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SPHU 1020: Cell, Individual, and Community, 2. 29. 16 HIV/AIDS and Tuberculosis

by: Claire Jacob

SPHU 1020: Cell, Individual, and Community, 2. 29. 16 HIV/AIDS and Tuberculosis SPHU 1020

Marketplace > Tulane University > Public Health > SPHU 1020 > SPHU 1020 Cell Individual and Community 2 29 16 HIV AIDS and Tuberculosis
Claire Jacob

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About this Document

These notes are from this past week's lectures! (2. 29. 16)
Cell, Individual & The Community
Dickey-Cropley, Lorelei
Class Notes
Public Health, HIV/AIDS, Tuberculosis
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This 6 page Class Notes was uploaded by Claire Jacob on Saturday March 5, 2016. The Class Notes belongs to SPHU 1020 at Tulane University taught by Dickey-Cropley, Lorelei in Summer 2015. Since its upload, it has received 21 views. For similar materials see Cell, Individual & The Community in Public Health at Tulane University.

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Date Created: 03/05/16
HIV/AIDS  2. 29.16    AIDS­ acquired immunodeficiency syndrome  ● caused by the human immunodeficiency virus (HIV)  ● is pandemic, has spread throughout the world, particularly in Africa  ● this syndrome diagnosed by certain signs and symptoms  ○ HIV positive  ○ low CD4+ (helper T cell) cell count  ○ one or more opportunistics infections (bacterial, viral, protozoal, and fungal)  ○ swollen lymph nodes, sudden weight loss, and a rare vascular cancer called  Kaposi’s sarcoma    Where did HIV come from?  ● found in monkeys… it’s a zoonotic disease    AIDS considered an “emerging disease”  ● HIV mutated in 1930s from a form exclusive to apes to one that could live in humans  ○ genetic studies link HIV to the chimpanzee Pan troglodytes  ● such diseases that move from one species to another are known as zoonoses  ○ ebola and TB both examples of other zoonoses  ● 1st well­documented case of AIDS occurred in an African man in 1959; he was  diagnosed decades after his death  ● 2 researchers claimed discovery of HIV  ○ Luc Montagnier of the Pasteur Institute in Paris  ■ created the patent for HIV determination  ○ Robert Gallo of the National Institutes of Health  ■ found the link between AIDS and HIV    Biology of HIV  ● HIV is a retrovirus  ○ as an obligate parasite, targets a host cell  ○ once inside the host cytoplasm, uses its own reverse transcriptase enzyme to  produce DNA from its RNA genome, the reverse of the usual pattern, thus retro  (backwards) virus  ○ new DNA is then incorporated into host cell genome by an enzyme  ○ host cell then treats viral DNA as part of its own genome, translating and  transcribing viral genes along with cell’s own genes, producing proteins required  to assemble new copies of the virus  ○ it is difficult to detect until it has infected the host  ● new virus particles released from the cell by budding  ● there are at least 2 types of HIV    Transmission of AIDS  ● HIV can be transmitted in 4 ways  1. sexual contact with an infected partner  2. contact with contaminated blood or blood products  3. sharing blood­contaminated needles and syringes, as with IV drug use (high  frequency of transmission) or by accidental needle stick in health provider (0.5%  risk of transmission)  4. transmitted from mother to child  ○ through passage of HIV across the placenta   ○ transmission during birth due to contaminated blood and secretions  ○ transmission via breast milk  5. Premastication, pre­chewing food for infants    HIV/AIDS Risk Groups in US  ● paid/commercial sex workers  ● men who have sex with men  ● injecting drug users  ● any sexually active person who does not assume he/she is at risk and take preventive  measures  ● HCW  ● Women  ○ HIV/AIDS mother to child transmission  ○ risk  ■ acquiring HIV during delivery without intervention: 15% to 30%  ■ HIV transmission during delivery if mother is taking ARVs: <2%  ■ acquiring HIV from breastfeeding without intervention: 25 to 45%  ■ HIV transmission during breastfeeding if the mother is taking ARVs: much  lower    HIV/AIDS epidemiology  ● 2.3 million adults and children newly infected with HIV in 2012  ○ represents 33% reduction in annual new cases compared to 2001  ○ new HIV infection among children fell 52% to 260,000 in 2012  ○ greater access to antiretroviral TX led to a 30 percent drop in AIDS­related  deaths from the peak in 2005  ● in the U.S., deaths typically through Pneumocystis carinii  ● in other parts of the world, it is TB  ● >90% of new HIV infections are in developing countries  ○ in Africa (mostly sub­saharan), >24 million people with HIV infection and about 1  million new cases of AIDS per year  ● of adult infections, 40% are in women and 15% are in individuals of 15­25 years of age    AIDS in US  ● US has one of the largest populations of HIV­infected in the world  ● annual number of new infections remains relatively stable  ○ ~50,000 newly infected people every year  ● 1.7 million people in U.S. infected with HIV since start of epidemic in 1981  ● 619,000 people have died    AIDS: the disease  ● HIV depletes number of T­helper cells, resulting in individual’s becoming  immunocompromised and vulnerable to opportunistic diseases caused by an array of  microbes  ● HIV positive individuals without tx progress to clinical AIDS over an incubation period  that can vary from a few years to 15 years or longer    The course of the disease from HIV Infection to AIDS  Acute infection (acute retroviral syndrome)  ● initially, HIV infection produces a mild disease  ○ not seen in all patients  ● IN period immediately after infection, virus titer rises (about 4 to 11 days after infection)  and continues at a high level over a period of a