This document summarizes a presentation on insurability and survival of people living with HIV and other chronic diseases like diabetes. It discusses:
1) Comparing mortality of HIV-infected South Africans initiating antiretroviral therapy to those initiating diabetes treatment and a control group to assess insurability.
2) HIV disease progression improved greatly with long-term antiretroviral therapy but long-term mortality remains uncertain.
3) Type 2 diabetes requires similar lifelong treatment to HIV and its control is associated with better outcomes, making it a relevant comparison.
4) Preliminary results show HIV mortality decreases with longer time on treatment and higher original CD4 count, but excess mortality remains compared to other groups
frequency of hepatitis C virus infection in patients with type 2 diabetes mel...Dr Tarique Ahmed Maka
ABSTRACT
Objective: To determine the frequency of hepatitis C virus infection in patients with type 2 diabetes mellitus and to look for the common risk factors leading to this infection in diabetics. Study Design: Descriptive cross sectional study design. Place and Duration of Study: Department of Medicine, Combined Military Hospital (CMH) Kharian, from Jan 2015 to Jun 2015. Patients and Methods: This study was conducted in the department of Medicine, Combined Military Hospital Kharian. Through a descriptive cross sectional study design, a total of 140 patients with type 2 diabetes mellitus, admitted through casualty, OPD or private clinics were selected and tested for Hepatitis C virus infection. The common risk factors leading to such infection among positive cases were also scrutinized. Results: The mean age of patients was 48.82 ± 10.14 with 60.7% female gender predominating the overall sample of diabetics. Using 3rd generation ELISA method, hepatitis C virus was found in 45 (32.1%) of patients with 41-50 years of age group most commonly affected age group (34.7%) and female (57.8%) commonly affected gender. The distribution of risk factors leading to hepatitis C virus in diabetics are: 21 (46.7%) had history of surgery in the past, 13 (28.9%) had history of blood transfusion in the past, 7 (15.55%) had history of hemodialysis while only 4 (8.9%) had history of tattooing in the past. Conclusion: Hepatitis C virus infection is still a common problem in diabetic patients of our local population and we recommend further research work over its risk factors so that the guidelines for its control may be formulated. Keywords: Blood transfusion, Diabetes Mellitus, Haemodialysis, Hepatitis C virus infection, Risk Factors, Surgery, Tattooing.
India has seen a 57% reduction in its HIV count between 2001-2011, while Bangladesh and Sri Lanka saw increases of 25%. As of 2011, an estimated 2.1 million people in India were living with HIV. India's epidemic is heterogeneous and concentrated in certain states and sub-populations. Successful prevention efforts have led international figures to praise India's HIV/AIDS prevention model. However, more work remains as even a small increase in prevalence could mean over half a million new infections. The continuum of HIV care involves testing and counseling, treatment of opportunistic infections, anti-retroviral therapy initiation and monitoring, management of co-infections, and adherence support. WHO guidelines recommend treatment for all HIV-positive individuals
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This article analyzes data from two HIV cohorts in Cote d'Ivoire to determine CD4 cell count-specific rates of AIDS, death, tuberculosis, and other diseases before antiretroviral therapy (ART). Over 2700 person-years of follow up, rates of AIDS or death increased from 0.9 to 99.9 events per 100 person-years as CD4 counts decreased from 650 to below 50 cells/uL. For patients with CD4>200 cells/uL, tuberculosis was the most common AIDS-defining illness (4.0 to 0.6 events/100 person-years) and invasive bacterial diseases were the most common non-AIDS illnesses (9.1 to 3.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Julia del Amo, Instituto de Salud Carlos III, Madrid
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Elliot Welford, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Assessment of Renal Function and Serum Levels of Alpha Tocopherol in HIV Sero...paperpublications3
Abstract: Increased Oxidative Stress markers in HIV/AIDS Patients may be as a result of free radicals generation and evidence is accumulating that Highly Active Antiretroviral Therapy (HAART) mimics AIDS progression but may be costly due to its Nephrotoxicity. In this research serum levels of Alpha tocopherol ( α- tocopherol), Urea, Creatinine as well as CD4 Counts were measured in 70 HIV Seropositive Patients (40 on HAART and 30 HAART-Naïve) and Thirty (30) apparently healthy individuals as controls in Federal Medical Centre Katsina, Nigeria.CD4 Counts, Serum Levels of Alpha tocopherol, Urea and Creatinine of HIV-HAART and HAART Naïve were 0.72±0.27mg/dl, 16.8±5.6 mmol/l, 237±123 µmol/l and 646±254cell/µl and 0.3±0.1mg/dl, 10.4±2.9 mmol/l, 91±26 µmol/l and 364±17 cell/ µl respectively. There were significantly (p<0.05) increased CD4 counts, serum levels of Alpha tocopherol, Urea and Creatinine in HIV/AIDS Patients on HAART compared to HAART- Naive. This is an indication that HIV/AIDS are predisposed to oxidative stress and that also HAART has debilitating effects on kidneys.
frequency of hepatitis C virus infection in patients with type 2 diabetes mel...Dr Tarique Ahmed Maka
ABSTRACT
Objective: To determine the frequency of hepatitis C virus infection in patients with type 2 diabetes mellitus and to look for the common risk factors leading to this infection in diabetics. Study Design: Descriptive cross sectional study design. Place and Duration of Study: Department of Medicine, Combined Military Hospital (CMH) Kharian, from Jan 2015 to Jun 2015. Patients and Methods: This study was conducted in the department of Medicine, Combined Military Hospital Kharian. Through a descriptive cross sectional study design, a total of 140 patients with type 2 diabetes mellitus, admitted through casualty, OPD or private clinics were selected and tested for Hepatitis C virus infection. The common risk factors leading to such infection among positive cases were also scrutinized. Results: The mean age of patients was 48.82 ± 10.14 with 60.7% female gender predominating the overall sample of diabetics. Using 3rd generation ELISA method, hepatitis C virus was found in 45 (32.1%) of patients with 41-50 years of age group most commonly affected age group (34.7%) and female (57.8%) commonly affected gender. The distribution of risk factors leading to hepatitis C virus in diabetics are: 21 (46.7%) had history of surgery in the past, 13 (28.9%) had history of blood transfusion in the past, 7 (15.55%) had history of hemodialysis while only 4 (8.9%) had history of tattooing in the past. Conclusion: Hepatitis C virus infection is still a common problem in diabetic patients of our local population and we recommend further research work over its risk factors so that the guidelines for its control may be formulated. Keywords: Blood transfusion, Diabetes Mellitus, Haemodialysis, Hepatitis C virus infection, Risk Factors, Surgery, Tattooing.
