A HIV/AIDS Basic Medical Science Presentation and Expert Discussion of the Politics of Treatment and Prevention in Sub-Sharan Africa

Areas Covered in this portion of the presentation

HISTORICAL SUMMARY

EPIDEMIOLOGY

PATHOLOGY AND MICROBIOLOGY

PHARMACOLOGY

PREVENTION

Reference Resource Link Outs :

AIDS Pathology: Web Path

Medical Management of HIV Infection Johns Hopkins

CDC Divisions of HIV/AIDS Prevention

Prepared and Presented By:
Marc Imhotep Cray, M.D.
June 2008

Uploaded on authorSTREAM by RBGStreetScholar

Presentation Transcript

HIV/AIDS BASIC MEDICAL SCIENCE

Slide3 : HIV/AIDS: A HISTORICAL SUMMARY

Slide4 : Acquired Immunodeficiency Syndrome (AIDS) 1950s: Blood samples from Africa have HIV antibodies. 1976: First known AIDS patient died. 1980: First human retrovirus isolated (HTLV-1). 1981: First reports of “Acquired Immuno-deficiency Syndrome” in Los Angeles. 1983: Virus first isolated in France (LAV). 1984: Virus isolated in the U.S. (called HTLV-III and AIDS-Related Virus, ARV). 1985: Development and implementation of antibody test to screen blood donors.

Slide5 : Acquired Immunodeficiency Syndrome (AIDS) History (Continued) 1986: Consensus name Human Immunodeficiency Virus (HIV-1). Related virus (HIV-2) identified. 1992: AIDS becomes the leading cause of death among adults ages 25-44 in the U.S. 1997: Mortality rates of AIDS starts to decline due to the introduction of new drug cocktails. 2001: World Health Organization predicts up to 40 million infected individuals. More than 22 million have already died.

Slide6 : EPIDEMIOLOGY & South Africa Data

AIDS: A Leading Cause of Death Among People Aged 25-44 years in U.S. Deaths per 100,000 people aged 25-44 years

Slide8 : Transmission of AIDS (Worldwide) Sexual contact with infected individual: All forms of sexual intercourse (homosexual and heterosexual). 75% of transmission 2. Sharing of unsterilized needles by intravenous drug users and unsafe medical practices: 5-10% of transmission 3. Transfusions and Blood Products: Hemophiliac population was decimated in 1980s. Risk is low today. 3-5% of transmission 4. Mother to Infant (Perinatal): 25% of children become infected in utero, during delivery, or by breast-feeding (with AZT only 3%). 5-10% of transmission

HIV Transmission in United States and Rest of the World : HIV Transmission in United States and Rest of the World

Slide10 : People Living with HIV/AIDS by End of 2001 North America 950,000 Latin America 1.5 million Western Europe 560,000 East Europe & Central Asia 1’000,000 Sub-Saharan Africa 28.5 million North Africa & Middle East 500,000 Australia & New Zealand 15,000 South/South East Asia 5.6 million East Asia & Pacific 1’000,000 Total: 40 million people Caribbean 420,000

Adults and children estimated to be living with HIV/AIDS as of
end 2001 :

Adults and children estimated to be living with HIV/AIDS as of end 2001 Western Europe 560 000 North Africa & Middle East 440 000 Sub-Saharan Africa 28.1 million Eastern Europe & Central Asia 1 million South & South-East Asia 6.1 million Australia & New Zealand 15 000 North America 940 000 Caribbean 420 000 Latin America 1.4 million Total: 40 million East Asia & Pacific 1 million

Estimated number of adults and children newly infected with HIV during 2001 :

Estimated number of adults and children newly infected with HIV during 2001 Western Europe 30 000 North Africa & Middle East 80 000 Sub-Saharan Africa 3.4 million Eastern Europe & Central Asia 250 000 East Asia & Pacific 270 000 South & South-East Asia 800 000 Australia & New Zealand 500 North America 45 000 Caribbean 60 000 Latin America 130 000 Total: 5 million

Estimated adult and child deaths from HIV/AIDS during 2001:

