The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against developing mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
Persistenza del virus HIV nei Pazienti sottoposti a HAART: valutazione delle ...mabasta
traduzione in italiano della presentazione del professor Robert F. Siliciano MD PhD (Johns Hopkins University) fatta alla XVII conferenza internazionale sull'AIDS tenutasi a Città del Messico dal 3 al 8 agosto 2008
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against developing mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
Persistenza del virus HIV nei Pazienti sottoposti a HAART: valutazione delle ...mabasta
traduzione in italiano della presentazione del professor Robert F. Siliciano MD PhD (Johns Hopkins University) fatta alla XVII conferenza internazionale sull'AIDS tenutasi a Città del Messico dal 3 al 8 agosto 2008
PPT Rizzardini "HAART, sostenibilità di un miracolo"StopTb Italia
This document discusses the sustainability of highly active antiretroviral therapy (HAART) for HIV/AIDS treatment. It begins by recounting the history of HAART from initial hope to "miracle" outcomes. However, it notes the global economic crisis challenges sustainability of healthcare systems. Charts show rising healthcare costs as a percentage of GDP in many nations by 2030 and 2050. Italy faces a large national debt and rising healthcare spending. The document questions if the HAART miracle can continue given these economic pressures and need to control costs.
PPT Rusconi "Le multiresistenze dell'HIV/AIDS"StopTb Italia
This document discusses HIV drug resistance and multiresistance. It notes that the emergence of resistance is an inevitable consequence of incomplete viral suppression by antiretroviral drugs. Resistance can develop through the selection of pre-existing mutations under drug pressure or the generation of new mutations over time. The level of resistance depends on factors like the genetic barrier of the drugs. Long-term failing treatment can lead to the accumulation of multiple resistance mutations. Data is presented on increasing resistance prevalence correlated with higher viral loads. Resistance testing is important to identify mutations and guide treatment choices.
PPT Concia "Localizzazioni extrapolmonari nella coinfezione"StopTb Italia
This document discusses various sites of extrapulmonary tuberculosis. It begins by listing common sites of extrapulmonary TB, with percentages of extrapulmonary cases that occur at each site. The most common sites are pleura (20-25%), lymphatics (20-40%), and genitourinary (5-18%). It then discusses specific forms of extrapulmonary TB including tuberculosis of the central nervous system, bones/joints, skin, and other organ systems. Risk factors for developing extrapulmonary TB are also mentioned.
PPT Bonora "Clinica e terapia dell'HIV"StopTb Italia
The document discusses the clinical management of HIV infection and lessons from anti-tuberculosis therapy. It notes that combination antiretroviral therapy is effective at suppressing HIV due to its ability to prevent the selection of drug-resistant strains, in contrast to less effective single-drug regimens. Over time, combination therapy has resulted in more HIV-infected individuals achieving sufficient immune recovery to approach the life expectancy of the general population. However, non-AIDS comorbidities have become more prevalent as the HIV-infected population ages.
This document summarizes a presentation on immunological testing for tuberculosis (TB) and HIV co-infection. It discusses the clinical utility of interferon gamma release assays (IGRAs) for detecting latent TB infection (LTBI) in HIV-infected individuals. While IGRAs perform similarly to the tuberculin skin test (TST) in identifying those who could benefit from LTBI treatment, important questions remain about their use in HIV-positive populations with different CD4 counts. The document also examines the diagnostic value of IGRAs for active TB, finding no evidence they are more sensitive than the TST, especially in low- and middle-income countries.
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
This document discusses the challenges of diagnosing HIV, AIDS, and co-infections. It notes that distinguishing between HIV infection, AIDS, and co-infections can be difficult. Point-of-care rapid tests have helped increase HIV testing, though they cannot identify acute HIV infections. The document emphasizes the importance of confirming positive rapid HIV tests with supplemental tests due to the potential for false positives in low prevalence populations.
PPT Bocchino "Diagnosi dell'infezione tubercolare"StopTb Italia
This document summarizes guidelines for diagnosing tuberculosis infection. It discusses the characteristics and performance of interferon gamma release assays (IGRAs) like QFT-IT and T-SPOT compared to the tuberculin skin test (TST). While IGRAs generally have higher specificity than TST, their sensitivity can be reduced in high prevalence settings. Factors like BCG vaccination, repeated exposures, and immunocompromise can affect test performance. Guidelines provide recommendations on using IGRAs and TST depending on the clinical setting and population. Further research is still needed to optimize IGRA testing methods and better predict which individuals will develop active tuberculosis.