India has seen a 57% reduction in its HIV count between 2001-2011, while Bangladesh and Sri Lanka saw increases of 25%. As of 2011, an estimated 2.1 million people in India were living with HIV. India's epidemic is heterogeneous and concentrated in certain states and sub-populations. Successful prevention efforts have led international figures to praise India's HIV/AIDS prevention model. However, more work remains as even a small increase in prevalence could mean over half a million new infections. The continuum of HIV care involves testing and counseling, treatment of opportunistic infections, anti-retroviral therapy initiation and monitoring, management of co-infections, and adherence support. WHO guidelines recommend treatment for all HIV-positive individuals
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This article analyzes data from two HIV cohorts in Cote d'Ivoire to determine CD4 cell count-specific rates of AIDS, death, tuberculosis, and other diseases before antiretroviral therapy (ART). Over 2700 person-years of follow up, rates of AIDS or death increased from 0.9 to 99.9 events per 100 person-years as CD4 counts decreased from 650 to below 50 cells/uL. For patients with CD4>200 cells/uL, tuberculosis was the most common AIDS-defining illness (4.0 to 0.6 events/100 person-years) and invasive bacterial diseases were the most common non-AIDS illnesses (9.1 to 3.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Julia del Amo, Instituto de Salud Carlos III, Madrid
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Elliot Welford, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Assessment of Renal Function and Serum Levels of Alpha Tocopherol in HIV Sero...paperpublications3
Abstract: Increased Oxidative Stress markers in HIV/AIDS Patients may be as a result of free radicals generation and evidence is accumulating that Highly Active Antiretroviral Therapy (HAART) mimics AIDS progression but may be costly due to its Nephrotoxicity. In this research serum levels of Alpha tocopherol ( α- tocopherol), Urea, Creatinine as well as CD4 Counts were measured in 70 HIV Seropositive Patients (40 on HAART and 30 HAART-Naïve) and Thirty (30) apparently healthy individuals as controls in Federal Medical Centre Katsina, Nigeria.CD4 Counts, Serum Levels of Alpha tocopherol, Urea and Creatinine of HIV-HAART and HAART Naïve were 0.72±0.27mg/dl, 16.8±5.6 mmol/l, 237±123 µmol/l and 646±254cell/µl and 0.3±0.1mg/dl, 10.4±2.9 mmol/l, 91±26 µmol/l and 364±17 cell/ µl respectively. There were significantly (p<0.05) increased CD4 counts, serum levels of Alpha tocopherol, Urea and Creatinine in HIV/AIDS Patients on HAART compared to HAART- Naive. This is an indication that HIV/AIDS are predisposed to oxidative stress and that also HAART has debilitating effects on kidneys.
HIV infection is increasingly affecting older individuals as treatment allows for longer lifespans. Older adults with HIV have higher rates of age-related comorbidities like cardiovascular disease, cancer, liver disease, kidney disease, lung disease, and bone disease than HIV-negative individuals of the same age. Management of these conditions in HIV requires screening for comorbidities, treating underlying viral infections, modifying lifestyle factors, and following guidelines for prevention and treatment of common age-related diseases.
This document discusses stroke in HIV infection. It begins by providing background on HIV/AIDS classifications and prevalence statistics. It then describes the CDC classification system for HIV infection and lists conditions under categories B and C. It discusses the epidemiology of stroke in HIV patients, noting rates vary from 0.5-5% in studies. Potential causes of ischemic and hemorrhagic stroke are outlined. Treatment focuses on underlying infections or disorders. While HAART reduced some complications, protease inhibitors may increase atherosclerosis risk. In conclusion, strokes in HIV patients tend to occur in severe immunosuppression and various infectious etiologies can cause ischemic or hemorrhagic strokes.
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This study analyzed cancer-related mortality among 83,282 people with AIDS in the United States from 1980 to 2006. Cancer mortality rates decreased significantly over time, as did AIDS-related mortality rates, due to increased availability of antiretroviral therapy. However, the proportion of deaths due to cancer increased, as other causes of AIDS-related mortality dramatically declined. Non-Hodgkin lymphoma remained the most common cancer cause of death. Lung cancer was the most frequent non-AIDS defining cancer cause of death. Improved cancer prevention and treatment could further reduce mortality among people with AIDS.
Regional epidemiology of hypertension in the GulfJAFAR ALSAID
This document discusses the prevalence of hypertension in the Gulf region and globally. It notes that hypertension currently affects around 25% of the population in the Gulf and 40% worldwide. If trends continue, it is estimated that the number of people with hypertension will double by 2050 to over 90 million in the Gulf alone. Other cardiovascular risk factors like diabetes, obesity, and hyperlipidemia are also increasing worldwide and contributing to the growing burden of non-communicable diseases. Urgent action is needed through increased awareness, prevention and management efforts to address this major health challenge.
Hypertension in Developing Countries 3JAFAR ALSAID
The document discusses hypertension prevalence and management in developing countries. It finds that hypertension prevalence is increasing globally and is a major public health challenge, especially in developing nations with limited resources. Studies show awareness, treatment and control rates are lowest in low-income countries compared to upper-middle and high-income nations. Urbanization, lifestyle changes and other risk factors are contributing to growing rates in developing areas. Improved prevention, access to care, medication and management are needed to address the substantial hypertension burden expected to rise further in coming decades if left unaddressed.
This presentation summarizes research on cryptococcal antigen screening and treatment in resource-limited settings. It finds that screening individuals with CD4 counts <100 cells/uL and <200 cells/uL can reduce mortality, and point-of-care tests now enable screening in primary care clinics. Studies of simplified treatment regimens show promise, such as using high-dose liposomal amphotericin B for only 1-2 weeks. Field work in Mozambique demonstrated a 7.3% prevalence of cryptococcal antigenemia through screening at two clinics, and identified opportunities to improve care through expanded screening and ambulatory treatment models.
