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AIDS

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AIDS

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  1. AIDS 邓子德 中山大学附属第三医院 传染病学教研室 Deng zide Department of Infectious Diseases The 3rd Hospital of Sun Yat-sen University

  2. A Acquired I Immuno D Deficiency S Syndrome

  3. AIDS • AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981 and has since become a major worldwide epidemic. • AIDS is caused by HIV (human immunodeficiency virus). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. • People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make healthy people sick.

  4. AIDS AIDS

  5. AIDS patient

  6. AIDS patient

  7. Timeline Post-Naming1982 – First use of term “AIDS”1983 – Virus isolated and identified Early to mid 80s – First wave of activism: community based groups securing visibility. 1985 – HIV Ab testing availableMid-80s – Border control regulations in more than 50 countries1987 – First FDA approved drug, AZT. Also, birth of ACT UP and transition to activism focused on treatment. Late 80s – WHO produces “world mapping”

  8. Recognizing “New Frontiers”1990 – Eastern Europe described as the new frontier of the AIDS epidemic; Signs of infection in China (in fact starting early to mid 80s)Always “the other” 'AIDS and drug addiction are still seen as consequences of contact with the West, AIDS being known as aizibing, the "loving capitalism disease".' -The Guardian1993 – concern about underreporting China, mostly reporting IV drug users1996 – China’s reported cases: 2/3 in southern province connected to drug use

  9. Etiology H Human I Immunodeficiency V Virus

  10. Etiology Pathogen 人免疫缺陷病毒 (HIV) (human immunodeficiency virus)∶HIV-1、HIV-2

  11. Etiology 人免疫缺陷病毒 (human immunodeficiency virus,HIV) HIV-1、HIV-2

  12. Etiology 透膜糖蛋白 包膜蛋白 逆转录酶 核酸蛋白

  13. HIV-Infected T-Cell New HIV Virus HIV Infected T-Cell HIV Virus T-Cell

  14. HIV病毒破坏人体免疫系统 HIV infected CD4

  15. HIV 生 活 周 期

  16. 急性期 潜伏期 艾滋病期 Anti-Ab Anti-gp41/120 (anti-gp36) HIV RNA Anti-Ag Anti-P24 1周 2周…..1月 2月………………….1年 2年 3年…………….10年……….. 窗口期 HIV抗原、抗体变化图

  17. 死亡 感染

  18. Epidemiology

  19. 1985-2004年9月全国历年报告HIV/AIDS情况 *上述数据为当年各省报告数汇总,本次筛查中有所变动,尚需根据筛查情况不断调整。

  20. 中国1985年发现艾滋病的省份

  21. 中国1989年发现艾滋病的省份

  22. 中国1995年发现艾滋病的省份

  23. 中国1998年发现艾滋病的省份

  24. 感染者数 1-50 51-100 101-500 501-1000 1001-10000 10001-20000 >20000 截至2004年底全国累计报告HIV感染者按地理分布The geographic distribution of cumulative reported HIV cases in China by the end of 2004 HIV cases

  25. HIV prevalence in adults in Asia, 1990−2005

  26. 血液/血制品 母婴传播 Blood and Blood MTCT products 2.8% 0.9% 采血 不详 静注毒品 异性/同性 截至2004年底全国累计报告HIV感染者传播途径构成Modes of transmission among HIV/AIDS cases by the end of 2004 Not clear 17.9% Commercial blood and plasma Donation 26.8% IDU 43.2% Heterosexual/MSM 8.3%

  27. 女 不详 截至2004年底全国累计报告HIV感染者按性别分布Proportions of male and female reported HIV cases in China by the end of 2004 Male 71.6% Female 27.8% Not clear 0.5%

  28. Distribution of HIV Infections by Age

  29. HIV Transmission

  30. Brief Statistics on the HIV/AIDS Epidemic in China • By the end of September 2004, • Cumulative reported HIV infections: 89,067 • Cumulative reported AIDS cases: 20,786 • Cumulative reported AIDS deaths: 5,024 • China CDC and WHO estimated: • People Living with HIV/AIDS: 840,000 • AIDS patients: 80,000

  31. HIV感染者数 1-100 101-500 501-1000 1001-5000 5001-10000 >10000 Geographic Distribution of Cumulative Reported HIV Infections in China (1985-2004.9)

  32. Features of the HIV/AIDS Epidemic in China • The epidemic is characterized by a wide disparity between high and low prevalence regions • The epidemic is becoming more severe • The main HIV transmission route is through injecting drug use. • The number of AIDS-related deaths is increasing • HIV is spreading from high risk groups to the general population • The proportion of female HIV cases are increasing

  33. Epidemiology传染源 • 病人 • 无症状HIV携带者 • ☆HIV存在于∶ 血液 唾液 精液 眼泪 阴道分泌物 乳汁

  34. Modes of Transmission • SEXUAL ACTIVITY • BLOOD-TO-BLOOD CONTACT • VERTICAL TRANSMISSION

  35. Routes of Transmission of HIV Sexual Contact:Male-to-male Male-to-female or vice versa Female-to-female Blood Exposure:Injecting drug use/needle sharing Occupational exposure Transfusion of blood products Perinatal:Transmission from mom to baby Breastfeeding

  36. HIV enters the bloodstream through: Open Cuts Breaks in the skin Mucous membranes Direct injection HIV Transmission

  37. Common fluids that are a means of transmission: Blood Semen Vaginal Secretions Breast Milk HIV Transmission

  38. HIV in Body Fluids Blood 18,000 Semen 11,000 Vaginal Fluid 7,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids

  39. Epidemiology传播途径 • 性接触 • 同性恋 • 异性恋 • 注射 • 不洁注射 • 输血及血制品 • 母--婴 • 其他

  40. HIV Transmission:Sexual Transmission • Highest risk activities • Unprotected anal intercourse • Unprotected vaginal intercourse • Oral sex ? • Condom efficacy:Consistent andcorrect use

  41. HIV and Sexually Transmitted Diseases

  42. HIV and Sexually Transmitted Diseases STDs increase infectivity of HIV • A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding • More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection

  43. HIV and Sexually Transmitted Diseases • STDs increase the susceptibility to HIV • Ulcerative and inflammatory STDs compromise the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV • Ulcerative STDs include: syphilis, chancroid, and genital herpes • Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis

  44. HIV and Sexually Transmitted Diseases • The effect of HIV infection on the immune system increases the the risk of STDs A suppressed immune response due to HIV can: • Increase the reactivation of genital ulcers • Increase the rate of abnormal cell growth • Increase the difficulty in curing reactivated or newly acquired genital ulcers • Increase the risk of becoming infected with additional STDs

  45. 艾滋病与性病相伴

  46. HIV Transmission:Blood-to-Blood Contact • Injecting drug users (IDUs) who share needles • Recipients of contaminated blood products • Healthcare workers with occupational exposure

  47. 静脉 注射毒品