Section 1 Slides Part 1

Section 1 Slides Part 1 - 8/23/11 BIOLOGY 327 AIDS: THE...

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Unformatted text preview: 8/23/11 BIOLOGY 327 AIDS: THE BIOLOGY OF A MODERN EPIDEMIC FALL 2011 PETER INGMIRE 20 AIDS Conferences 1985 Atlanta 1986 Paris 1987 Washington DC 1988 Stockholm 1989 Montreal 1990 San Francisco* 1991 Florence 1992 Amsterdam 1993 Berlin 1994 Yokohama 1996 Vancouver 1998 Geneva 2000 Durban 2002 Barcelona 2004 Bangkok 2006 Toronto 2008 Mexico City 2010 Vienna 2012 Washington DC THE DIFFERENCES BETWEEN THE TERMS HIV DISEASE AND AIDS • INFECTION WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV) CAUSES HIV DISEASE • LONG-TERM, CHRONIC, MOST OFTEN DEBILITATING BUT MANAGEABLE INFECTIOUS DISEASE • AIDS IS THE OFTEN FATAL FORM OF HIV DISEASE What is the difference between HIV and AIDS? THE DIFFERENCES BETWEEN THE TERMS HIV DISEASE AND AIDS AIDS Established when an HIV+ individual shows immune dysfunction •  A class of lymphocytes: CD4+ T lymphocytes •  < 200 per microliter (uL) of blood or < 14% of total lymphocytes •  Presence of specific illnesses or conditions listed by the CDC constituting an AIDS diagnosis 1 8/23/11 Difficulties in combating the epidemic •  •  •  •  •  Biology Issues of sexuality Difficult dealing with social issues Isms – what are some of them? Initial groups infected are widely misunderstood (or worse) •  The appendices in back of the Reader contain useful information. Survive AIDS vs ACT-UP SF •  ACT-UP=AIDS Coalition to Unleash Power (1987) •  ACT-UP Golden Gate changed its name to Survive AIDS to disassociate itself from the denialist group ACT-UP SF which denies HIV causes AIDS. Errors in Celia Farber's March 2006 article in Harper's Magazine HIV Denialist •  Does not accept HIV as the cause of AIDS •  Believes other factors involved –  HIV medications –  Recreational drug use Final version: Released 25 March 2006 Authors (in alphabetical order by surname): Robert Gallo MD1, Nathan Geffen2, Gregg Gonsalves3, Richard Jefferys4, Daniel R. Kuritzkes MD5, Bruce Mirken6, John P. Moore PhD7, Jeffrey T. Safrit PhD8 1. Director Institute of Human Virology, University of Maryland Baltimore 2. Policy, Communications and Research Coordinator, Treatment Action Campaign, South Africa 3. Gay Men's Health Crisis 4. Basic Science, Prevention & Vaccines Project, Treatment Action Group 5. Director of AIDS Research, Brigham and Women's Hospital, Associate Professor of Medicine, Harvard Medical School 6. Director of Communications, Marijuana Policy Project (previously a health journalist who covered HIV/AIDS for AIDS Treatment News, Men's Health and other publications) 7. Professor of Microbiology and Immunology, Weill Medical College of Cornell University, New York 8. Senior Programs Officer, Elizabeth Glaser Pediatric AIDS Foundation; Visiting Assistant Professor, Department of Pediatrics David Geffen School of Medicine, University of California, Los Angeles •  ACT-UP San Francisco •  Peter Duesberg •  Christine Maggiore AIDSTruth.org "What mattered to me as person living with HIV was to be told that HIV did not cause AIDS. That was nice. Of course, it was like printing money when the economy is not doing well. Or pissing in your pants when the weather is too cold. Comforting for a while but disastrous in the long run." – Winstone Zulu, a Zambian AIDS activist, who briefly became a denialist •  The Global Epidemic 2 8/23/11 Figure 2.1 Number of people newly infected with HIV 4.0 3.5 MILLIONS 3.0 2.5 2.0 1.5 1.0 0.5 0.0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Dotted lines represent ranges, solid lines represent the best estimate. 