Knowledge, Attitude and Practice of Migrant Workers’ Wives on HIVAIDS in Bang...Md. Tarek Hossain
In Bangladesh, the targets under MDG-6 are to halt the spread of HIV/AIDS, malaria and other diseases by 2015 and reverse the spread of the diseases. The increasing trend of HIV/AIDS positively indicates that country is on the brink of a nationwide crisis. Mobility is a key structural factor that has been linked to increased HIV incidence and vulnerability globally. Bangladeshi migrant workers suffer problems found among other internal and international migrant groups including socioeconomic and power inequalities, limited social capital, loneliness, and coping with different cultural norms relating to sex. HIV transmission from international migrant workers who have returned and are HIV positive has been mostly restricted to their spouses, although the degree of spousal transmission and couples in which one person is HIV positive and putting the other at high risk has not been evaluated methodically in Bangladesh. Given the large numbers of people on the move, ensuring the rights and access to HIV prevention, treatment and care and support services for the wives of these migrant workers is a crucial component of an effective regional response to HIV. Therefore, it is important to analyze the knowledge, attitude and practice level of these groups of women. Therefore, the present study aims to analyze the knowledge, attitude and practice of wives of the emigrant workers of Bangladesh and factors that may influence their health decisions. Seven
(7) districts from seven (7) administrative divisions of the country were selected purposively as the study area. The study areas include Tangail (Dhaka division), Comilla (Chittagong division), Moulovibazar (Sylhet division), Meherpur (Khulna division), Dinajpur (Rangpur division), Barisal (Barisal division) and Serajganj (Rajshahi division). Women at their reproductive age from selected households of these seven districts, whose heads are/used to be a migrant worker, was the study subject. Respondents also include health service professionals from the study areas. The general knowledge/ perception, attitudes, and practices were assessed through qualitative study method while a quantitative socio economic survey was also done to attain information related to respondents’ age, education, income and expenditure. The tools include in-depth interview (II), focus group discussion (FGD) and key informant interview (KII). In total,
70 KIIs and 7 FGDs with 63 women participants were done while a short survey of the socioeconomic status of all 133 women was conducted through structured questionnaire.
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
1) The document discusses the rising burden of cardiovascular disease (CVD) in India, highlighting that it is occurring a decade earlier and is a leading cause of death under 70 years of age.
2) It presents data on the traditional risk factors for CVD in India, such as high rates of hypertension, diabetes, tobacco use, physical inactivity, and air pollution. These risk factors are occurring at younger ages.
3) The National Programme for Prevention and Control of Cancer, Diabetes, CVDs and Stroke (NPCDCS) aims to prevent and control non-communicable diseases through screening, early diagnosis, and management across primary healthcare centers and district hospitals in India.
Prevalence of HCV virus genotypes in Albaniatheijes
The epidemic of Hepatitis C virus infection is continuously evolving in Albania such as in Europe. Until now the intravenous drug use has become the main risk factor for the HCV transmission, prevalent infections have increased and genotype distribution has changed and diversified. Meanwhile in Eastern European countries epidemiological data are limited such as in Albania. Through this study, we furnish more information about the prevalence of HCV virus genotypes in Albania. Methods: In this study we enrolled 174 subjects HCV RNA positive during the period 2007-2015 with an median age of 38.7 years old, from the Public Health Institute and National Blood Transfusion Centre, Albania. Results: The HCV virus genotype 1b is the most frequent with 35.6% (62/174). It’s important to mention that genotype 3 and 3a is more frequent among IDU (Intravenous drug users). Conclusions: Even though limited data, we noticed that HCV virus genotype 1b is the most frequent in Albania such as in other countries of Central-South Europe. Parenteral route of transmission of different subtypes of this virus in Albania is very evident, but further epidemiological studies are required.
The document discusses the START trial, which aims to determine if initiating antiretroviral treatment (ART) earlier in HIV-infected individuals with CD4 counts above 500 cells/mm3 can reduce morbidity and mortality compared to deferring ART until the CD4 count falls below 350 cells/mm3. The START trial will randomize 4,000 participants to either initiate ART immediately or defer ART, and follow them to measure rates of AIDS-related events, serious non-AIDS events, and death. Preliminary results from SMART and observational studies provide evidence that continuous ART use may reduce non-AIDS related complications in HIV-infected individuals.
This document discusses the epidemiology of hypertension globally and nationally in India. Some key points:
- Globally, nearly 1 billion adults had hypertension in 2000, predicted to increase to 1.56 billion by 2025. Hypertension contributes to 13% of global deaths.
- In India, the prevalence of hypertension has risen from 2-15% in urban areas and 2-8% in rural areas in the late 1990s/early 2000s to approximately 25% in urban adults and 10-15% in rural adults currently.
- Cardiovascular disease is the leading cause of death in India, responsible for over 2 million deaths annually according to recent reports. There are large regional variations in cardiovascular mortality within
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
This document provides an overview and summary of recent data on antiretroviral therapy (ART) for HIV. Key findings include:
- A study in Thailand found that daily oral tenofovir reduced HIV infection risk among injection drug users by 48.9%, leading to new guidelines recommending PrEP for high-risk drug users.
- US demonstration projects found high adherence to PrEP among at-risk populations, with tenofovir levels indicating protection.
- Multiple studies found dolutegravir to be superior to other regimens in suppressing HIV and had fewer side effects, establishing it as a preferred integrase inhibitor.
- No transmissions occurred in a large study of serod
HCV/HIV co-infection is common, with prevalence rates as high as 60% in some groups. Coinfection may accelerate the progression of liver disease and increase the risk of complications like cirrhosis and liver cancer. Successful treatment of HCV has the potential benefits of reducing liver disease progression, improving tolerance of antiretroviral therapy, and decreasing the risk of liver-related death. However, HCV treatment can also cause side effects and drug interactions with antiretrovirals require careful management. Overall, treatment should be considered on a case by case basis for coinfected patients with stable HIV control and significant liver disease.
