul><ul><ul><li>The envelope is the most mutable part of HIV, so HIV keeps changing its coat, making it impossible for antibodies to bind. </li></ul></ul><ul><li>HIV uses part of the envelope to enter cells </li></ul><ul><ul><li>But these critical parts are cloaked with carbohydrates molecules. Antibodies rarely bind effectively to carbohydrates. </li></ul></ul>Image from The National Cancer Institute, http://newscenter.cancer.gov/sciencebehind/immune/immune00.htm
    37. 37. Killer T-cells are “big guns” in viral infections <ul><li>Antibodies snare free-floating virus </li></ul><ul><li>But viruses infiltrate cells </li></ul><ul><ul><li>They turn the cells into factories that churn out thousands of copies of themselves </li></ul></ul><ul><ul><li>Inside the cells, they are protected from antibodies </li></ul></ul><ul><ul><li>HIV also mutates to escape the antibodies </li></ul></ul><ul><li>Killer T-cells kill cells that HIV has infected </li></ul>
    38. 38. This is one scientific reason that HIV is so difficult to stop once it is in the body … and why AIDS is so difficult to cure. Look 
    39. 39. HIV replicates mainly in lymph tissue, the immune-system stronghold Images from The National Cancer Institute, http://newscenter.cancer.gov/sciencebehind/immune/immune00.htm
    40. 40. Site of HIV Production and Storage Photos and slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota Lymph tissue with HIV stained to look bright. “Stars” are cells producing HIV. Close up of several cells in lymph tissue producing HIV
    41. 41. HIV in the lymph nodes <ul><li>The lymph nodes normally trap viruses in the lymphoid “germinal centers” and cleanse the viruses from the body. </li></ul><ul><li>The lymph nodes trap HIV, but doing so activates CD4 T-cells. Therefore, lymph nodes provide “food” for HIV: activated CD4+ T-cells. </li></ul><ul><li>HIV prefers to be in the very place where the immune system kills most other viruses. HIV sets up camp in the immune system’s stronghold. </li></ul><ul><li>But: The fight between HIV and the immune system is balanced at a standoff for many years </li></ul>
    42. 42. Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
    43. 43. HIV destroys the lymph nodes <ul><li>HIV causes persistent lymph-node swelling, or “lymphadenopathy,” one of the signs of HIV infection. </li></ul><ul><li>Chronic, long-lasting activation of the immune system, combined with HIV’s disruption of the normal immune regulation, causes physical destruction of the lymph nodes. </li></ul><ul><li>The lymph nodes can no longer trap and destroy HIV. The “delicate balance” tips in favor of HIV. </li></ul>
    44. 44. Lymph tissue in HIV-negative and HIV-positive people HIV-negative person Upper left-hand corner: round germinal center surrounded by healthy mantle HIV-positive for 5 years, no ARV treatment All “geographical” features destroyed—no discernible germinal centers Photos and information courtesy of Timothy Schacker, University of Minnesota
    45. 45. The consequences of HIV infection <ul><li>As HIV slowly wins the battle, the immune system can no longer repel some infections. </li></ul><ul><ul><li>These are called “opportunistic infections” (OIs for short) because they take the “opportunity” given to them by the weakened immune system. </li></ul></ul><ul><li>These other infections are what kills people. HIV itself does not (though it can cause dementia.) </li></ul>
    46. 46. Antiretroviral drugs (ARVs) attack HIV itself <ul><li>They stop HIV from replicating, but they do not eradicate HIV from the body </li></ul><ul><li>They allow the immune system to recover </li></ul><ul><ul><li>Not full immune reconstitution. Lymphoid tissue often retains signs of damage; CD4 cells often don’t rise to pre-HIV levels. </li></ul></ul><ul><ul><li>But usually enough immune recovery to fight off most infections. </li></ul></ul><ul><li>Therefore, ARVs take the place of drugs to prevent or treat most OIs </li></ul><ul><li>But antiretroviral drugs are expensive </li></ul>
    47. 47. Antiretroviral drugs (ARVs) block HIV’s assault on the CD4 T-cell Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antigen Presenting Cell Promote B-cell Antibody Response (also called “ Humoral” response ) Promote Killer T-cells (also called “CTL” short for “Cytotoxic T-Lymphocyte”) Secrete ß Chemokines Rantes Mip 1alpha Mip 1 ß Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota. ARV graphic (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center ARVs
    48. 48. Lymph nodes in HIV-negative, HIV-positive, and ARV-treated patients HIV-negative person Upper left-hand corner: Round “germinal center” surrounded by healthy mantle HIV-positive for 5 years, no ARV treatment All “geographical” features destroyed—no discernible germinal centers The same HIV-positive patient after 6 months on ARV treatment Germinal centers discernible again but lack healthy surrounding mantle Photos and information courtesy of Timothy Schacker, University of Minnesota
    49. 49. Without ARVs, many non-HIV “OIs” can be cured or prevented cheaply <ul><li>Tuberculosis </li></ul><ul><li>Pneumocystis Carinii Peumonia </li></ul><ul><li>Thrush (candidiasis) </li></ul><ul><li>Cyrptococcal meningitis </li></ul><ul><li>Can be prevented short-term with INH. Cured with combination antibiotics. </li></ul><ul><li>Can be prevented with Cotrimoxazole (Bactrim) and cured with that and other antibiotics. </li></ul><ul><li>Can be cured with fluconazole. </li></ul><ul><li>Can be cured and prevented from recurring with fluconzazole. </li></ul>
    50. 50. (This ends Mark’s brilliant review of HIV/AIDS)
    51. 51. So why is there no vaccine against, or a cure for, HIV/AIDS?