Estimated adult and child deaths from HIV/AIDS during 2001 Western Europe 6 800 North Africa & Middle East 30 000 Sub-Saharan Africa 2.3 million Eastern Europe & Central Asia 23 000 East Asia & Pacific 35 000 South & South-East Asia 400 000 Australia & New Zealand 120 North America 20 000 Caribbean 30 000 Latin America 80 000 Total: 3 million

Children (<15>

Estimated deaths in children (<15>

Total: 580 000

Estimated number of children (<15>

Total: 800,000

South African (SA) Public Ante-natal Clinic
HIV Prevalence Surveys : South African (SA) Public Ante-natal Clinic HIV Prevalence Surveys

SA antenatal clinic survey 2001 HIV Prevalence by Age Group : SA antenatal clinic survey 2001 HIV Prevalence by Age Group

The impact of HIV/AIDS on adult mortality in South Africa : The impact of HIV/AIDS on adult mortality in South Africa About 40% of the adult deaths aged 15-49 in the year 2000 were due to HIV/AIDS About 20% of all adult deaths in 2000 were due to AIDS AIDS accounted for about 25% of all deaths in the year 2000 AIDS has become the single biggest cause of death in South Africa

Source: MRC Report on the Impact of HIV/AIDS on Adult Mortality in South Africa : 2001

The impact of HIV/AIDS on adult mortality in South Africa : The impact of HIV/AIDS on adult mortality in South Africa Without treatment to prevent AIDS, the number of AIDS deaths can be expected to grow, within the next 10 years, to more than double the number of deaths due to all other causes, resulting in 5 to 7 million cumulative AIDS deaths in South Africa by 2010.

Source: MRC Report on the Impact of HIV/AIDS on Adult Mortality in South Africa : 2001

Slide21 : PATHOLOGY AND MICROBIOLOGY

Slide22 : African AIDS patient with slim disease Source: Tropical Medicine and Parasitiology, 1997

Opportunistic Oral Yeast Infection by Candida albicans in an AIDS Patient : Opportunistic Oral Yeast Infection by Candida albicans in an AIDS Patient Source: Atlas of Clinical Oral Pathology, 1999

Slide24 : AIDS Associated Disease Categories 2. Respiratory: 70% of AIDS patients develop serious respiratory problems. Partial list of respiratory problems associated with AIDS: Bronchitis Pneumonia Tuberculosis Lung cancer Sinusitis Pneumonitis

Chest X-Ray of AIDS Patient with Tuberculosis : Chest X-Ray of AIDS Patient with Tuberculosis

Slide26 : AIDS Associated Disease Categories 3. Neurological: Opportunistic diseases and tumors of central nervous system. Symptoms many include: Headaches, peripheral nerve problems, and AIDS dementia complex (Memory loss, motor problems, difficulty concentration, and paralysis).

Slide27 : AIDS Associated Disease Categories 4. Skin Disorders: 90% of AIDS patients develop skin or mucous membrane disorders. Kaposi’s sarcoma 1/3 male AIDS patients develop KS Most common type of cancer in AIDS patients Herpes zoster (shingles) Herpes simplex Thrush Invasive cervical carcinoma 5. Eye Infections: 50-75% patients develop eye conditions. CMV retinitis Conjunctivitis Dry eye syndrome

Slide28 : Extensive tumor lesions of Kaposis’s sarcoma in AIDS patient. Source: AIDS, 1997

Slide29 : Chronic Herpes Simplex infection with lesions on tongue and lips. Source: Atlas of Clinical Oral Pathology, 1999.

Slide30 : Non-Hodgkin’s Lymphoma & ascites in AIDS patient Source: Tropical Medicine and Parasitiology, 1997

Slide31 : Drugs Against HIV Reverse Transcriptase Inhibitors: Competitive enzyme inhibitors. Example: AZT, ddI, ddC. Protease Inhibitors: Inhibit the viral proteases. Prevent viral maturation. Problem with individual drug treatments: Resistance. Drug Cocktails: A combination of: One or two reverse transcriptase inhibitors One or two protease inhibitors. Drug cocktails have been very effective in suppressing HIV replication and prolonging the life of HIV infected individuals, but long term effectiveness is not clear.

PHARMACOLOGY

PREVENTION

The Charge To All 21st Century Physicians

Expert Discussion of the Politics of
Treatment and Prevention in sub-Sharan Africa



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