This document provides guidelines for the management of persons living with HIV, including recommendations for antiretroviral therapy (ART). It discusses the goals of ART which are to suppress HIV viral load, improve CD4 counts, delay drug resistance, and confer clinical benefits. Initiation of ART is recommended for all individuals regardless of CD4 count to reduce morbidity and mortality and prevent transmission. First-line regimens usually consist of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (INSTI), non-nucleoside reverse transcriptase inhibitor (NNRTI), or protease inhibitor (PI) with a booster. Adherence counseling and management of comorbid
Evolution and Revolution: Current Issues in HIV and HCV Co-infection
Chapter 1 – HIV-Hepatitis C Virus Co-infection: An evolving epidemic
Chapter 2 - Management of HIV infection in HIV/HCV co-infected patients
Chapter 3 - Management of HCV in co-infected patients
Chapter 4 - HCV Therapy: Direct acting antiviral agents in co-infected individuals
Chapter 5 - Drug interactions with directly acting antivirals for HCV: Overview & challenges in HIV/HCV Co-infection
Chapter 6 - Complicated cases
Chapter 7 - Future trials of Hepatitis C therapy in the HIV co-infected
Chapter 8 - HCV infection in marginalized populations
Chapter 9 - HIV/HCV Co-infection: Through the eyes of a co-infected hemophiliac
This document provides an overview of Acquired Immunodeficiency Syndrome (AIDS) and the Human Immunodeficiency Virus (HIV) that causes it. It discusses how HIV breaks down the immune system, leaving those infected vulnerable to life-threatening infections. The document outlines the history of the HIV epidemic and how it has affected both developed and developing countries. It also summarizes HIV transmission routes, clinical stages of infection from initial exposure to AIDS, diagnostic testing approaches, treatment options including antiretroviral drugs, prevention strategies, and healthcare follow-up for those living with HIV/AIDS.
HIV infection is increasingly affecting older individuals as treatment allows for longer lifespans. Older adults with HIV have higher rates of age-related comorbidities like cardiovascular disease, cancer, liver disease, kidney disease, lung disease, and bone disease than HIV-negative individuals of the same age. Management of these conditions in HIV requires screening for comorbidities, treating underlying viral infections, modifying lifestyle factors, and following guidelines for prevention and treatment of common age-related diseases.
This document discusses stroke in HIV infection. It begins by providing background on HIV/AIDS classifications and prevalence statistics. It then describes the CDC classification system for HIV infection and lists conditions under categories B and C. It discusses the epidemiology of stroke in HIV patients, noting rates vary from 0.5-5% in studies. Potential causes of ischemic and hemorrhagic stroke are outlined. Treatment focuses on underlying infections or disorders. While HAART reduced some complications, protease inhibitors may increase atherosclerosis risk. In conclusion, strokes in HIV patients tend to occur in severe immunosuppression and various infectious etiologies can cause ischemic or hemorrhagic strokes.
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This study analyzed cancer-related mortality among 83,282 people with AIDS in the United States from 1980 to 2006. Cancer mortality rates decreased significantly over time, as did AIDS-related mortality rates, due to increased availability of antiretroviral therapy. However, the proportion of deaths due to cancer increased, as other causes of AIDS-related mortality dramatically declined. Non-Hodgkin lymphoma remained the most common cancer cause of death. Lung cancer was the most frequent non-AIDS defining cancer cause of death. Improved cancer prevention and treatment could further reduce mortality among people with AIDS.
Regional epidemiology of hypertension in the GulfJAFAR ALSAID
This document discusses the prevalence of hypertension in the Gulf region and globally. It notes that hypertension currently affects around 25% of the population in the Gulf and 40% worldwide. If trends continue, it is estimated that the number of people with hypertension will double by 2050 to over 90 million in the Gulf alone. Other cardiovascular risk factors like diabetes, obesity, and hyperlipidemia are also increasing worldwide and contributing to the growing burden of non-communicable diseases. Urgent action is needed through increased awareness, prevention and management efforts to address this major health challenge.
Hypertension in Developing Countries 3JAFAR ALSAID
The document discusses hypertension prevalence and management in developing countries. It finds that hypertension prevalence is increasing globally and is a major public health challenge, especially in developing nations with limited resources. Studies show awareness, treatment and control rates are lowest in low-income countries compared to upper-middle and high-income nations. Urbanization, lifestyle changes and other risk factors are contributing to growing rates in developing areas. Improved prevention, access to care, medication and management are needed to address the substantial hypertension burden expected to rise further in coming decades if left unaddressed.
This presentation summarizes research on cryptococcal antigen screening and treatment in resource-limited settings. It finds that screening individuals with CD4 counts <100 cells/uL and <200 cells/uL can reduce mortality, and point-of-care tests now enable screening in primary care clinics. Studies of simplified treatment regimens show promise, such as using high-dose liposomal amphotericin B for only 1-2 weeks. Field work in Mozambique demonstrated a 7.3% prevalence of cryptococcal antigenemia through screening at two clinics, and identified opportunities to improve care through expanded screening and ambulatory treatment models.
Knowledge, Attitude and Practice of Migrant Workers’ Wives on HIVAIDS in Bang...Md. Tarek Hossain
In Bangladesh, the targets under MDG-6 are to halt the spread of HIV/AIDS, malaria and other diseases by 2015 and reverse the spread of the diseases. The increasing trend of HIV/AIDS positively indicates that country is on the brink of a nationwide crisis. Mobility is a key structural factor that has been linked to increased HIV incidence and vulnerability globally. Bangladeshi migrant workers suffer problems found among other internal and international migrant groups including socioeconomic and power inequalities, limited social capital, loneliness, and coping with different cultural norms relating to sex. HIV transmission from international migrant workers who have returned and are HIV positive has been mostly restricted to their spouses, although the degree of spousal transmission and couples in which one person is HIV positive and putting the other at high risk has not been evaluated methodically in Bangladesh. Given the large numbers of people on the move, ensuring the rights and access to HIV prevention, treatment and care and support services for the wives of these migrant workers is a crucial component of an effective regional response to HIV. Therefore, it is important to analyze the knowledge, attitude and practice level of these groups of women. Therefore, the present study aims to analyze the knowledge, attitude and practice of wives of the emigrant workers of Bangladesh and factors that may influence their health decisions. Seven
(7) districts from seven (7) administrative divisions of the country were selected purposively as the study area. The study areas include Tangail (Dhaka division), Comilla (Chittagong division), Moulovibazar (Sylhet division), Meherpur (Khulna division), Dinajpur (Rangpur division), Barisal (Barisal division) and Serajganj (Rajshahi division). Women at their reproductive age from selected households of these seven districts, whose heads are/used to be a migrant worker, was the study subject. Respondents also include health service professionals from the study areas. The general knowledge/ perception, attitudes, and practices were assessed through qualitative study method while a quantitative socio economic survey was also done to attain information related to respondents’ age, education, income and expenditure. The tools include in-depth interview (II), focus group discussion (FGD) and key informant interview (KII). In total,
70 KIIs and 7 FGDs with 63 women participants were done while a short survey of the socioeconomic status of all 133 women was conducted through structured questionnaire.