3 8/23/11 Figure 2.5 Global HIV trends, 1990 to 2009 Number of people living with HIV Number of Figure 2.5 Global HIV trends, 1990 to 2009 Global Trends, 1990 to 2009 Number of people living with HIV Number of children living with HIV Adult and child deaths due to AIDS Number of orphans due to AIDS Adult and child deaths due to AIDS Number o Dotted lines represent ranges, solid lines represent the best estimate. Source: UNAIDS. Dotted lines represent ranges, solid lines represent the best estimate. Source: UNAIDS. 2006 WHO ART Guidelines 4 8/23/11 2010 WHO ART Guidelines !"#$%&#%'($%)*+#,&%)-.+/!012+3'(&%)4&5+6778 9&'4%)-,$3)*+ :&%3&"#)4&+';+&*$4$<*&+-&'-*&+ %&4$'" %&3&$($"4+#%&)#=&"# >?<@>),)%)"+ !"#$%!&#'&(#) !;%$3) A&"#%)*5+>'?#,+ &*#$%!+#'&"#) !=&%$3) B3&)"$) +,#$%&(#'-(#) A)%$<<&)" &.#$%&*#'++#) C)D#&%"+C?%'-&+E+ ,/#$%,+#'*,#) A&"#%)*+!D$) 5 8/23/11 Estimate of the annual number of infant infections averted through the provision of antiretroviral prophylaxis to HIV-positive pregnant women, globally, 1996–2008 70 000 Infant infections averted 60 000 50 000 40 000 30 000 20 000 10 000 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 AIDSepidemic update Figure II 6 8/23/11 Regional estimates of the number of infant infections at current levels of antiretroviral prophylaxis and without antiretroviral prophylaxis Asia Latin America Eastern Europe and Central Asia 6 8 5 (thousands) 40 30 20 6 4 10 2 0 0 1996 1998 2000 2002 2004 2006 2008 Caribbean 3 2 1 1996 1998 2000 2002 2004 2006 0 2008 1.0 3 2 1 0.5 1998 2000 2002 2004 2006 2008 2000 2002 2004 2006 2008 2006 2008 400 (thousands) (thousands) 1.5 1998 500 4 2.0 1996 1996 Sub-Saharan Africa 5 3.0 2.5 0 4 Middle East and North Africa 3.5 (thousands) (thousands) 10 50 (thousands) 60 0 300 200 100 1996 1998 2000 2002 2004 No prevention of mother-to-child transmission 2006 2008 0 1996 1998 2000 2002 2004 At current levels of antiretroviral prophylaxis 2009 AIDSepidemic update Figure IV UN Global Report 2011: HIV and AIDS Statistics SUB-SAHARAN AFRICA Table 2.3 AIDS statistics for sub-Saharan Africa, 2001 and 2009 Source: UNAIDS. People living with HIV Children living with HIV AIDS-related deaths 2009 22.5 million [20.9–24.2 million] 1.8 million [1.6–2.0 million] 2.3 million [1.4 –3.1 million] 1.3 million [1.1–1.5 million] 2001 SUB-SAHARAN AFRICA People newly infected with HIV 20.3 million [18.9–21.7 million] 2.2 million [1.9–2.4 million] 1.8 million [1.1–2.5 million] 1.4 million [1.2–1.6 million] Figure 2.7 HIV prevalence in sub-Saharan Africa HIV prevalence among adults aged 15–49 years old in sub-Saharan Africa, 1990 to 2009. Source: UNAIDS. 7 8/23/11 Figure 2.8 HIV trends in sub-Saharan Africa Number of people living with HIV Number of people newly infected with HIV Number of children living with HIV Adult and child deaths due to AIDS Dotted lines represent ranges, solid lines represent the best estimate. Source: UNAIDS. Sub-Saharan Africa Over 6 times higher prevalence – 25% in some areas Majority of cases, incidence, and deaths At-Risk Populations Adult women -  60% globally -  ¾ of all women -  2/3 of adults in sub-Saharan -  difficulty in negotiating condom use Sub-Saharan Africa Swaziland, Lesotho, Botswana South Africa, Nigeria, Kenya, Mozambique, Uganda HIV-Infected Children 28% ART (2010 WHO Guidelines) Dosage Adherence Form Nutrition 8 8/23/11 At-Risk Populations ABC and PEPFAR IDU – 1 in 3 MSM – 1 in 8 to nearly 1 in 2 stigmatized 38 countries Sex workers – up to 50% Serodiscordant couples ASIA Uganda Table 2.4 AIDS statistics for Asia, 2001 