Update in HIV/AIDS New millennium, New challenge

1. Update in HIV/AIDSNew millennium, New challenge 王永衛 醫師 台北榮民總醫院感染科主治醫師

2. Global summary of the HIV/AIDS epidemic, December 2001 Number of people living with HIV/AIDS Total 40 millionAdults 37.2 millionWomen 17.6 million Children under 15 years 2.7 million People newly infected with HIV in 2001 Total 5 millionAdults 4.3 millionWomen 1.8 million Children under 15 years 800 000 AIDS deaths in 2001 Total 3 millionAdults 2.4 millionWomen 1.1 million Children under 15 years 580 000

3. Regional HIV/AIDS statistics and features, end of 2001 % of HIV-positive adults who are women Main mode(s) of transmission for those living with HIV/AIDS ** Adults & children newly infected with HIV Epidemic started Adults & children living with HIV/AIDS Adult prevalence rate * 28.1 million 440 000 6.1 million 1 million 1.4 million 420 000 1 million 560 000 940 000 15 000 40 million late ’70s early ’80s late ’80s late ’80s late ’80s late ’70s early ’80s late ’70s early ’80s early ’90s late ’70s early ’80s late ’70s early ’80s late ’70s early ’80s 3.4 million 80 000 800 000 270 000 130 000 60 000 250 000 30 000 45 000 500 5 million 8.4% 0.2% 0.6% 0.1% 0.5% 2.2% 0.5% 0.3% 0.6% 0.1% 1.2% 55% 40% 35% 20% 30% 50% 20% 25% 20% 10% 48% Hetero Hetero, IDU Hetero, IDU IDU, Hetero, MSM MSM, IDU, Hetero Hetero, MSM IDU MSM, IDU MSM, IDU, Hetero MSM Sub-Saharan Africa North Africa & Middle East South and South-East Asia East Asia & Pacific Latin America Caribbean Eastern Europe & Central Asia Western Europe North America Australia & New Zealand TOTAL * The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2001, using 2001 population numbers ** Hetero: heterosexual transmission – IDU: transmission through injecting drug use – MSM: sexual transmission among men who have sex with men

4. Update in HIV/AIDS - New millennium, New challenge

5. 中華民國愛滋病統計報告台灣地區感染者危險因素別統計中華民國愛滋病統計報告台灣地區感染者危險因素別統計 民國 91年9月1曰

6. 中華民國愛滋病統計報告台灣地區感染者年齡別統計中華民國愛滋病統計報告台灣地區感染者年齡別統計 民國 91年9月1曰

7. Update in HIV/AIDS - New millennium, New challenge

8. Update in HIV/AIDS - New millennium, New challenge

9. STD and HIV Factors Associated with Increased Risk of Transmission MALE->FEMALE FEMALE->MALE MALE->MALE Anal intercourse YesUnknown Yes No. of sexual contactsYes Yes Yes Advanced HIV diseaseYes Yes Yes Primary HIV infectionYes Yes Yes Genital sores/ infectionsYes Yes Yes Sex during menses No Yes NA Lack of circumcision Possibly Yes Unknown Cervical ectopy Yes Possibly NA Oral contraceptivesYes Unknown NA IUD use Possibly Unknown NA Pregnancy Unknown Possibly NA

10. STD and HIV Factors Associated with Decreased Risk of Transmission MALE->FEMALE FEMALE->MALE MALE->MALE Condom use Yes Yes Yes Antiretroviral therapyPossibly Possibly Possibly Spermicide use Possibly Unknown Unknown Microbicidal Unknown Unknown NA

11. Natural History of HIV Infection

12. Natural History of HIV Infection

13. Life Cycle of HIV-1 and Targets of Anti-retroviral agents Fusion inhibitor T20

14. Strongly Recommended Column A Column B Indinavir combivir Saquinavir d4T+3TC Nelfinavir Saquinavir+ritonavir Indinavir+Ritonavir Efavirenz Nevirapine Recommended as Alternatives Column A Column B Abacavir AZT+3TC Ritonavir AZT+ddI AZT+ddC D4T+ddI ddI+3TC Update in HIV/AIDS - New millenniumIDSROC, Med. Found. In Memory of Dr. DL Cheng, March 2001 Acute / asymptomatic HIV Infection