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
1) The document discusses the rising burden of cardiovascular disease (CVD) in India, highlighting that it is occurring a decade earlier and is a leading cause of death under 70 years of age.
2) It presents data on the traditional risk factors for CVD in India, such as high rates of hypertension, diabetes, tobacco use, physical inactivity, and air pollution. These risk factors are occurring at younger ages.
3) The National Programme for Prevention and Control of Cancer, Diabetes, CVDs and Stroke (NPCDCS) aims to prevent and control non-communicable diseases through screening, early diagnosis, and management across primary healthcare centers and district hospitals in India.
Prevalence of HCV virus genotypes in Albaniatheijes
The epidemic of Hepatitis C virus infection is continuously evolving in Albania such as in Europe. Until now the intravenous drug use has become the main risk factor for the HCV transmission, prevalent infections have increased and genotype distribution has changed and diversified. Meanwhile in Eastern European countries epidemiological data are limited such as in Albania. Through this study, we furnish more information about the prevalence of HCV virus genotypes in Albania. Methods: In this study we enrolled 174 subjects HCV RNA positive during the period 2007-2015 with an median age of 38.7 years old, from the Public Health Institute and National Blood Transfusion Centre, Albania. Results: The HCV virus genotype 1b is the most frequent with 35.6% (62/174). It’s important to mention that genotype 3 and 3a is more frequent among IDU (Intravenous drug users). Conclusions: Even though limited data, we noticed that HCV virus genotype 1b is the most frequent in Albania such as in other countries of Central-South Europe. Parenteral route of transmission of different subtypes of this virus in Albania is very evident, but further epidemiological studies are required.
The document discusses the START trial, which aims to determine if initiating antiretroviral treatment (ART) earlier in HIV-infected individuals with CD4 counts above 500 cells/mm3 can reduce morbidity and mortality compared to deferring ART until the CD4 count falls below 350 cells/mm3. The START trial will randomize 4,000 participants to either initiate ART immediately or defer ART, and follow them to measure rates of AIDS-related events, serious non-AIDS events, and death. Preliminary results from SMART and observational studies provide evidence that continuous ART use may reduce non-AIDS related complications in HIV-infected individuals.
This document discusses the epidemiology of hypertension globally and nationally in India. Some key points:
- Globally, nearly 1 billion adults had hypertension in 2000, predicted to increase to 1.56 billion by 2025. Hypertension contributes to 13% of global deaths.
- In India, the prevalence of hypertension has risen from 2-15% in urban areas and 2-8% in rural areas in the late 1990s/early 2000s to approximately 25% in urban adults and 10-15% in rural adults currently.
- Cardiovascular disease is the leading cause of death in India, responsible for over 2 million deaths annually according to recent reports. There are large regional variations in cardiovascular mortality within
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
This document provides an overview and summary of recent data on antiretroviral therapy (ART) for HIV. Key findings include:
- A study in Thailand found that daily oral tenofovir reduced HIV infection risk among injection drug users by 48.9%, leading to new guidelines recommending PrEP for high-risk drug users.
- US demonstration projects found high adherence to PrEP among at-risk populations, with tenofovir levels indicating protection.
- Multiple studies found dolutegravir to be superior to other regimens in suppressing HIV and had fewer side effects, establishing it as a preferred integrase inhibitor.
- No transmissions occurred in a large study of serod
HCV/HIV co-infection is common, with prevalence rates as high as 60% in some groups. Coinfection may accelerate the progression of liver disease and increase the risk of complications like cirrhosis and liver cancer. Successful treatment of HCV has the potential benefits of reducing liver disease progression, improving tolerance of antiretroviral therapy, and decreasing the risk of liver-related death. However, HCV treatment can also cause side effects and drug interactions with antiretrovirals require careful management. Overall, treatment should be considered on a case by case basis for coinfected patients with stable HIV control and significant liver disease.
This document provides guidelines for the management of persons living with HIV, including recommendations for antiretroviral therapy (ART). It discusses the goals of ART which are to suppress HIV viral load, improve CD4 counts, delay drug resistance, and confer clinical benefits. Initiation of ART is recommended for all individuals regardless of CD4 count to reduce morbidity and mortality and prevent transmission. First-line regimens usually consist of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (INSTI), non-nucleoside reverse transcriptase inhibitor (NNRTI), or protease inhibitor (PI) with a booster. Adherence counseling and management of comorbid
Evolution and Revolution: Current Issues in HIV and HCV Co-infection
Chapter 1 – HIV-Hepatitis C Virus Co-infection: An evolving epidemic
Chapter 2 - Management of HIV infection in HIV/HCV co-infected patients
Chapter 3 - Management of HCV in co-infected patients
Chapter 4 - HCV Therapy: Direct acting antiviral agents in co-infected individuals
Chapter 5 - Drug interactions with directly acting antivirals for HCV: Overview & challenges in HIV/HCV Co-infection
Chapter 6 - Complicated cases
Chapter 7 - Future trials of Hepatitis C therapy in the HIV co-infected
Chapter 8 - HCV infection in marginalized populations
Chapter 9 - HIV/HCV Co-infection: Through the eyes of a co-infected hemophiliac
This document provides an overview of Acquired Immunodeficiency Syndrome (AIDS) and the Human Immunodeficiency Virus (HIV) that causes it. It discusses how HIV breaks down the immune system, leaving those infected vulnerable to life-threatening infections. The document outlines the history of the HIV epidemic and how it has affected both developed and developing countries. It also summarizes HIV transmission routes, clinical stages of infection from initial exposure to AIDS, diagnostic testing approaches, treatment options including antiretroviral drugs, prevention strategies, and healthcare follow-up for those living with HIV/AIDS.
This document discusses HIV and hepatitis C, and how treatment has improved outcomes. It presents two case studies of patients with advanced HIV presenting with opportunistic infections who were successfully treated. It also summarizes research showing that early antiretroviral therapy improves survival for patients with HIV/AIDS or opportunistic infections like PCP, and that cure of hepatitis C through direct-acting antivirals reduces mortality and complications like liver cancer. While treatment access has increased globally, challenges remain in testing and treating all those in need.
HIV/AIDS is a pandemic disease caused by the HIV virus that weakens the immune system and leads to AIDS. The document discusses the epidemiology, transmission, diagnosis and management of HIV/AIDS globally and in Kenya. It provides statistics on prevalence in various populations in Kenya and clinical staging systems used by WHO and CDC to classify and manage HIV infection. Treatment involves antiretroviral therapy to suppress the virus although there is currently no cure.
