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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. Emerging Diseases Epidemiology of HIV/AIDS Shahid Beheshti University of medical sciences, 2005 By: Hatami H. MD. MPH. Definition of AIDS. Acquired immune deficiency syndrome (AIDS) Caused by HIV (Human Immunodeficiency Virus). Etiologic agents:.

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم Emerging Diseases Epidemiology of HIV/AIDS Shahid Beheshti University of medical sciences, 2005 By: Hatami H. MD. MPH

  2. Definition of AIDS • Acquired immune deficiency syndrome (AIDS) • Caused by HIV (Human Immunodeficiency Virus)

  3. Etiologic agents: Human Immunodeficiency Virus : • HTLV-I and HLTV-II , HIV-I and HIV-II • RNA virus • Retrovirus (Oncovirus vs. Lentivirus) • Target cell T4 cell and Lymphocyte/Monocyte

  4. HIVI & HIVII Are serologically and geographically relatively distinct Have similar epidemiologic and pathologic characteristic HIVI is found in the Americas, Europe Africa and most other countries HIVII is found in Africa

  5. HIV-Infected T-Cell New HIV HIV Infected T-Cell T-Cell HIV

  6. Incubation period • Serologic incubation period • Clinical incubation period

  7. Window Period • This is the period of time after becoming infected when an HIV test is negative • 90% of cases test positive within 3 months of exposure • 10% of cases test positive within 3-6 months of exposure

  8. HIV Infection and Antibody Response ---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage--- Flu-like Symptoms Or No Symptoms Symptom-free AIDS Symptoms ---- Infection Occurs ---- <

  9. HIV/AIDSFactors affecting Incubation period • Accelerated Progression • Extremes of age • Poor immune response • Slowed Progression • Viral mutants • Chemokine receptor mutations • Anti-HIV therapy

  10. Natural course Primary infection 3-6 weeks Acute HIV syndrome 1 week – 3 months Immune response to HIV 1-2 weeks Clinical latency

  11. Clinical findings in acute HIV syndrome General • Fever • Pharyngitis • Lymphadenopathy • Headache/retroorbital pain • Arthralgia/myalgia • Lethargy/malaise • Anorexia/weight loss • Nausea/vomiting/diarrhea

  12. Clinical findings in acute HIV syndrome Neurologic • Meningitis • Encephalitis • Peripheral neuropathy • Myelopathy Dermatologic • Erythematous maculopapular rash • Mucocutaneous ulceration

  13. Clinical findings in acute HIV syndrome • Most patients recover spontaneously • Many are left with a mildly depressed CD4+ T cell • Followed by prolonged period of clinical latency

  14. Clinical Stages of HIV Infection Clinical latency CD4 Tcell < 200 L Symptomatic disease • Opportunistic infections • Neoplasms

  15. Bacterial Strep pneumonia TB MAI Viral Herpes Varicella Zoster CMV / EBV Influenza Parasites Pneumocystis carinii Toxoplasmosis Cryptosporidum Fungus Candida Aspergillus Cryptococcus Opportunistic Infections

  16. MALIGNANCIES IN AIDS • AIDS defining • Kaposi’s sarcoma • Primary brain lymphoma • High grade non-Hodgkin’s lymphoma • Invasive carcinoma of the cervix • Other • Anorectal squamous carcinoma • Hodgkin’s disease

  17. HIV AIDS • Once persons are infected they are always infected • Medications are available to prolong life but they do not cure the disease • Are capable of infecting others without having symptoms or knowing of the infection

  18. HIV: The 4th Decade • Pre - 1970 Silent • 1971 - 1980 Sporadic Cases • 1981 - 1990 Epidemic • 1991 - Current Pandemic

  19. Geographical distribution AIDS is Present in Virtually Every Country in the World

  20. Global estimates foradults and children end 2004 39.4 million [35.9 – 44.3 ] 4.9 million [4.3 – 6.4 ] 3.1 million [2.8 – 3.5 ] 28 million • People living with HIV • New HIV infections in 2004 • Deaths due to AIDS in 2004 • Total number of AIDS deaths