15. HIV infected pregnant women Strongly Recommended Column A Column B Saquinavir (B) Combivir (C) Ritonavir (B) AZT+ddI (B) Nevirapine (C) Post Exposure Prophylaxis Column A Column B Indinavir Combivir Recommended as Alternatives Column A Column B Indinavir AZT+3TC Nelfinavir d4T+3TC Column A Column B Saquinavir AZT+3TC Nelfinavir d4T+3TC Update in HIV/AIDS - New millenniumIDSROC, Med. Found. In Memory of Dr. DL Cheng, March 2001

16. Update in HIV/AIDS - New millennium

17. 3-Year Suppression of HIV Viremia with Indinavir, Zidovudine, and Lamivudine

18. Update in HIV/AIDS - New millennium

19. Update in HIV/AIDS - New challenge

20. Factors Affecting Adherence in HIV-infected Patients • Food effects • Pill burden • Drug interactions • Spacing of medications • Side effects • Adherence issues • Confusion with drug names

21. Factors Affecting Adherence in HIV-infected PatientsRegimen Pills per day Trizivir 2 Combivir / Abacavir 4 Combivir / Efavirenz 5 Combivir / Kaletra 8 d4T / 3TC / Indinavir 10 d4T / 3TC / Nelfinavir 13 ZDV / ddI / Ritonavir / Saquinavir 22 ddI / d4T / Saquinavir 22

22. Factors Affecting Adherence in HIV-infected Patients

23. Factors Affecting Adherence in HIV-infected Patients

24. Factors Affecting Adherence in HIV-infected Patients

25. Factors Affecting Adherence in HIV-infected Patients

26. Factors Affecting Adherence in HIV-infected Patients

27. Metabolic and Morphologic Complications Associated With HAART

28. Metabolic and Morphologic Complications Associated With HAART

29. Metabolic and Morphologic Complications Associated With HAART

30. Kaplan-Meier curves for the occurrence of hypercholesterolemia in protease inhibitor (PI)–exposed vs –nonexposed patients.The graphic representation shows the proportion of patients in whom hypercholesterolemia does not develop.

31. Kaplan-Meier curves for the occurrence of hypertriglyceridemia on protease inhibitor (PI)–exposed vs –nonexposed patients. The graphic representation shows the proportion of patients in whom hypertriglyceridemia does not develop.

32. Metabolic and Morphologic Complications Associated With HAART

33. Metabolic and Morphologic Complications Associated With HAART

34. Metabolic and Morphologic Complications Associated With HAART

35. Metabolic and Morphologic Complications Associated With HAART

36. Metabolic and Morphologic Complications Associated With HAART

37. Immune Therapy: Non-HAART Management of HIV-infected Patients Rebuilding the Immunity - Immune Booster • CD4 Repertoire naive CD4 cell memory CD4 cell Loss of CD4 cells produce 'gaps' in the repertoire where the immune system can no longer respond to certain antigens • RES architecture

38. Immune Therapy: Non-HAART Management of HIV-infected Patients Rebuilding the Immunity - Immune Booster (cont.) - IL2 pooled analysis of 157 participants in 3 placebo-controlled studies • 6 OIs occurred among IL-2 recipients • 14 among placebo recipients Early treatment may prevent irreversible damage from occurring in the first place

39. Immune Therapy: Non-HAART Management of HIV-infected Patients

40. Vaccination in HIV Infection

41. Update in HIV/AIDS - New millennium, New challenge Post exposure prophylaxis • Health-care Workers average 0.3% for percutaneous and mucosa exposure risk increased for deep injury, visible blood on device, device had been placed in vessels, or patients died of AIDS within 60 days chemoprophylaxis initiated within 1 to 2 hours and continued for 4 weeks zidovudine plus lamivudine1 (+PI 2) 1 Johnson MA, Goodwin C, yen GJ, et al. 11th Int. Conf. On AIDS 1996 2 Centers for Diseases Control and Prevention. JAMA 1996

42. Update in HIV/AIDS - New millennium, New challenge Post exposure prophylaxis Risk Factor Adjusted OR (95%CI) • deep injury 16.1 (6.1-44.6) • visible blood on device 5.2 (1.8-17.7) • device had been placed in vessels 5.1 (1.9-14.8) • patients died within 60 days 6.4 (2.2-18.9) • chemoprophylaxis 0.2 (0.1- 0.6) Sepkowitz KA. Ann Intern Med 1996