    52. 52. Unfortunately, these are some of the responses … <ul><li>The virus is incredibly complex and operates in a way rarely seen before </li></ul><ul><li>Theories about how HIV operates have all had failings </li></ul><ul><li>Drug development takes time, and is expensive. </li></ul><ul><li>When testing a new drug, the risk to the individual trial patient must be weighed against the hoped-for benefit </li></ul><ul><li>Global HIV Vaccine Enterprise </li></ul>
    53. 53. So until medicine and science can give us the answer … We have to look at ways to prevent HIV infections & AIDS
    54. 54. HIV/AIDS As A Public Health Issue
    55. 55. Some basic definitions <ul><li>HIV – Human Immunodeficiency Virus </li></ul><ul><li>AIDS – Acquired Immune Deficiency Syndrome </li></ul><ul><li>Medicine – a focus on the individual </li></ul><ul><li>Public health – a focus on populations </li></ul><ul><li>Incidence – the number of new cases arising in a given population in a given time </li></ul><ul><li>Prevalence – the proportion of people with HIV at a specific point in time; expressed as a %. </li></ul>
    56. 56. Some basic definitions <ul><li>HIV – Human Immunodeficiency Virus </li></ul><ul><li>AIDS – Acquired Immune Deficiency Syndrome </li></ul><ul><li>Medicine – a focus on the individual </li></ul><ul><li>Public health – a focus on populations </li></ul><ul><li>Incidence – the number of new cases arising in a given population in a given time </li></ul><ul><li>Prevalence – the proportion of people with HIV at a specific point in time; expressed as a %. </li></ul>
    57. 57. A very informal way of looking at HIV transmission … <ul><li>You have to do something </li></ul><ul><li>Or have something done to you </li></ul><ul><li>To contract HIV </li></ul>
    58. 58. Vulnerable People <ul><li>Women </li></ul><ul><ul><li>Especially in male-dominant cultures </li></ul></ul><ul><ul><li>In war zones </li></ul></ul><ul><ul><li>Sex workers </li></ul></ul><ul><li>Children </li></ul><ul><ul><li>students </li></ul></ul><ul><li>Medical workers </li></ul><ul><li>Men in risky relationships </li></ul>
    59. 59. Transmission <ul><li>Unprotected sexual contact </li></ul><ul><li>IV drug use </li></ul><ul><li>Unsafe clinical environment </li></ul><ul><li>Mother-to-child transmission </li></ul>
    60. 60. Vulnerable Groups <ul><li>Local communities </li></ul><ul><li>National defense </li></ul><ul><li>Migrant workers </li></ul><ul><li>Agriculture </li></ul><ul><li>Education </li></ul>
    61. 61. If there is infection, these are possible movements of HIV <ul><li>IDU or Sex worker </li></ul><ul><li> or Unknowingly </li></ul><ul><li>infected person </li></ul><ul><li>Spouse or Partner </li></ul><ul><ul><li>Child (in utero) </li></ul></ul><ul><li>Blood contact </li></ul><ul><li>Hospital environment </li></ul><ul><li>Unknown </li></ul>
    62. 62. Until we have a vaccine or a cure … We have to focus on prevention
    63. 63. Personal Prevention <ul><li>Condoms – Male or female </li></ul><ul><li>Microbicides </li></ul><ul><li>Limited sexual partners </li></ul><ul><li>Clean needles </li></ul><ul><li>male circumcision, for adults </li></ul>
    64. 64. Societal Prevention <ul><li>Developing of new drugs </li></ul><ul><ul><li>Distribution of those drugs </li></ul></ul><ul><ul><li>Preventing mother-to-child transmission </li></ul></ul><ul><li>Development of Vaccines </li></ul><ul><li>Sterile clinical environments </li></ul><ul><li>Government & industry attitudes </li></ul>
    65. 65. Medicine & Public Health Compared for the Benefit of Journalists
    66. 66. Medicine Public Health <ul><li>Primary focus on individual </li></ul><ul><li>Diagnosis & treatment </li></ul><ul><li>Medical care </li></ul><ul><li>Social sciences as an elective part of PH education </li></ul><ul><li>Laboratory & bedside </li></ul><ul><li>Primary focus on population </li></ul><ul><li>Emphasis on prevention </li></ul><ul><li>Interventions aimed at environment, behavior, lifestyle, medical care </li></ul><ul><li>Social science as an integral part of PH education </li></ul><ul><li>Laboratory & field work </li></ul><ul><li>( after H. Fineberg, 1990) </li></ul>