  21. Adults and children estimated to be living with HIV as of end 2004 Eastern Europe & Central Asia 1.4 million [920 000 – 2.1 million] Western & Central Europe 610 000 [480 000 – 760 000] North America 1.0 million [540 000 – 1.6 million] East Asia 1.1 million [560 000 – 1.8 million] North Africa & Middle East 540 000 [230 000 – 1.5 million] Caribbean 440 000 [270 000 – 780 000] South & South-East Asia 7.1 million [4.4 – 10.6 million] Sub-Saharan Africa 25.4 million [23.4 – 28.4 million] Latin America 1.7 million [1.3 – 2.2 million] Oceania 35 000 [25 000 – 48 000] Total: 39.4 (35.9 – 44.3) million

  22. Adults and children estimated to be living with HIV as of end 2004

  23. Estimated number of newly infected with HIV during 2004 Eastern Europe & Central Asia 210 000 [110 000 – 480 000] Western & Central Europe 21 000 [14 000 – 38 000] North America 44 000 [16 000 – 120 000] East Asia 290 000 [84 000 – 830 000] North Africa & Middle East 92 000 [34 000 – 350 000] Caribbean 53 000 [27 000 – 140 000] South & South-East Asia 890 000 [480 000 – 2.0 million] Sub-Saharan Africa 3.1 million [2.7 – 3.8 million] Latin America 240 000 [170 000 – 430 000] Oceania 5 000 [2 100 – 13 000] Total: 4.9 (4.3 – 6.4) million

  24. Estimated deaths from AIDS during 2004 Western & Central Europe 6 500 [<8 500] Eastern Europe & Central Asia 60 000 [39 000 – 87 000] North America 16 000 [8 400 – 25 000] East Asia 51 000 [25 000 – 86 000] North Africa & Middle East 28 000 [12 000 – 72 000] Caribbean 36 000 [24 000 – 61 000] South & South-East Asia 490 000 [300 000 – 750 000] Sub-Saharan Africa 2.3 million [2.1 – 2.6 million] Latin America 95 000 [73 000 – 120 000] Oceania 700 [<1 700] Total: 3.1 (2.8 – 3.5) million

  25. Children(<15 years)estimated to be living with HIV as of end 2004 Eastern Europe & Central Asia 8 800 [7 100 – 13 000] Western & Central Europe 6 200 [4 900 – 7 900] North America 11 000 [5 600 – 17 300] East Asia 9 400 [3 300 – 27 000] North Africa & Middle East 24 000 [7 100 – 82 000] Caribbean 23 000 [12 000 – 49 000] South & South-East Asia 170 000 [95 000 – 320 000] Sub-Saharan Africa 1.9 million [1.7 – 2.3 million] Latin America 26 000 [21 000 – 43 000] Oceania 700 [< 2 500] Total: 2.2 (2.0 – 2.6) million

  26. Estimated deaths in children (<15 years) from AIDS during 2004 Eastern Europe & Central Asia 1 100 [800 – 2 200] Western & Central Europe < 100 [< 200] North America < 100 [< 200] East Asia 2 400 [900 – 6 900] North Africa & Middle East 5 600 [1 700 – 19 000] Caribbean 5 300 [2 700 – 11 000] South & South-East Asia 37 000 [22 000 – 70 000] Sub-Saharan Africa 450 000 [400 000 – 540 000] Latin America 6 000 [4 800 –9 800] Oceania < 200 [< 600] Total: 510 000 (460 000 – 600 000)

  27. Estimated number of children (<15 years) newly infected with HIV during 2004 Western & Central Europe < 100 [< 200] Eastern Europe & Central Asia 1 800 [1 200 – 3 700] North America < 100 [< 200] East Asia 4 100 [1 500 – 11 000] North Africa & Middle East 9 100 [2 800 – 30 000] Caribbean 6 100 [3 100 – 13 000] South & South-East Asia 51 000 [30 000 – 95 000] Sub-Saharan Africa 560 000 [500 000 – 650 000] Latin America 6 800 [5 400 – 11 000] Oceania < 300 [< 1 000] Total: 640 000 (570 000 – 750 000)

  28. About 14 000 new HIV infections a day in 2004 • More than 95% are in low and middle income countries • Almost 2000 are in children under 15 years of age • About 12000 are in persons aged 15 to 49 years, of whom: • almost 50% are women • about 50% are 15–24 year olds

  29. Situation of HIV/AIDS in High-income countries End 2004, prevalence = 0.4%

  30. Situation of HIV/AIDS in High-income countries Approximately 64000 people become infected in 2004 A total of 1.6 million are now living with HIV/AIDS Dramatic reduction in deaths due to antiretroviral therapy About 500000 people were receiving these drugs

  31. Number of deaths reported among AIDS cases in Western Europe: 1997-2001 12,000 10,000 Number of deaths 8,000 6,000 4,000 2,000 0 1997 1998 1999 2000 2001* * January – June 2001 data multiplied by 2.