National HIV testing and treatment guidelines BISHAL SAPKOTA
1. The document provides guidelines for HIV testing, treatment, and management in Nepal. It summarizes global HIV statistics and outlines the epidemiology of HIV in Nepal.
2. Guidelines are provided for HIV testing services, diagnosis, treatment, monitoring of people on antiretroviral therapy (ART), and management of coinfections. Recommendations include "treat all" and early infant diagnosis.
3. Prevention of mother-to-child transmission (PMTCT), ART for prevention, post-exposure prophylaxis, and combination prevention are discussed. Clinical features and management of pediatric HIV are also reviewed.
Impact of DM and its control on the risk of developing TB in TaiwanMing Chia Lee
This study investigated the impact of diabetes mellitus (DM) and its control on the risk of developing active tuberculosis (TB) using Taiwan's National Health Insurance Research Database. The results showed that: (1) DM significantly increased the risk of TB and this effect persisted for at least 5 years, (2) the risk of TB was higher with worse DM control as measured by hospital admissions and medication doses, (3) better adherence to anti-DM medication was protective against TB. The study suggests that controlling DM may help prevent some cases of TB.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Jens Lundgren, CHIP
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
The document provides information on HIV/AIDS, including:
1. HIV was first identified in 1981 and there have been two major strains identified, HIV-1 and HIV-2.
2. HIV is transmitted through bodily fluids and can be transmitted sexually or through contact with infected blood.
3. There are three phases of HIV infection eventually resulting in AIDS if not treated. Antiretroviral treatment can suppress the virus and prevent AIDS.
Preventing TB infection in HIV-infected
individuals living in medium and high TB endemic
settings
February 5, 2016
Jeffrey D. Jenks, MD, MPH
UCSD HIV & Global Health Rounds
HIV/AIDS is caused by the human immunodeficiency virus (HIV) which selectively infects CD4+ T cells. Over time, HIV destroys and impairs the immune system, making the body increasingly susceptible to opportunistic infections. There are two types of HIV, HIV-1 and HIV-2. HIV is most commonly transmitted through unprotected sex, contaminated blood transfusions, needle sharing, and from mother to child during pregnancy, childbirth or breastfeeding. As the immune system weakens from HIV, individuals become vulnerable to various infections and cancers that define AIDS. There is currently no cure for HIV/AIDS.
The document summarizes a seminar presentation on HIV/AIDS. It provides background on HIV/AIDS, including how it attacks the immune system. It discusses the global and national epidemiology of HIV/AIDS, highlighting trends in prevalence. It presents the epidemiological triad of HIV/AIDS, including the agent (HIV virus), reservoir of infection (humans), and factors influencing transmission. It states the objectives of the seminar were to explore the epidemiology, review milestones and current policies/strategies in Nepal, and discuss prevention and control methods.
The document outlines a seminar presentation on HIV/AIDS given by Group B. It includes an introduction, background on HIV/AIDS, the epidemiological triad, risk factors, the current situation in Nepal, objectives, methodology, findings, and recommendations for prevention and control. The group discussed the stages of HIV infection, transmission methods, symptoms, complications, and strategies like education, condom promotion, and treatment.
This slide discusses about epidimiology of HIV its National and international response HIV:- Human Immuno deficiency Virus (retro-virus)
HIV attacks body immune system and reduces the count of CD4 cells (T cells) in human body making the person more likely to get life-threating opportunistic infections.
AIDS:- Acquired Immune Deficiency Syndrome, is a set of symptoms and illness which develops at the final stage of HIV infection.
There is currently no effective cure for HIV. Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled and who get effective treatment can live long, healthy lives and protect their partners.
As far back as the late 1800s, HIV may have spread from chimpanzees to humans.
Simian immunodeficiency virus (SIV) is a lentivirus (genus of retrovirus) that infect more than 36 different nonhuman primate species in sub-Saharan Africa.
In June 1981, the first cases of AIDS reported from Los Angeles in five homosexual men.
In Nepal first case detected in 1988.
A 47-year-old woman presented with fever, cough, and difficulty breathing for one week. She was diagnosed with HIV 5 years ago but stopped treatment after one month. She now has oral thrush, tachycardia, and crackles in her lungs. Her CD4 count is low at 235 and HIV viral load is high. She is diagnosed with Pneumocystis jiroveci pneumonia, an opportunistic infection seen in advanced HIV/AIDS due to her severely compromised immune system from lack of antiretroviral treatment.
This study evaluated the prevalence of acute kidney injury (AKI) in 120 patients with confirmed dengue fever over one year at a hospital in India. The prevalence of AKI among these patients was found to be 27.5%. Several factors were analyzed to identify predictors of AKI in dengue patients, including demographics, severity of illness, laboratory values, and presence of complications. The majority of patients recovered and were discharged, while mortality was observed in 16.7% of cases. This research helps address the lack of data on renal involvement and AKI in dengue virus infection.
Global tuberculosis rates have declined significantly since 1990. 56 million patients have been successfully treated and 22 million lives have been saved since 1995. The TB mortality rate has declined 45% globally since 1990. However, TB remains one of the top three killers of women worldwide. In 2012, there were an estimated 530,000 TB cases among children and 74,000 TB deaths among HIV-negative children. Treatment success rates have improved dramatically from 69% in 2000 to 87% in 2011. Despite progress, many TB cases are still being missed due to lack of diagnosis. In 2012, only 66% of the estimated 8.6 million incident TB cases were detected and notified. Multidrug-resistant TB also remains a major public health crisis,
This document provides an overview of HIV and AIDS. It discusses the background of HIV, including how it attacks the immune system. It describes the stages of HIV infection and provides a brief history of AIDS. The epidemiological triad of agent, host, and environment related to HIV transmission is examined. At-risk groups and behaviors are identified. Global and national statistics on prevalence and distribution are presented. Objectives of preventing and controlling HIV/AIDS through various strategies like education, testing, and treatment are outlined. Key findings around transmission modes, clinical features, and prevention/management approaches are summarized.
