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Early epidemiology of HIV and turning point

Common in homosexuals, immigrants, drug users, poor. Then heterosexual spread and transfusion recipients.


Progress against it up to 2000

Test for HIV AB in mid 80s, able to prevent mother-to-child in mid 90s, HAART in mid 90s


Epidemic by the numbers

About 35 million infected in world, newly infected is 2.3M/year, deaths are over 1M/year.


How much is HIV spread sexually? what is the other percent?

About 80%. Also can be mother-to-child (helped with therapy), injection drugs, transfusion, needlestick (low)


Opportunistic infections with HIV

TB, mycobateria, fungal, pneumonia, others (thrush, shingles)


Risk categories by gender in Canada

Men: highest in homosexual contact, then drugs, then heterosexual. Female: most is heterosexual contact, then drugs. Hetero females are at high risk


AIDS defn

low CD4 (<200), and other opportunistic infections



set new targets and guidelines to help control it. goal was 3M by 05. Still only reached 20% of people affected, barriers to ART, costs to patients.


Societal impact in African countries

Life expectancy dropped significantly in 80s/90s. Forced to choose b/w school and ART and malaria Tx. Uganda: political campaign promoting ABC (abstinence, be faithful, condoms).


Needlestick injury

Usually very low risk (.42%). Factors depend on wearing gloves, type of needle (venous needle more), viral load of patient (if on therapy it is lower). Wash with sad and water, call for risk assessment, consider ART prophylaxis.


Why does HIV spread so much?

86% is heterosexual (truckers, prostitutes, trade routes). Most is transmitted with acute infected people, i.e. early on and not diagnosed probably (in AIDS and chronic patients, transmission is much lower/# of contacts)


General targets to prevent HIV transmission

Decrease exposure (ART lowers HIV in sex fluids), block transmission (condoms), block entry of virus to new cells, treat after exposure,


Mother to child transmission

Risk is 25-40%. Can be before, during and after birth (breast feeding = 10-20% w/o ART). ART helps; C section reduces risk; formula


Male circumcision

decreases transmission by 50%. Apparently there are many cells that are likely to absorb HIV and other infections there.


Pre-exposure of ART for HIV negative people?

For MSM, sex workers, and partners with a known patient. Shown to work to some degree (need to take pills!), but not every group. Issues: Resistance


HIV vaccines

Some candidates, some recombinant gp120, etc. Trials aren’t great tho so far.


Methods for reducing spread worldwide

Eliminate in kids, fidelity, condoms, vaccine (not yet), circumcision, encourage testing, increase care (people more comfortable), counselling.


Methods for controlling the spread of the virus itself

Prevent virus from entering fluids (Tx); prevent contact (condoms); prevent HIV entering and replicating in cells