HIV Update

1
HIV Update

• (Lecture 4/3 Health Psychology)
• Jann DeWitt, Ph.D.
• Director,
• Utah AIDS Education Training Center
• Assistant Professor, Department of
• Family Preventive Medicine
• Public Health Program
• University of Utah

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History of HIV

• HIV is a zoonosis from Chimpanzee (HIV 1) or
  Sooty-Managabee (HIV 2)
• Origin established through DNA testing.
• Studies suggest the virus was around since 1920
  to 1940 in Central Africa.
• Currently there is no cure or vaccine.

3
History of HIV

• 1981 - Immunodeficiency syndrome is described in
  sexually active young gay men in USA.
• 1983-84 - Robert Gallo in USA and Luc Montagnier
  in France independently publish data on the new
  retrovirus that causes immunodeficiency syndrome
  and call it HIV.
• 1985 - FDA approves first HIV Antibody test and
  it is used to start screening the blood supply.
• 1987 AZT, the first anti-HIV drug, is approved
  by the FDA.

4
History of HIV

• 1991 - 10 million people with HIV worldwide.
• 1996 - First protease inhibitor drug approved and
  first RNA Viral Load kit released.
• 1997 - Profound decline in AIDS related
  mortality and morbidity in persons on
• HAART (Highly Active Anti-retroviral Therapy).
  HAART consists of combinations of three or four
  different HIV drugs).
• 1998 - Ultra sensitive RNA assay for viral load.

5
History of HIV

• 2000 - 33 million people with HIV worldwide.
• 2001 - FDA approves first HIV genotype assay.
• 2002 - 40 million people with HIV worldwide.
• 2004 - 46 million people with HIV worldwide.

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Worldwide HIV Epidemic in 2004
Low to High Estimates of Incidence of HIV/AIDS.
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Worldwide HIV Epidemic in 2004
Low to High Estimates of Incidence of HIV/AIDS.
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General Concepts of HIV

• HIV 1 and 2
• HIV 1 Groups M, O, N
• M-Subtype B is most common in USA/Europe
• M-Non- B Subtype prevalent in developing world
• HIV 2 found mostly in West Africa

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HIV Transmission

• HIV is a sexually transmitted disease
• Male to Male
• Male to Female
• Female to Male
• Female to Female (rare)

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HIV Transmission

• Injection Drug Use (IDU)
• Needle, syringe and cooker sharing
• Major link to heterosexual and pediatric cases

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HIV TransmissionOccupational Exposure

• Only 60 cases of known occupational transmission
  since the start of the epidemic.
• Significant exposure involves visible blood, a
  hollow, large bore needle, deep puncture wound
  and a known HIV positive patient with high viral
  loads.
• Prophylaxis should begin within 1 to 4 hours
  after exposure. Use 2-drug or 3-drug combination
  therapy.

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HIV TransmissionOccupational Exposure

• Health care provider needs a baseline HIV test at
  the time of exposure.
• Use universal precautions to protect against HIV,
  Hepatitis C.

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Time Course of HIV Seroconversion
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Primary HIV Infection

• 80 to 90 percent of patients suffer from acute
  HIV infection.
• A significant proportion of patients seek medical
  attention during this syndrome.
• The average duration of symptoms if 22 days.

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Manifestations of Primary HIV Infection

• Fever
• Pharyngitis
• Lymphadenopathy
• Arthralgias/ myalgias
• Lethargy/malaise
• Anorexia/weight loss

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Categories of HIV Drugs

• Neucleoside Reverse Transcriptase Inhibitors
  (NRTI)
• Non-Neucleoside Reverse Transcriptase Inhibitors
  (NNRTI)
• Fusion Inhibitors
• Protease Inhibitors

17
Treatment Failure Rates
Assuming treatment 2X/day (60 doses)
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HIV Antibody Tests

• Elisa
• Western Blot
• Orasure
• Oraquick

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Trends in the HIV Epidemic

• More HIV Women 30 of US cases.
• More African Americans Hispanic Americans
  total 66 of US cases.
• More young MSM (Men who have sex with men)
  roughly 50 of US cases.

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Trends in the HIV Epidemic

• With the success of HAART therapy, more and more
  people are living with HIV.
• For the past 2 years, the number of new cases in
  the US has gone from 40,000 per year to 47,000
  per year.
• The CDC is pushing for more Prevention for
  Positives to try to slow the epidemic and to
  limit the spread of resistant virus.