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9. HIV Review - HIV review Rupert Kaul(MD PhD HIV infection...

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1 HIV review Rupert Kaul (MD, PhD) HIV infection and AIDS the virus: structure, life cycle epidemiology: global and local transmission of HIV natural history of HIV infection (untreated) clinical manifestations HIV therapy in the 21st century HIV issues for health-care workers occupational transmission post-exposure prophylaxis HIV - structure, classification RNA virus in the lentivirus family divided into HIV-1 and HIV-2 • HIV-2: less common, spreads less easily, less virulent only common in West Africa, Portugal HIV-1 is divided into several strains (“clades”) clade B: most common in Europe / NA clade C: most common globally (SA) clades are beginning to mix together
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2 (1) HIV-1 attachment; (2) Fusion ; (3) Cell entry; (4) Reverse transcription , formation of the pre-integration complex (PIC); (5) Nuclear transport; (6) Chromosomal integration of DNA provirus; (7) Transcription of viral RNA; (8) Nuclear export of RNA; (9) Translation and processing ; (10) Membrane transport; (11) Virion assembly; (12) Budding; (13) Maturation. Outline of HIV life cycle Weiss RA. Trop Med Int Health. 2000.
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3 Kahn. IAVI Report - May / August 2003 . HIV epidemiology: global worst affected is sub-Saharan Africa: up to 30% of sexually-active adults (SA) 10% in east, west Africa, less in north may be lower in some rural areas (<1%) HIV rates low in some countries (Senegal <1%) in some countries incidence is falling (Uganda) in some epidemic is escalating (SA, Botswana) in Kenya over 50% of inpatients are HIV+ gender differences - adolescent women
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4 Gender split in HIV/AIDS varies by region 0% 20% 40% 60% 80% 100% Australia/NZ North America East Asia/Pacific Western Europe Eastern Europe/Central Asia Latin America South & South-East Asia Caribbean North Africa/Middle East Sub-Saharan Africa Women Men Gender split among people with HIV infection, by region UNAIDS, 2002; www.unaids.org Gender and HIV risk Per-act risk; sexual patterning; adolescent mucosa KAIS, 2007 (pre-pub) Important to “know your epidemic”
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5 HIV epidemiology: local Statistics are often not available or very biased Some (often outdated) figures from Ontario: Heterosexual, “low risk” contacts only 0.1% Heterosexual, “high risk” contacts 0.4%
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