PPT Angarano "Storia naturale dell'HIV"StopTb Italia
The document summarizes the natural history of HIV/AIDS, beginning with its identification and description in 1981. It describes how HIV attacks and destroys CD4+ T cells, ultimately overwhelming the immune system. As the immune system is compromised, victims develop secondary infections and diseases that they are no longer able to fight off, leading to AIDS and death if left untreated. The introduction of antiretroviral therapy in the 1990s was able to control viral replication and boost CD4+ counts, reducing AIDS-related illnesses and death rates dramatically. However, even with treatment, chronic inflammation persists and contributes to accelerated aging effects and non-AIDS comorbidities over time.
The document discusses the genetic epidemiology of tuberculosis. It summarizes that analysis of TB epidemics in Europe from the 18th-19th centuries found mortality rates of up to 2% per year without chemotherapy. There was an initial spike in cases over the first 50-100 years, followed by a slow decline over the next 200-250 years. This supports the hypothesis that the initial phase eliminated the most susceptible 20% of the population.
The document summarizes epidemiological data on tuberculosis (TB) in Italy and globally. It notes that the TB notification rate in Italy decreased by 7.7% from 2007 to 2012. In 2012, 58.3% of Italian TB cases were in foreign-born individuals and the rate of multi-drug resistant TB was 3%. Globally in 2012, there were an estimated 8.6 million incident TB cases and 1.3 million deaths, with South-East Asia and Africa accounting for most cases and deaths. Major ongoing challenges include TB/HIV co-infection, multi-drug resistant TB, and improving detection of "missing" TB cases.
PPT Rizzardini "HAART, sostenibilità di un miracolo"StopTb Italia
This document discusses the sustainability of highly active antiretroviral therapy (HAART) for HIV/AIDS treatment. It begins by recounting the history of HAART from initial hope to "miracle" outcomes. However, it notes the global economic crisis challenges sustainability of healthcare systems. Charts show rising healthcare costs as a percentage of GDP in many nations by 2030 and 2050. Italy faces a large national debt and rising healthcare spending. The document questions if the HAART miracle can continue given these economic pressures and need to control costs.
PPT Rusconi "Le multiresistenze dell'HIV/AIDS"StopTb Italia
This document discusses HIV drug resistance and multiresistance. It notes that the emergence of resistance is an inevitable consequence of incomplete viral suppression by antiretroviral drugs. Resistance can develop through the selection of pre-existing mutations under drug pressure or the generation of new mutations over time. The level of resistance depends on factors like the genetic barrier of the drugs. Long-term failing treatment can lead to the accumulation of multiple resistance mutations. Data is presented on increasing resistance prevalence correlated with higher viral loads. Resistance testing is important to identify mutations and guide treatment choices.
PPT Concia "Localizzazioni extrapolmonari nella coinfezione"StopTb Italia
This document discusses various sites of extrapulmonary tuberculosis. It begins by listing common sites of extrapulmonary TB, with percentages of extrapulmonary cases that occur at each site. The most common sites are pleura (20-25%), lymphatics (20-40%), and genitourinary (5-18%). It then discusses specific forms of extrapulmonary TB including tuberculosis of the central nervous system, bones/joints, skin, and other organ systems. Risk factors for developing extrapulmonary TB are also mentioned.
PPT Bonora "Clinica e terapia dell'HIV"StopTb Italia
The document discusses the clinical management of HIV infection and lessons from anti-tuberculosis therapy. It notes that combination antiretroviral therapy is effective at suppressing HIV due to its ability to prevent the selection of drug-resistant strains, in contrast to less effective single-drug regimens. Over time, combination therapy has resulted in more HIV-infected individuals achieving sufficient immune recovery to approach the life expectancy of the general population. However, non-AIDS comorbidities have become more prevalent as the HIV-infected population ages.
This document summarizes a presentation on immunological testing for tuberculosis (TB) and HIV co-infection. It discusses the clinical utility of interferon gamma release assays (IGRAs) for detecting latent TB infection (LTBI) in HIV-infected individuals. While IGRAs perform similarly to the tuberculin skin test (TST) in identifying those who could benefit from LTBI treatment, important questions remain about their use in HIV-positive populations with different CD4 counts. The document also examines the diagnostic value of IGRAs for active TB, finding no evidence they are more sensitive than the TST, especially in low- and middle-income countries.
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
This document discusses the challenges of diagnosing HIV, AIDS, and co-infections. It notes that distinguishing between HIV infection, AIDS, and co-infections can be difficult. Point-of-care rapid tests have helped increase HIV testing, though they cannot identify acute HIV infections. The document emphasizes the importance of confirming positive rapid HIV tests with supplemental tests due to the potential for false positives in low prevalence populations.
