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HIV/AIDS The Fatal STI

HIV/AIDS The Fatal STI. HIV – The Global picture 1. HIV has become one of the world’s most important diseases with a great burden on health and development. More than 34 million people are currently living with HIV around the world.

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HIV/AIDS The Fatal STI

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  1. HIV/AIDS The Fatal STI

  2. HIV – The Global picture1 • HIV has become one of the world’s most important diseases with a great burden on health and development. • More than 34 million people are currently living with HIV around the world. • More than 25million people have already died since the first cases of HIV was diagnosed in 1981. • Sub-Saharan Africa and Asia are worst hit from this epidemic. While the Middle East & North Africa now have the fastest rate of spread of this virus. Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization (WHO). UNAIDS report on the global AIDS epidemic 2010.

  3. Centers for Disease Control and Prevention. HIV/AIDS Surveillance; 1981-2008. MMWR 2011;60(21):689-693. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008;300:520--29. Approximately 1,178,350 are living with HIV in US1 About 1 in 5 of these individuals are unaware that they are infected. Approximately 50,000 new infections each year1,2 HIV infection leads to Acquired Immunodeficiency Syndrome (AIDS) Over half a million Americans have died of AIDS1 Human Immunodeficiency Virus

  4. Ambroziak J, Levy JA. Epidemiology, natural history, and pathogenesis of HIV infection. In: Holmes KK, Sparling PF, Mardh PA, et al, eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill; 1999:251-258. UNAIDS World AIDS Day Report 2011. How to Get to Zero: Faster. Smarter. Better.December 2011. Geneva : UNAIDS, World Health Organization; 2011. AIDS is the leading cause of death in African Americans aged 25-40 years1 Worldwide, 2.7million new cases occur every year2 1.8 million AIDS related deaths occurred in 2010.2 Human Immunodeficiency Virus (cont)

  5. AIDS Cases by race and ethnicity 2009 • Blacks / African Americans still have the highest rates of AIDS diagnoses. • In 2009, among adolescents, blacks/African Americans accounted for 73% of diagnosed infections, and the rate of diagnoses was more than 5 times the rate for Hispanics/Latinos and nearly 23 times the rate for whites. • Among young adults, blacks/African Americans accounted for 62% of diagnosed infections, and the rate of diagnoses was nearly 4 times the rate for Hispanics/Latinos and nearly 13 times the rate for whites. 1. CDC HIV Surveillance Supplemental Report 2012

  6. HIV Incidence by Transmission category 2009 Source: CDC HIV/AIDS Surveillance Report 2009

  7. Females Males 25% 75% New HIV Infections by Gender Source: CDC. 2009. HIV/AIDS Surveillance Report 2011.

  8. New HIV Infections by Race: Females Total Males Source: CDC.

  9. Moir S, Chun T, Fauci AS. Immunology and pathogenesis of HIV infection. In: Holmes KK, Sparling PF, Stamm WE, et al, eds. Sexually Transmitted Diseases. 4th ed. New York, NY: McGraw Hill; 2008: 341-355. After initial infection with HIV, spread of infection in the body occurs within 4-11 days1 Virus invades certain white cells in the blood and destroys them Weakens body’s ability to fight infections (ie, immune system) What is HIV Infection?

  10. Transmission through Sexual contact Needle sharing Mother to child Occupational exposure Contaminated transfusion How Do I Get HIV?

  11. Ambroziak J, Levy J. 1999. In: Holmes KK, et al. Lifson A, et al. 1991. Amer J Pub Health. Receptive anal intercourse poses the highest risk1 Oral sex may also transmit HIV infection2 Not transmitted through casual contact3 Presence of STIs enhances transmission4 How Do I Get HIV? (cont) 3. CDC. 2011. Basic Information about HIV/AIDS 4. Spach DH. 2003. In: Dale DC.

  12. Fleming DT, Wasserheit JN. Sex Transm Infect. 1999 February;75(1):3-17. Sulkowski MS, Thomas DL.. Ann Intern Med 2003 February 4;138(3):197-207. HIV and STI Coinfection • Generally people with certain STIs are 2-5 times more susceptible to HIV1 • Females infected with chlamydia have 3- to 5-fold increased risk of acquiring HIV1 • 15-30% of HIV-infected persons in the US are coinfected with hepatitis C virus2

  13. Spach DH. HIV and AIDS. In: Dale DC, ed. Infectious Diseases: The Clinician’s Guide to Diagnosis, Treatment, and Prevention. New York, NY: WebMD; 2003:224-253. Initially nonspecific influenza-like infection Fever, fatigue, rash, headache, lymph node enlargement Usually lasts for <14 days Newly infected people are immediately able to pass on the disease even though they may not test positive for up to 6 months1 What if I Get HIV?

  14. Source: Spielberg F. In Holmes KK Sexually Transmitted Diseases 2008 4th E Traditionally, an ELISA (enzyme linked immunoassay) test is used to detect HIV antibodies Blood test Oral fluid test Urine test Rapid antibody tests How is HIV Diagnosed?

  15. US Dept of Health and Human Services (DHHS). HIV and Its Treatment: What you Should Know: Health Information for Patients. Rockville, MD: February 2008. Mocroft A, Lundgren JD. Antimicrob Chemother 2004 July;54(1):10-3. Spach DH. HIV and AIDS. In: Dale DC, ed. Infectious Diseases: The Clinician’s Guide to Diagnosis, Treatment, and Prevention. New York, NY: WebMD; 2003:224-253. HIV Treatment • Combination antiretroviral therapy is recommended to slow the progress of disease • _ Regimen called Highly Active Antiretroviral Therapy (HAART) 1 • May lead to resistant strains of HIV and other complications2,3 • Best hope for controlling AIDS pandemic is to prevent new infections3

  16. Ambroziak J, Levy JA. Epidemiology, natural history, and pathogenesis of HIV infection. In: Holmes KK, Sparling PF, Mardh PA, et al, eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill; 1999:251-258. Spach DH. 2003. In: Dale DC. A few weeks after primary infection, asymptomatic stage begins Symptoms from a weakened immune system start usually between 5-8 years (range is 1-18 years)1 Risk of untreated HIV-infected person developing AIDS is 1%-2% per year for first few years and 5% per year after that2 Long Term Effects of HIV

  17. Even 100% use of condoms does not eliminate risk, although risk is reduced1,2 Mother-to-child transmission can be reduced by treating the mother before delivery1 Antiretroviral treatment lowers viral load and may reduce sexual transmission3 Treatment of STIs reduces the risk of transmission4 Circumcised males are at significantly lower risk5 Reducing HIV Risk • Ambroziak J, Levy J. 1999. In: Holmes KK, et al. • Davis K, Weller S. 1999. Fam Plann Perspect. • Beers MH, Berkow R. 2005. The Merck Manual… • CDC. 2010 STD Treatment Guidelines. • Sullivan PS et al. 2007. PLoS Med.

  18. Merck & Co., Inc. and the HIV Vaccine Trials Network developing HIV vaccine Step Study is the clinical trial to test vaccine Results: vaccine increased risk of HIV infection1 HIV Vaccine Update 1. Robertson M 2008 CROI Session Presentation #88LB

  19. For unmarried individuals, sexual abstinence is the only practical and certain way to avoid HIV For those who choose to be sexually active, a marriage (mutually faithful, life-long relationship with an uninfected sexual partner) is the healthiest choice Do not share needles Avoid contact with infected body fluids and tissues Avoiding HIV

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