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The global epidemic of HIV infection

The global epidemic of HIV infection. Ford von Reyn Infectious Disease Section Dartmouth-Hitchcock Medical Center. AIDS at DHMC. 7/15/81 33 yo gay man, IDU Admitted with bilateral pulmonary infiltrates Dx: Pneumocystis carinii pneumonia (PCP) Rx: Died after 16 days

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The global epidemic of HIV infection

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  1. The global epidemic of HIV infection Ford von Reyn Infectious Disease Section Dartmouth-Hitchcock Medical Center

  2. AIDS at DHMC • 7/15/81 33 yo gay man, IDU Admitted with bilateral pulmonary infiltrates Dx: Pneumocystis carinii pneumonia (PCP) Rx: Died after 16 days CDC: 30-35 cases reported

  3. Rock Hudson reported with AIDS-1985

  4. -1986

  5. Global estimates for adults and childrenend 2003 • People living with HIV/AIDS • New HIV infections • Deaths due to HIV/AIDS 46 million 5 million 3 million

  6. Adults and children estimated to be living with HIV/AIDS as of end 2001 Eastern Europe & Central Asia 1 million Western Europe 550 000 North America 950 000 East Asia & Pacific 1 million North Africa & Middle East 500 000 South & South-East Asia 5.6 million Caribbean 420 000 Sub-Saharan Africa 28.5 million Latin America 1.5 million Australia & New Zealand 15 000 Total: 40 million

  7. Modes of transmission of HIV • Sexual • Parenteral • Perinatal

  8. Global transmission patterns Pattern I: developed countries (e.g. US, Australia, W Europe) • Sexual: homosexual>heterosexual • Parenteral: injecting drug use • Perinatal: perinatal/postnatal>prenatal Seroprevalence: <1% (M>>F)

  9. Global transmission patterns Pattern II: developing countries (e.g. sub-Saharan Africa) • Sexual: heterosexual (M=F) • Parenteral: unsterile needles, transfusion • Perinatal: perinatal/postnatal>prenatal Seroprevalence: 1-25%(M=F)

  10. Modes of transmission of HIV • Sexual • Parenteral • Perinatal

  11. Heterosexual Transmission: Uganda • 415 couples with HIV pos and HIV neg partner • Up to 30 month follow with counseling • Seroconversion in 90 couples (12/100 py) • No difference in M to F vs F to M transmission • Role of circumcision • seroconversion 16.7/100 py in uncircumcised males • seroconversion 0/100 py in circumcised males • Role of viral load: seroconversion 0/100 py in 51 patients with viral load <1500 -Quinn 2000

  12. Sexual transmission of HIV • Transmission is bidirectional M F = F M • Rate of transmission per episode intercourse: 1/1000long term partner: 15-25% • Risk factors: viral load lack of circumcision genital ulcers

  13. Modes of transmission of HIV • Sexual • Parenteral • Perinatal

  14. Modes of transmission of HIV • Sexual • Parenteral • Perinatal

  15. Perinatal Transmission of Human Immunodeficiency Virus (HIV) Prenatal(7%) -Transplacental Intrapartum(13%) -During delivery Postpartum (14%) -Breast feeding Mofenson 2001

  16. AIDS as a zoonosis Simian immunodeficiency viruses Pan troglodytes SIVcpz (chimpanzee) Sooty mangabeys SIVsm -Hahn 2000, Science

  17. Tuberculosis Risk: active TB = 5% in reported AIDS cases reactivation 7%/yr Mortality: low (unless MDR) CD4 range: all, median = 354 (US, Theuer) Surveillance: annual PPD skin testing (read by provider) Prevention: childhood BCG (developing countries) INH 300 mg+pyr 50 mg x 12 mos for PPD > 5mm anergic patients at high risk (e.g. IDU)

  18. Pneumocystis carinii Pneumonia Risk: 80% cumulative risk Mortality: 15% per episode CD4 range: usually <200, (10% higher, most <50) Prevention: for CD4<200 or any OI (e.g. thrush), give TMP/SMZ DS (160/800) 3x/wk or Dapsone 100 qd or 50 bid or Aerosol pentamidine 300/mo

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