and 2009 Prevalence 15% - 1992 6% - 2004 6.5% currently Source: UNAIDS. People living with HIV 2009 4.9 million [4.5–5.5 million] 360 000 160 000 [300 000– 430 000] [110 000– 210 000] 300 000 [260 000–340 000] 2001 ASIA People newly infected with HIV Children living with HIV 4.2 million [3.8– 4.6 million] 450 000 [410 000–500 000] 250 000 [220 000–300 000] 100 000 [69 000–140 000] AIDS-related deaths Figure 2.10 Frontline World HIV prevalence in Asia HIV prevalence among adults aged 15–49 years old in Asia, 1990 to 2009. Source: UNAIDS. Figure 2.11 HIV trends in Asia Number of people living with HIV Number of people newly infected with HIV Number of children living with HIV Adult and child deaths due to AIDS No data < .1% .1% – <.5% .5% – <1% 1% – <1.5% 1.5% – 2.5% Dotted lines represent ranges, solid lines represent the best estimate. Source: UNAIDS. 32 Chapter 2: Epidemic update | 2010 GLOBAL REPORT 9 8/23/11 Asia Asia Low prevalence, high numbers India, China, Myanmar, Thailand, Indonesia 84% SE Asia 34% ART (2006 WHO guidelines) Prevalence rates IDUs MSM Myanmar, Cambodia, Pakistan, Thailand, Indonesia Myanmar, Thailand, Southern India, China -  Lao, Bangladesh, Philippines, Pakistan Incidence rates -  India, Thailand -  Bangladesh, Philippines Sex Workers Myanmar, Southern India, Thailand India About half of total – 2.4 million Sex, Southern India 50% prevalence IDU, Northern India 10 8/23/11 China Low IDU, contaminated blood (donors), medical equipment NEP, methadone MSM – “abnormal” 5% prevalence - 2009 Heterosexual transmission 42% Condoms Thailand EASTERN EUROPE AND CENTRAL ASIA Table 2.5 > 500,000 1.3% IDUs 30-50%: 39% MSM – 30% mid-1990s 1 in 3 to 1 in 35 AIDS statistics for Eastern Europe and Central Asia, 2001 and 2009 Source: UNAIDS. People living with HIV Children living with HIV AIDS-related deaths 2009 1.4 million [1.3–1.6 million] 130 000 [110 000 –160 000] 18 000 [8600–29 000] 76 000 [60 000–95 000] 2001 EASTERN EUROPE + CENTRAL ASIA People newly infected with HIV 760 000 [670 000–890 000] 240 000 [210 000–300 000] 4000 [2000– 6100] 18 000 [14 000–23 000] Figure 2.12 HIV prevalence in Eastern Europe and Central Asia HIV prevalence among adults aged 15–49 years old in Eastern Europe and Central Asia, 1990 to 2009. Source: UNAIDS. Figure 2.13 HIV trends in Eastern Europe and Central Asia Number of people living with HIV Number of people newly infected with HIV Number of children living with HIV Adult and child deaths due to AIDS No data < .1% .1% – <.5% .5% – <1% 1% – <2% 2% – 5% Dotted lines represent ranges, solid lines represent the best estimate. Source: UNAIDS. 36 Chapter 2: Epidemic update | 2010 GLOBAL REPORT 11 8/23/11 Russia, Ukraine CARIBBEAN Table 2.6 AIDS statistics for the Caribbean, 2001 and 2009 85% increase 2001 1% 37% IDU Russia, 50% Ukraine criminalize and no Tx 22% ART, 2006 guidelines Source: UNAIDS. People living with HIV Children living with HIV AIDS-related deaths 2009 240 000 [220 000–270 000] 17 000 [13 000–21 000] 17 000 [8500–26 000] 12 000 [8500–15 000] 2001 CARIBBEAN People newly infected with HIV 240 000 [210 000–270 000] 20 000 [17 000–23 000] 18 000 [9100–27 000] 19 000 [16 000–23 000] Figure 2.14 HIV prevalence in the Caribbean HIV prevalence among adults aged 15–49 years old in the Caribbean, 1990 to 2009. Source: UNAIDS. CENTRAL AND SOUTH AMERICA Figure 2.15 HIV trends in Caribbean Table 2.7 Number of people living with HIV AIDS statistics for Central and South America, 2001 and 2009 Number of people newly infected with HIV Source: UNAIDS. People living with HIV CENTRAL AND SOUTH AMERICA Adult and child deaths