Антиретровирусное лечение – перспективы Европейского клинического общества по...hivlifeinfo
Антиретровирусное лечение – перспективы Европейского клинического общества по СПИДу (EACS)/Antiretroviral Treatment.The European AIDS Clinical Society (EACS) Perspective.2017
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Valerie Delpech, Public Health Engand
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Similar to ICA2014_Sarkin_Leisegang_Presentation _final (20)
1. w w w . I C A 2 0 1 4 . o r g
Insurability and Survival of Lives Living
with HIV and Other Chronic Disease
2 April 2014
Lee Sarkin and Dr Rory Leisegang
Dr Gary Maartens, Dr Maia Lesosky, Dr Anne Zutavern, Michael Hislop, Lourens Walters
2. • Context
– Insurability of HIV
– Why Type 2 Diabetes (DM2)
– HIV timeline
– South African context
• Disease progression
– Definitions
– HIV and DM2
• Data and methodology
• Results
• Limitations
• Conclusions
Agenda
3. § Mortality at longer-term durations on ART remains uncertain in South Africa
§ Short follow up periods used to extrapolate 10-30 years
§ In developed countries, life cover for HIV+ lives is often restricted to term cover
§ Limitations of life expectancy estimates for insurance
§ Further research is required to assess subgroup mortality differences
§ Comparisons of subgroups of HIV-infected lives and subgroups of lives with other
chronic conditions requiring lifelong treatment, e.g. Diabetes
§ However…no published South African study has compared the mortality of HIV-infected lives with
insured-lives or lives with other chronic conditions
§ Study Design: Estimate and compare the mortality of HIV-infected South African adults
initiating ART with that of South African adults initiating therapy for Type II Diabetes and a
control group in a large cohort of privately insured South Africans with long follow-up time to
assess the hypothesis that there exist insurable subgroups of HIV-infected South African adults
on ART
Insurability of HIV in South Africa
4. • Insurability is often defined by a threshold of extra mortality
– Further context given by comparing to other chronic manageable diseases that are already covered
• Similarities to HIV:
– Laboratory marker of treatment success - HbA1c is analogous to HIV viral load
– Control of either is associated with better short- and long-term prognoses
– Requires life-long treatment
• One of the most common non-communicable diseases
– International Diabetes Federation: in 2011, 8.3% global prevalence (adults aged 20-79) and by 2030
9.9%
– 2011: 8.2% of global all-cause mortality (adults aged 20-79)
• Low- and middle-income countries bear 80% of the global DM2 burden
– Africa: largest expected percentage increase (90%) in adult DM2 numbers by 2030, outstripping
population growth
Why Type 2 Diabetes (DM2)
5. Timeline of HIV
1900s • HIV thought to have spread to humans from chimpanzees (bush meat
trade in central africa)
• First identified HIV infection in Congo
• Acquired immune deficiency syndrome (AIDS) described in
patients – pathogen not yet identified
• Zidovudine (AZT) first active antiretroviral therapy (ART)
1980
• The syndrome of AIDS was described
• HIV identified as the cause of AIDS
• First treatment for patients with AIDS: AZT
1950s
1960s
1980s
1990s
2000s
• Access to ART in low- and middle-income countries
• Safer and more effective ART
• Combination ART suppresses HIV replication completely with the
advent newer classes of therapy
• First actuarial AIDS and demographic model
6. South African context
• People (all ages) with HIV in 2012 (UNAIDS, 2013):
• South Africa: 6.1m living with HIV out of 50.7m (UNAIDS,2013)
• South Africa: 17.9% adult HIV prevalence (2012)
• Globally, 17% of adult deaths attributed to HIV & TB
• South Africa: 70% of adult deaths attributed to HIV & TB
(WHO, GBoD 2010)
7. South African context
Dr Aaron Motsoaledi (South African Minister of
Health since 2009) with the first “one pill per day”
regimen in South Africa
NumberonART(millions)
• Exponential growth in numbers receiving ART
• One of the largest pharmacological interventions in history
• >2 million lives on ART by mid-2012 (HSRC, 2013)
• Coverage <50% in 2011 assuming eligibility at CD4 <350 cells/µl (Johnson, 2012)
• 8.7m medical scheme/insurance beneficiaries (3.82m principal), CMS, 2012/2013
8. • CD4 count:
– CD4 cells infected by HIV
– CD4 prognostic marker
– Monitoring state of immune system
• Viral load (VL):
– amount of virus in the blood stream in
copies/ml of blood
– Monitoring effectiveness of ART
.
Definitions
9. Pantaleo, G et al. 1993. New concepts in the immunopathogenesis of human immunodeficiency virus infection". New England Journal of
Medicine 328 (5): 327-335.
HIV disease progression and response to ART
ART initiation
• CD4 count declines
• The higher the VL, the faster the CD4 declines, the greater the risk of
developing AIDS
• With ART, CD4 recovers and VL falls to undetectable levels
Baseline
10. ART management
• When to start ART?
– CD4 count or symptoms
• LMICs:
– Standardised ART regimens
• VL:
– Monitoring informs changes in regimen
– Measure of ART success
– Drug resistance develops if VL unsuppressed on ART
• Change in regimen
11. • Characterized by
– Slow development of insulin resistance
– Insulin-producing cells in pancreas unable to
fully cope with a sugar – impaired glucose
tolerance
– Full-blown diabetes – uncontrolled blood
sugar levels
• Complications
• HbA1c
DM2 disease progression
• Fonseca VA. Defining and characterizing the progression of type 2 diabetes. Diabetes care. 2009
Nov;32 Suppl 2:S151-6.
• Sherifali D, Nerenberg K, Pullenayegum E, Cheng JE, Gerstein HC. The effect of oral antidiabetic
agents on A1C levels:a systematic review and meta-analysis. Diabetes care. 2010 Aug;33(8):
1859-64.
12. • Non-medication:
– Lifestyle – physical activity, diet
– Foot and eye screening
– Monitoring HbA1c
• Medication:
– Therapy recommended: HbA1c >7 mmol/L
– “Line” of therapy:
• Oral
• Injectable insulin
Management of DM2
• Sherifali D, Nerenberg K, Pullenayegum E, Cheng JE, Gerstein HC. The effect of oral antidiabetic agents on A1C levels:a
systematic review and meta-analysis. Diabetes care. 2010 Aug;33(8):1859-64.