  32. 2.5 2.0 1.5 1.0 0.5 0.0 AIDS deaths in Africa Yearly Deaths as a Proportion of 1995 Values AIDS deaths in Western Europe HAART 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Care Prolongs Productive LifeThe widening gap between North and South

  33. Situation of HIV/AIDS in High-income countries (2) • 59% of new HIV diagnoses in several countries is occurring through heterosexualintercourse • 14% OF IDUs in USA are infected win HIV (Spain = 23% , France = 10-23% , Portugal => 50% • The epidemic’s shift into poorer and marginalized sections of society is continuing

  34. 70 60 50 40 30 20 10 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Percentage of probable route of HIV infection in the United Kingdom: 1990-2000 Sex between men and women Injecting drug use

  35. Situation of HIV/AIDS in SUB-SAHARAN AFRICA End 2004, prevalence = 7.4%

  36. Situation of HIV/AIDS in SUB-SAHARAN AFRICA • The worst-affected region • 29.4 million people living win HIV/AIDS • Approximately 3.1 million new infections occurred in 2004 • 10 million young people (15-24) and 3 million (< 15 years old) live with HIV/AIDS

  37. Number of people living with HIV/AIDS in sub-Saharan Africa, 1980-2001 30 Millions 25 20 15 10 5 0 1980 1983 1986 1989 1992 1995 1998 2001

  38. Number of people who died from HIV/AIDS in sub-Saharan Africa, 1980-2001 2,500 Thousands 2,000 1,500 1,000 500 0 1980 1983 1986 1989 1992 1995 1998 2001

  39. Situation of HIV/AIDS in SUB-SAHARAN AFRICA • A tiny fraction of the millions are receiving antiretroviral drugs • Many millions are not receiving medicines to treat opportunistic infections • Adult HIV PREVALENCE

  40. Situation of HIV/AIDS in SUB-SAHARAN AFRICA

  41. HIV prevalence in adults in sub-Saharan Africa, end 2001 2001 20 – 39% 10 – 20% 5 – 10% 1 – 5% 0 – 1% trend data unavailable outside region End 2004, prevalence = 7.4%

  42. HIV prevalence among people consuming alcohol and among non-drinkers, Carletonville, South Africa, 1998 70 drinkers 60 non-drinkers 50 40 HIV prevalence (%) 30 20 10 0 men women women in commercial sex areas

  43. 30 25 20 15 10 5 0 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘01 HIV prevalence among pregnant women in South Africa, 1990 to 2001 HIV prevalence (%) 1990 2000

  44. Situation of HIV/AIDS in SUB-SAHARAN AFRICA

  45. Projected population structure with and without the AIDS epidemic, Botswana, 2020 80 Projected population structure in 2020 75 Males Females 70 65 Deficits due to AIDS 60 55 50 Age in years 45 40 35 30 25 20 15 10 5 0 140 120 100 80 60 40 20 0 0 20 40 60 80 100 120 140 Population (thousands)

  46. Leading causes of death in Africa, 2000 22.6 25.0 20.0 15.0 % of Total 10.1 9.1 10.0 6.7 5.5 4.3 3.6 3.1 2.9 2.3 5.0 0.0 HIV/AIDS Malaria Perinatal conditions Tuber culosis Cerebro vascular disease Measles Lower respiratory infections Diarrhoeal disease Ischaemic Heart disease Maternal conditions

  47. Estimated deaths at ages 15-34, with and without AIDS in South Africa: 1980-2025 2,000 Without AIDS 1,600 With AIDS 1,200 Deaths (Thousands) 800 400 0 1980-1985 1985-1990 1990-1995 1995-2000 2000-2005 2005-2010 2010-2015 2015-2020 2020-2025

  48. Estimated impact of AIDS on under-5 child mortality rates, selected African countries, 2010 250 Deaths per 1,000 live births 200 WithoutAIDS WithAIDS 150 100 50 0 Botswana Malawi Kenya Tanzania Zambia Zimbabwe

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