due to AIDS Figure 2.16 Children living with HIV AIDS-related deaths 2009 1.4 million [1.2–1.6 million] 92 000 [70 000–120 000] 36 000 [25 000 –50 000] 58 000 [43 000–70 000] 2001 Number of children living with HIV People newly infected with HIV 1.1 million [1.0–1.3 million] 99 000 [85 000–120 000] 30 000 [20 000–42 000] 53 000 [44 000–65 000] No data < .1% .1% – <.5% HIV prevalence in Central and South America Dotted lines represent ranges, solid lines represent the best estimate. .5% – <1% 1% – <2% 2% – 5% HIV prevalence among adults aged 15–49 years old in Central and South America, 1990 to 2009. Source: UNAIDS. 40 CSource: UNAIDS. update | 2010 GLOBAL REPORT hapter 2: Epidemic Figure 2.17 HIV trends in Central and South America Number of people living with HIV Number of people newly infected with HIV Number of children living with HIV Adult and child deaths due to AIDS No data < .1% .1% – <.5% .5% – <1% 1% – <2% 2% – 5% Dotted lines represent ranges, solid lines represent the best estimate. Source: UNAIDS. 44 Chapter 2: Epidemic update | 2010 GLOBAL REPORT 12 8/23/11 MIDDLE EAST AND NORTH AFRICA Figure 2.21 HIV trends in the Middle East and North Africa Table 2.9 AIDS statistics for the Middle East and North Africa, 2001 and 2009 Number of people living with HIV Number of people newly infected with HIV Number of children living with HIV Adult and child deaths due to AIDS Source: UNAIDS. People living with HIV Children living with HIV AIDS-related deaths 2009 460 000 [400 000–530 000] 75 000 [61 000–92 000] 21 000 [13 000–28 000] 23 000 [20 000 –27 000] 2001 MIDDLE EAST AND NORTH AFRICA People newly infected with HIV 180 000 [150 000–200 000] 36 000 [32 000– 42 000] 7100 [3800–13 000] 8300 [6300–11 000] Figure 2.20 HIV prevalence in Middle East and North Africa Dotted lines represent ranges, solid lines represent the best estimate. HIV prevalence among adults aged 15–49 years old in Middle East and North Africa, 1990 to 2009. Source: UNAIDS. Source: UNAIDS. NORTH AMERICA AND WESTERN AND CENTRAL EUROPE Figure 2.23 HIV trends in Oceania Table 2.8 AIDS statistics for North America and Western and Central Europe, 2001 and 2009 Number of people living with HIV Number of people newly infected with HIV Source: UNAIDS. People living with HIV No data < .1% Adult and child deaths due to AIDS .1% – <.5% .5% – <1% 1% – <1.5% AIDS-related deaths 2009 2.3 million [2.0– 2.7 million] 100 000 [73 000–150 000] 6000 [3500– 8000] 35 000 [29 000–56 000] 1.8 million [1.6– 2.0 million] 97 000 [82 000–110 000] 7400 [4500– 10 000] 37 000 [32 000–44 000] Figure 2.18 1.5% – 3% HIV prevalence in North America and Western and Central Europe HIV prevalence among adults aged 15-49 years old in North America and Western and Central Europe, 1990 to 2009. Dotted lines represent ranges, solid lines represent the best estimate. 52 Children living with HIV 2001 NORTH AMERICA AND WESTERN AND CENTRAL EUROPE Number of children living with HIV People newly infected with HIV Source: UNAIDS. Chapter 2: Epidemic update | 2010 GLOBAL REPORT Source: UNAIDS. Figure 2.19 HIV trends in North America and Western and Central Europe Number of people living with HIV Adult and child deaths due to AIDS Dotted lines represent ranges, solid lines represent the best estimate. No data 48 Source: UNAIDS. < .1% .1% – <.5% .5% – 1% 1% – 1.5% 1.5% – 2% Chapter 2: Epidemic update | 2010 GLOBAL REPORT 13 8/23/11 US Trends •  Est. adult prevalence is 0.6% •  Incidence is ≈ 54,000/year •  Has been largely stable incidence –  Why aren’t these numbers declining? 14 ...
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