    67. 67. Leading Causes of Death In the United States <ul><li>In the Year 1900 </li></ul><ul><li>Influenza </li></ul><ul><li>Pneumonia </li></ul><ul><li>Tuberculosis </li></ul><ul><li>Gastritis </li></ul><ul><li>Heart Disease </li></ul><ul><li>Cerebrovascular Diseases </li></ul><ul><li>Chronic Nephritis </li></ul><ul><li>Accidents </li></ul><ul><li>Cancer and other Malignant Tumors </li></ul><ul><li>Early Infancy Diseases </li></ul><ul><li>Diphtheria </li></ul><ul><li>In the Year 2000 </li></ul><ul><li>Tobacco </li></ul><ul><li>Poor Diet and Physical Inactivity </li></ul><ul><li>Alcohol Consumption </li></ul><ul><li>Microbial Agents </li></ul><ul><li>Toxic Agents </li></ul><ul><li>Motor Vehicle Crashes </li></ul><ul><li>Incidents involving Firearms </li></ul><ul><li>Sexual Behaviors </li></ul><ul><li>Illicit Use of Drugs </li></ul>
    68. 68. Each of the following pictures can be viewed … <ul><li>as a story of an individual </li></ul><ul><li>Or as the story of community issue </li></ul><ul><li>Or both </li></ul>
    69. 69.
    70. 70.
    71. 71.
    72. 72.
    73. 73. And if you’re going to view them as both, then you need two more basic definitions …
    74. 74. Some basic definitions <ul><li>HIV – Human Immunodeficiency Virus </li></ul><ul><li>AIDS – Acquired Immune Deficiency Syndrome </li></ul><ul><li>Medicine – a focus on the individual </li></ul><ul><li>Public health – a focus on populations </li></ul><ul><li>Incidence – the number of new cases arising in a given population in a given time </li></ul><ul><li>Prevalence – the proportion of people with HIV at a specific point in time; expressed as a %. </li></ul>
    75. 75. Journalism Practice
    76. 76. In the next four days we’re going to look at a lot of issues, both as journalists and as concerned citizens...
    77. 77. … But right now I want to briefly discuss this question – do we as journalists have a special obligation to cover HIV/AIDS?
    78. 78.
    79. 79. I believe that AIDS is curable… <ul><li>Despite all the failed vaccine trials </li></ul><ul><li>Despite the failed scientific interventions </li></ul><ul><li>Despite the difficulties at prevention… </li></ul>
    80. 80. HIV/AIDS is curable … through education
    81. 81.
    82. 82. Journalists are educators… <ul><li>We research difficult situations </li></ul><ul><li>We show people what we have learned </li></ul><ul><li>We give them information </li></ul><ul><ul><li>so they can improve their lives </li></ul></ul><ul><ul><li>so they can improve society </li></ul></ul>
    83. 83. Because we are educators, and given … <ul><li>The size of the epidemic </li></ul><ul><li>The potential for its growth </li></ul><ul><li>The impact on society </li></ul><ul><li>The impact on people </li></ul>
    84. 84. And the fact that print, or broadcast & online journalists cover everything from …. <ul><li>Poor people </li></ul><ul><li>Rich people </li></ul><ul><li>National defense </li></ul><ul><li>Marginalized populations </li></ul><ul><li>Sex workers </li></ul><ul><li>Our country’s future </li></ul>
    85. 85. Then I think we can educate many segments of the population about what we know.
    86. 86. And I think that is why we came here …
    87. 87.
    88. 88. Thank you!
    89. 89. Acknowledgements <ul><li>Mark Schoofs, The Wall Street Journal </li></ul><ul><li>Anthony S. Fauci & Greg Folkers, National Institute of Allergy and Infectious Diseases </li></ul><ul><li>Bruce D. Walker & Marylyn Addo, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center </li></ul><ul><li>Timothy Schacker, University of Minnesota </li></ul><ul><li>Laurie Garrett, Newsday, & Omololu Falobi, Journalists Against AIDS Nigeria </li></ul><ul><li>Howard Hughes Medical Institute </li></ul>

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