PPT Bocchino "Diagnosi dell'infezione tubercolare"StopTb Italia
This document summarizes guidelines for diagnosing tuberculosis infection. It discusses the characteristics and performance of interferon gamma release assays (IGRAs) like QFT-IT and T-SPOT compared to the tuberculin skin test (TST). While IGRAs generally have higher specificity than TST, their sensitivity can be reduced in high prevalence settings. Factors like BCG vaccination, repeated exposures, and immunocompromise can affect test performance. Guidelines provide recommendations on using IGRAs and TST depending on the clinical setting and population. Further research is still needed to optimize IGRA testing methods and better predict which individuals will develop active tuberculosis.
PPT Angarano "Storia naturale dell'HIV"StopTb Italia
The document summarizes the natural history of HIV/AIDS, beginning with its identification and description in 1981. It describes how HIV attacks and destroys CD4+ T cells, ultimately overwhelming the immune system. As the immune system is compromised, victims develop secondary infections and diseases that they are no longer able to fight off, leading to AIDS and death if left untreated. The introduction of antiretroviral therapy in the 1990s was able to control viral replication and boost CD4+ counts, reducing AIDS-related illnesses and death rates dramatically. However, even with treatment, chronic inflammation persists and contributes to accelerated aging effects and non-AIDS comorbidities over time.
The document discusses the genetic epidemiology of tuberculosis. It summarizes that analysis of TB epidemics in Europe from the 18th-19th centuries found mortality rates of up to 2% per year without chemotherapy. There was an initial spike in cases over the first 50-100 years, followed by a slow decline over the next 200-250 years. This supports the hypothesis that the initial phase eliminated the most susceptible 20% of the population.
The document summarizes epidemiological data on tuberculosis (TB) in Italy and globally. It notes that the TB notification rate in Italy decreased by 7.7% from 2007 to 2012. In 2012, 58.3% of Italian TB cases were in foreign-born individuals and the rate of multi-drug resistant TB was 3%. Globally in 2012, there were an estimated 8.6 million incident TB cases and 1.3 million deaths, with South-East Asia and Africa accounting for most cases and deaths. Major ongoing challenges include TB/HIV co-infection, multi-drug resistant TB, and improving detection of "missing" TB cases.
3. Trasmissione per via aerea
attraverso la disseminazione di
nuclei di goccioline evaporate
(droplet nuclei, di misura < 5 μm
μm),
contenenti microrganismi, che
rimangono sospese nell’aria per un
lungo periodo
4. Numero di goccioline
prodotte da differenti manovre
Number of Droplets produced by Different
50.000 - Aerosol Producing Maneuvers
50000
40.000 -
Number of droplets
40000
30.000 -
30000
20.000 -
20000
10.000 -
10000
0-
0 Tosse Parlare Canto
Coughing Talking Singing
Loudon RG, et al. Am Rev Respir Dis 1968;98:297-300
11. Persistenza del Mt vivo, prevalen-
temente all’interno dei “granulomi
tubercolari”, in una condizione di
latenza caratterizzata clinicamen-
te dalla positività della mantoux (o
degli IGRA) e dall’assenza dei se-
gni e dei sintomi della TB attiva.
23. Wood R, et al.
J Acquir Immune
Defic Syndr 2000:
23(1): 75-80
TST +
< 2 anni
The annual The lifetime
risk of active TB risk of active TB
is up to 30% in HIV is 5-10% in immuno-
infected individuals competent individuals
24.
25.
26. Impact of smoking on the airways
Pai M, Mohan A, Dheda K,et al. Lethal interaction: the colliding epidemics of
tobacco and tuberculosis. Expert Rev Anti Infect Ther 2007;5:385-391
27. In assenza di terapia,
Dopo 5 anni
qual è l’evoluzione
60 –
50 –
naturale della TB?
Percentuale (%)
40 –
30 –
20 –
10 –
0–
morti guariti cronici morti guariti cronici
28. 100 –
… invece, se la TB
90 –
fosse stata trattata …
80 –
70 –
60 – Dopo 5 anni
50 –
Percentuale (%)
40 –
30 –
20 –
10 –
0–
morti guariti cronici morti guariti cronici
29. Nel paz. destinato all’exitus, quanto dura la PTB ?
│
ESCREATO NEGATIVI
( , ; < 50 anni)
Dati pre-che-
mioterapia
≈
│
ESCREATO POSITIVI Dati TB MDR e
( , ; < 50 anni) TB XDR (?)
1│ 2│ 3│ 4│ 5│
anni Fonte: Tiemersma EW et al.
PloS One 2011;6 (4) e17601
30.
31.
32.
33. Focolaio
POOR Focolaio di Ghon complicato o malattia disseminata
EXCESSIVE
di Ghon
Linfoadenopatia complicata
CONTINENTE
Pleurite TB dell’adulto
Frequenza
Caverne/contagio
0 1 2 3 4 5 6 7 8 10 12 14 16
Età (B.J. Marais et al. 2006)