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HIV “Myths, controversies and challenges”

HIV “Myths, controversies and challenges”. Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital. “10 questions ....”. 1. What is the difference b/w HIV and AIDS 2. What is the origin? 3. How is it transmitted?

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HIV “Myths, controversies and challenges”

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  1. HIV “Myths, controversies and challenges” Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital

  2. “10 questions ....” • 1. What is the difference b/w HIV and AIDS • 2. What is the origin? • 3. How is it transmitted? • 4. Does the risk of transmission vary? • 5. Can you know when a person got infected? • 6. Is lengthy pretest counselling needed before a test is done? • 7.How is HIV treated? • 8. Can it be cured? • 9. What is the life expectancy? • 10. What about a vaccine and is there hope?

  3. How many people are affected? • Globally 34 million PLHAs, 1.7M deaths a year, 2.5M new infections a year • 15 million eligible for treatment and 8 million on treatment. • 24 million cases in Africa • 5% adult prevalence in Cameroon (2011) – 900000 PLHA • UK – 70000 PLHA • No. Of new cases and deaths Falling due to success of treatment

  4. 1. What is the difference b/w HIV and AIDS? Not the same thing but related. AIDS is a stage of HIV infection.

  5. NOT ALL HIV INFECTION = AIDS

  6. Most people with HIV have no symptoms

  7. 2. Origin? Jump from chimpanzees to humans - SIV

  8. Figure 1 Source: The Lancet Infectious Diseases 2011; 11:45-56 (DOI:10.1016/S1473-3099(10)70186-9) Terms and Conditions

  9. 3. How is HIV transmitted? • Unprotected sex – 70% of infections • Mother to child transmission – mum must be positive – during pregnancy, at birth or during breastfeeding! • Intravenous drug use – sharing needles • Blood transfusion and other blood products • Medical equipment

  10. Mother to child transmission 30% risk of transmission reduced to <2% with ARVS

  11. How is HIV not transmitted? • Cutlery • Mosquitoes • Kissing • Hugging

  12. 4. Does the risk of transmission vary? • Varies depending on • Positive person • Negative person • Route of transmission • Sex 3/1000 but can happen with first contact • Transmission to women easier • IV drug user high risk

  13. 5. Can you know when a person acquired the infection? • No but can guess!!!

  14. Viral load & CD4 after HIV Infection[without treatment] Death No symptoms Symptoms AIDS 2 million 1000 CD4 count HIV viral load 500 200 0 0 Up to 12 years 4-8 wks 2-12 mo 2-3 years Time Understanding HIV Treatment and adherence.

  15. Development of AIDS is like an impending train wreck Viral Load = Speed of the train CD4 count = Distance from cliff HIV infection J. Coffin, XI International Conf. on AIDS, Vancouver, 1996

  16. Infections and cancer!

  17. 6. Is lengthy pretest counselling needed? • An HIV test is a routine test!!!

  18. 7. How is HIV treated and it is effective?

  19. Protease New HIV particles Capsid proteins and viral RNA CD4 Receptor Viral RNA Reverse Transcription Attachment Translation Uncoating Integration Transcription HIV Replication Cycle and Sites of Drug Activity • NNRTIs Cellular DNA • nRTI • NRTIs • Protease Inhibitors Nucleus HIV Virions Reverse Transcriptase Integrase Fusion Inhibitors Unintegrated double stranded Viral DNA gag-pol polyprotein Integrated viral DNA Viral mRNA CCR5 or CXCR4 co-receptor 6 5 1 3 4 2 Assembly and Release At least 3 drugs to stop the virus from multiplying clinicaloptions.com/hiv

  20. enfuvirtide HIV Medication Timeline • Between ’87 and ’95 (9 years), 4 antiretrovials were launched. • Since ’95 (11 years), 25 new products have been introduced!! emtricitabine emtricitabine/ tenofovir stavudine lamivudine lamivudine/zidovudine efavirenz zalcitabine nevirapine tenofovir abacavir/ lamivudine/ zidovudine didanosine delavirdine zidovudine abacavir ’93 ’87 ’88 ’89 ’90 ’91 ’92 ’94 ’95 ’96 ’97 ’98 ’99 ‘00 ’01 ‘02 ‘03 ‘04 ‘05 ‘06 saquinavir NRTI tipranavir atazanavir ritonavir darunavir nelfinavir NNRTI indinavir saquinavir PI didanosine Kaletra amprenavir fosamprenavir FI Corrections Curriculum Development, NY/NJ AETC Many drugs available and more in development – outlook is good!

  21. Treatment & Treatment as prevention Most patients on one or two tablets a day!

  22. After HIV treatment (ARVs): effect on CD4 and viral load Start treatment Viral load <50 copies/mL 2 million 1000 CD4+ cells/mm3 viral load (RNA) copies/mL 500 200 < 50 copies/mL 0 0 + 1-40+ years !! 1-12 yrs +1-6 mo Time Chronic Infection Understanding HIV Treatment and adherence.

  23. 8. What is life expectancy like? • We don’t know for sure however we have estimates.... • HIV survival similar to other chronic diseases! • Life expectancy at 25 years diagnosis estimated to be 70 years

  24. 9. What about a cure?

  25. 10. What about a vaccine? • Problem is variability of the virus!!! • Stays one step ahead of immune system!!!

  26. What are challenges? • Early diagnosis • Access to treatment in developing countries

  27. Thank you nsutebufru@hotmail.com

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