5F9FFB0Cd01 - HIV en AIDS Algemene inleiding Infectie en...

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HIV en AIDS Algemene inleiding Infectie en transmissie Epidemiologie Diagnose Virale lading Therapie Drug resistentie Nieuwe ontwikkelingen CCR5 remmers Opleiding Klinische Biologie, 23 November 2009
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HIV en AIDS 1981 : eerste melding van homosexuele man met voordien zeldzame ziektebeelden (pneumocystis pneumonie en kaposi’s sarcoma) Kort daarna werden gelijkaardige gevallen gemeld, in homosexuele mannen en in druggebruikers 1983 : herkenning van het HIV-1 (Human Immunodeficiency Virus type 1) als verwekker van de ziekte die het Acquired Immunodeficiency Syndrom (AIDS) werd genoemd. F. Barré-Sinoussi & L. Montagnier Nobelprijs 2009
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Transmissie route : Onbeschermd sexueel contact met een geïnfecteerde partner Injectie of transfusie van besmet bloed of bloedprodukten Gedeeld gebruik van niet gesteriliseerd injectiemateriaal Moeder-kind transmissie (15-30%): tijdens zwangerschap (10%), net voor of tijdens de geboorte (75%), borstvoeding (10-15%) Acute infectie: Gaat vaak gepaard met een periode van aspecifieke symptomen (koorts, rash, orale ulcers, faryngitis, algemene malaise,…)
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Transmissie-risico
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Virale lading = aantal HIV-1 RNA moleculen/ ml (plasma)
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Adults and Children Newly Infected With HIV in 2008 32.75 million UNAIDS, 2008. Available at: http://www.unaids.org. North Africa and Middle East 40,000 Total: 380,000 Sub-Saharan Africa 1.9 million Total: 22 million Eastern Europe and Central Asia 110,000 Total: 1.5 million Oceania 13,000 Total: 74,000 Caribbean 20,000 Total: 230,000 Asia 380,000 Total: 4.2 million Latin America 140,000 Total: 1.7 million North America and Western/Central Europe 81,000 Total: 2.0 million
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EVOLUTIE VAN HET AANTAL NIEUWE SEROPOSITIEVEN PER SEMESTER IN BELGIE (1985-2008)
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VERSPREIDING HIV-1 SUBTYPES
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HIV-1 subtype-distributie patiënten in opvolging in ARC Gent 2001-2009
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Transmissie-clusters in subtype B infectie
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Karakteristieken van lokale HIV transmissie Subtype B only Cluster Cluster Count Count p-value # Patienten 143 (47,4%) 159 (52,6%) HO 122/132 (92,4%) 107/139 (77,0%) <0,001 HBV + 47/141 (33,3%) 59/155 (38,1%) 0,396 HCV + 11/141 (7,8%) 15/154 (9,7%) 0,557 Syfilis + 64/143 (44,8%) 55/157 (35,0%) 0,086 Chlamydia 57/132 (43,2%) 49/127 (38,6%) 0,452 Gender(male) 121/143 (84,6%) 138/159 (86,8%) <0,001 Caucasian 140/140 (100%) 145/159 (91,2%) <0,001 DRM 12/143 (8,4%) 13/159 (8,2%) 0,946 PHI 32/137 (23,4%) 28/138 (20,3%) 0,538 Median (IQR) Median(IQR) p-value CD4 419,5 (314,5-578) 429 (230-597) 0,425 Age 36 (31-41) 41 (34-47) <0,001
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Flow chart HIV diagnose HIV screening Reactief Doorsturen staal naar ARL 2de screening Western blot of InnoLIA p24 Ag bepaling Negatief
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