13. • A large private-sector cohort (>1 million) of South African adults, from which three cohorts are
observed over the period 1998-2013:
– HIV cohort: Aid for Aids (AfA) – HIV managed care provider in Southern Africa
• Authorised for ongoing ART and medicine claim data available
• Identity numbers available
• Medical scheme/insurance beneficiaries and generally employed
• Largest study of HIV-infected patients managed in a private healthcare setting globally: >340,000
person years of observation (PYO) and >10,000 deaths
• Large patient volumes surviving 5-13 years on ART
• Baseline and updated patient characteristics
– Type II Diabetes cohort: patients initiating therapy
– Control cohort: assumed HIV-negative and without Diabetes due to no history of CD4 or
viral load tests; no ART claimed, no AHT claimed
• Deaths matched to national death registry (80-90% complete*) to improve death ascertainment
• Generalized mixed-effects Poisson model and standardized mortality ratios
Data and Methodology
*Van Cutsem, G., et al. 2011. and Yiannoutsos, C.T., et al. 2012.
14. Descriptive statistics
Description Units HIV Diabetes Control
Patient numbers:
• Overall
• >5 years follow-up
• >8 years follow-up
Number of
patients 83,994
23,451
9,807
67,806
41,954
23,837
552,364
389,667
247,011
Person years of observation PYO 342,698 366,029 3,455,510
Deaths 9,719 8,006 25,459
Median [IQR] follow up Years 3.3 [2.1,5.3] 6.2 [3.9,9.5] 7.2 [4.6,11.2]
Median [IQR] baseline age Years 38 [33,45] 48 [40,56] 34 [27,44]
Gender Female 63% 49% 48%
Population group Black 96% 62% 61%
Crude mortality incidence Deaths per
1000 PYO
28.4 21.9 7.4
Median [IQR] baseline CD4 (cells/µl) 159 [73,241] - -
Descriptive Statistics
16. Time since ART initiation
●
●
●
● ● ●
●
●
● ●
●
●
● ●
● ●
● ●
●
●
●
●
●
●
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
0 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120 126 132 138
Duration since ART initiation (months)
Deathsper1000PYO
Most published studies in low and middle-income countries often report outcomes
only within the first two years of ART
Smoothed
17. CD4 response to ART
Source: study data
Median
Longitudinal
CD4 test results
Lower range of
‘normal’ (HIV-negative)
CD4 count
Risk of AIDS below
200
27. Adjusted relative risk
Time
(months)
since
ART
ini3a3on
at
policy
applica3on
6
12
18
24
30
36
42
48
54
60
0
Example policy applicant:
• Baseline variables:
• CD4: 200-349
• VL: 5log-6log
• Demographic
• At policy application:
• Age
• Current CD4: 200+
• Current VL: suppressed
• On ART
• Time since ART: 18 months
• Underwriting criteria?
• Extra-mortality?
Forward looking extra-mortality over policy lifetime
• Subgroups analysed by current CD4 and VL, baseline CD4 and time since ART initiation:
Current VL
Suppressed
(≤400)
Unsuppressed
(>400)
Current CD4
≥200
<200
28. Adjusted relative risk
Baseline
CD4
Industry
sub-‐
standard
threshold
Rela3ve
risk
(HIV
/
Control)
Time
(months)
since
ART
ini3a3on
at
policy
applica3on
Current CD4 200+ and VL suppressed Current CD4 200+ and VL unsuppressed
Current CD4 <200 and VL suppressed Current CD4 <200 and VL unsuppressed
Baseline
CD4
penalty
wanes
over
3me
Accept if baseline
CD4 <50?
Accept if baseline
CD4 200-349?
BUT…other populations groups 200-500%
29. Adjusted relative risk
Baseline
CD4
Industry
sub-‐
standard
threshold
Rela3ve
risk
(HIV
/
Control)
Time
(months)
since
ART
ini3a3on
at
policy
applica3on
Current CD4 200+ and VL suppressed Current CD4 200+ and VL unsuppressed
Current CD4 <200 and VL suppressed Current CD4 <200 and VL unsuppressed
30. Adjusted relative risk
Time
(months)
since
ART
ini3a3on
at
policy
applica3on
Rela3ve
risk
(HIV
/
Control)
• Sensitivity to current CD4
• Other sensitivities observed:
• Age
• Gender
• Population group
Current CD4 350+ and VL suppressed Current CD4 200-349 and VL suppressed
Baseline
CD4
31. Life expectancy check
• Assumed fully underwritten standard-life risk rates
• Ratio of life expectancy from ART initiation to HIV-negative life expectancy
• Sensitivity to α = HIV+/standard-life life expectancy
0%
200%
400%
600%
800%
1000%
1200%
15
19
23
27
31
35
39
43
47
51
55
59
63
67
71
75
79
83
87
91
95
99
EM
(%)
Age
at
entry
Males
50%
60%
70%
80%
90%
α
32. • Generalizability to other populations
– Differences in underlying unnatural mortality
– Co-infection, e.g. Tuberculosis
– Socio-economic status
• DM2: no measure of control
• Virological suppression rates of treatment programmes
using Markov models
Limitations
33. Conclusions
• Key underwriting criteria:
– At policy application:
• current CD4 count and viral load
• Age, gender, socio-economic status
• Time since ART initiation – first 6 months far in excess of 500% relative risk
– Baseline CD4 count <100 predictive within first three years on ART
• Stratification of relative risk:
Current VL
Suppressed (≤400) Unsuppressed (>400)
Current
CD4
≥200
Approaches HIV-negative mortality
after three years on ART
BUT…sensitive to socio-economic
status and baseline CD4
+/- 300-400%
Improving over time
<200
+/- 300-400%
Worsening over time
> 700%
34. Conclusions (ctd)
– Current CD4 >=350 and 200-349 both within the 500% threshold
– Generally stable after 36 months since ART initiation
• Type 2 Diabetes:
– Relative risk initially 200%, increasing with duration on therapy
– Further analysis of sub groups required, e.g. by HbA1c
• Findings support most existing market underwriting
criteria
35. Acknowledgments
• The authors are grateful for support from:
• Munich Re:
• Douw De Jongh
• Colin Van der Meulen
• Dr Anne Zutavern
• Dr Alfred Beil
• University of Cape Town, Department of Medicine
• Dr Gary Maartens
• Maia Lesosky
• University of Cape Town, Department of Statistics
• Francesca Little
• AfroCentric Health and Aid for Aids
• Michael Hislop
• Lourens Walters
36. Questions
§ Contact: Lsarkin@munichre.com
§ Disclaimer:
§ Application of relative risk estimates contained in this presentation
should not be applied withtout considering the sensitivity to the:
§ Socio-economic mix of the target market
§ Adherence of the target market to treatment guidelines