few weeks  ● mononucleosis­like symptoms (fever, rash, swollen lymph glands) but none of these are  life­threatening  ○ may mimic the flu  ● result is an initial fall in the number of CD4+ cells but the numbers quickly return to near  normal    Treatment Interventions for HIV/AIDS  ● antiretroviral drugs  ○ highly active antiretroviral therapy: combination of antiretroviral drugs that are  used as medications to control retroviruses  ○ extend years between infection and onset of clinical AIDS  ○ extend years between onset of AIDS and death  ■ works against HIV by using drugs in combo to suppress HIV replication as  many times as possible  ● problems for HIV replication, keeps HIV offspring low, and reduces  the possibility of HIV mutating  ■ must be used in combo to suppress HIV symptoms    Testing for HIV  ● antibody tests: once infected, takes 3­6 months for enough antibodies to be formed for  screening tests to be positive  ● PCR tests  ● once positive additional tests may be done for:  ○ CD4 count to show how the disease is progressing  ○ viral load  ○ drug resistance­ need to know strain so they know what kind of antiviral  medication they should be taking    HIV/AIDS key driver of change in public health  ● enormous impact because  ○ no biological control mechanism  ○ enormous cost  ○ many are vulnerable  ● effect on other infectious disease programs  ○ TB surveillance and control programs were successful public health interventions  ● effect on maternal child health programs and reproductive health programs  ○ changes to program planning and infrastructure due to:  ■ use of antiretroviral drugs for treatment  ■ prophylactic treatment for exposed babies  ■ breast feeding    Role of Advocacy and Activism  ● International response to epidemic  ○ U.S. PEPFAR program  ○ Global fund to treat AIDS, TB, and Malaria  ○ Bill and Melinda Gates Foundation  ○ World Bank    HIV/AIDS critical challenges  ● developing vaccine  ● cost­effective approaches to prevention in different settings  ● universal treatment for all those who are eligible  ● management of TB and HIV coinfection    AIDS treatment and prevention: vaccines  ● difficult to develop a safe and effective vaccine for AIDS because viruses mutate  ● several AIDS vaccine “breakthroughs” have been failures  ● ideal vaccine would be a one dose, safe, effective, oral vaccines that would establish  lifelong protection against all subtypes of HIV  ● AIDS “should be” easy to control, if not eradicate, because there are no vectors or  animal reservoirs; the reality is very different  ● modifying sexual behavior currently is best protection against contracting AIDS          Tuberculosis    ● Mycobacterium tuberculosis is the cause of tuberculosis (TB)  ● TB is a leading cause of death worldwide  ● in the US and other developed countries, it is an emerging disease  ● become resistant to medications    A brief History  ● TB originally spread from animals to humans, probably from cows, about 80,000 to  100,000 YA  ● TB afflicted Ancient Egyptian Civilization  ● “Sanatorium cure” provided the first public health step against TB  ● early 1880s Koch visualizes TB under a microscope    Tuberculosis  ● agent: Mycobacterium tuberculosis  ○ 2 categories:  ■ pulmonary TB  ● only kind which is contagious  ■ extrapulmonary TB  ● ex. skin, cervical, lymph nodes  ● 2 manifestations  ○ TB infection (latent TB): more than ⅓ of the world’s population worldwide have  TB infection in their body  ■ do not present symptoms, aren’t sick, not contagious  ○ TB disease (active TB): about 1/10 of infected people will, at some point during  their lives develop, contagious form of the disease and have symptoms of TB  (cough, weight loss, etc)  ● 8­9 million new cases worldwide  ○ are sick, frequently symptomatic, and very often contagious  ■ considered a global emergency    Current Status  ● in 1993, WHO declared TB a global emergency  ● 5­10% of infected people will develop active TB during lifetime  ● the number of TB cases has been falling since 2006  ● as of 2010, an estimated 8.8 million incidents of TB globally  ○ 59% in Asia  ○ 26% in Africa    Tuberculosis epidemiology  ● new infection every second  ● 2 million deaths annually  ○ HIV causes death due to TB because it suppresses the immune system  ● TB occurs in every part of the world  ○ 10 million new cases every year  ○ 12 million people living with TB disease  ○ 1 million deaths…    Factors contributing to Re­emergence  ● a 20% increases in TB occurred from 1985 to 1992 in the United States due to:  ○ TB and HIV Coinfection (each accelerates the other’s progress)  ■ those infected by HIV are 800 times more likely to develop active TB  ■ TB is the leading cause of death in HIV­infected populations    Multiple drug resistant (MDR) and extremely drug­resistant (XDR) TB  ● MDR resistant to at least 2 first line drugs, isoniazid and rifampin  ● XDR rare; resistant to isoniazid, rifampin and at least 3 second­line drugs    Factors contributing to re­emergence  ● complacency factor in 1980s, when more developed countries of the world relaxed their  TB control programs  ● Travel and immigration recommended that immigrants from countries with high TB rates  be tested for latent t and active TB  ○ concern exists about risk of transmission of TB during long airplane flights    Transmission  ● TB is an airborne disease  ● it can be spread when a patient with pulmonary TB talks, spits, coughs, or sneezes  ● estimated that each person with active TB who is not put on appropriate TB treatment  will infect an average of 10­15 other people annually  ● special immune cells form a barrier shell to keep the tubercle bacilli latent/contained    The course of TB infection   


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