Clinical Background on HIV/AIDS, Malaria, and Tuberculosis · 2017-07-06 · Clinical’Background’ ’ GHD2C10 2’ Pathogenesis and Transmission of HIV/AIDS Human!Immunodeficiency!Virus!(HIV)!is!avirus!thatcauses!the!bodyas!immune!system

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C A S E S I N G L O B A L H E A L T H D E L I V E R Y

Julie Rosenberg, Kileken ole-‐‑MoiYoi, and Michelle Morse prepared this note with assistance from Claire Donovan for the purposes of classroom discussion rather than to illustrate either effective or ineffective health care delivery practice. !

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Clinical Background GHD-‐C10

2

Pathogenesis and Transmission of HIV/AIDS

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GHD-‐C10 Clinical Background

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HIV/AIDS Treatment

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HIV/AIDS Preventi on


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Further Reading on HIV/AIDS

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6

Exhibit 1 HIV Life Cycle

Note: The structural proteins and enzymes found in HIV allow for viral entry into host cells, replication, and characteristic spread of the disease. The virion (entire virus particle) is surrounded by multiple layers. The outer layer, the lipid envelope, has two important proteins that protrude from its surface.27 The virus cannot infect other cells. The virus fuses with the CD4 T cell or macrophage cell and injects its core contents into the host cell’s cytoplasm. The virion’s RNA is incorporated into host DNA where it lays latent until a triggering event occurs, such as T-cell proliferation in response to a new infection. At that time, millions of new HIV virions are assembled that can infect new cells or be transmitted to others.7

Source: Terrence Higgins Trust. The immune system. 2014. http://www.tht.org.uk/myhiv/HIV-and-you/Simple-science/The-immune-system


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Exhibit 2 The Course of HIV

During primary infection, HIV disseminates widely through the body, usually accompanied by an abrupt decrease in CD4+ T cells. An immune response to HIV ensues, with a detectable decrease in viral load. Clinical latency follows but CD4+ T cells slowly continue to decrease until they fall to a critical level below which there is a substantial risk of opportunistic infections.

Source: Adapted from NIAID website publication (3). NIAID website publication. Course of HIV infection. http://www.niaid.nih.gov/topics/hivaids/understanding/biology/Pages/clinicalCourse.aspx


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Exhibit 3 Annual global number of deaths due to AIDS and new HIV infections, 1990-2013

Source: Max Roser, http://www.ourworldindata.org/data/health/hiv-aids Data source:

AIDSinfoonline.org


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Exhibit 4 HIV Transmission by Activity

Activity Risk per exposure T#=&’#)!$%^S!F%:#)%H-* H:#)%S!$-54&%$!&’!.&=.H

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K’8%6-&’=!415=!5$%! N$-&:#-%$!1#’=%!F1*:!C9E[U!YDkDR‘Z!-*!B9JU!YDkJDZ!

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Source: AidsMap. Estimated risk per exposure. http://www.aidsmap.com/Estimated-risk-per-exposure/page/1324038

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10

Malaria!

Global Epidemiology of Malaria

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! 11

Malaria Transmission

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12

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! 13

Malaria Prevention

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14


! 15

Exhibit 5 History of Malaria Mortality

Source: Global Malaria Action Plan, RBM 2008. 29


16

Exhibit 6 Plasmodium Falciparum Life Cycle

Source: US Centers for Disease Control and Prevention. Malaria Biology. [accessed 12/4/2012]

http://www.cdc.gov/malaria/about/biology/


! 17

Exhibit 7 Projected Changes in Malaria Rates by Country, 2000–2005

Source: WHO Malaria Map, 2015.


18

Tuberculosis

Global Epidemiology of Tuberculosis

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! 19

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20

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! 21

6*’-1*))&’=! #&1F)*;! 3#--%1’$S! #’4! 5$&’=! #&1! F&)-1#-&*’! $2$-%:$! *1! 5)-1#0&*)%-! &11#4-&*’S! #)$*! 1%456%!&’F%6-&*5$!41*3)%-$!&’!-.%!#&19!O#$M$!6#’!31*0&4%!#!+#11&%1!F*1!31*-%6-&*’!#$!;%))S!3#1-&65)#1)2!;.%’!;*1’!+2!6*5=.&’=!3#-&%’-$!&’!;#&-&’=!#1%#$!*F!6)&’&6$!#’4!.*$3&-#)$9!!


22

Exhibit 8 Estimated TB Incidence Rates, 2010!

Source: World Health Organization, Global Tuberculosis Control Report 2011. 2011, WHO: Geneva, Switzerland.


! 23

Exhibit 9 The 22 High-burden TB Countries

!

Source: World Health Organization, Global Tuberculosis Control Report 2012, WHO: Geneva, Switzerland.

!


24

Exhibit 10 Funding for TB Control in the High-burden Countries, 2002 - 2011

Source: World Health Organization, Global Tuberculosis Control Report 2011. 2011, WHO: Geneva,

Switzerland.


! 25

References

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B9!! eIGK/>!#’4!L,_9! Global Report 2013: UNAIDS Report on the Global AIDS Epidemic 20139h!BCD[9!.--3kXX;;;95’#&4$9*1=X%’X:%4’#&4$X6*’-%’-#$$%-$X4*65:%’-$X%3&4%:&*)*=2XBCD[X=1BCD[XeIGK/>l()*+#)lQ%3*1-lBCD[l%’934F9!G66%$$%4!O#2!BVS!BCDJ9!

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DC9!! _3%’!>*6&%-2!K’$-&-5-%9!Mandatory Premarital HIV Testing9!I%;!o*1Mk!_3%’!>*6&%-2!@*5’4#-&*’$h!BCDCkDHDB9!.--3$kXX;;;9*3%’$*6&%-2F*5’4#-&*’$9*1=X$&-%$X4%F#5)-XF&)%$X:#’4#-*12H31%:#1&-#)H.&0H-%$-&’=HBCDCCRD[934F9!G66%$$%4!G5=5$-!BJS!BCDE9!

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26

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DV9!! Untangling the Web of Antiretroviral Price Reductions9!O%4%6&’$!>#’!@1*’-&%1%$h!BCD[9!.--3kXX4B34[+R#+?WR++96)*54F1*’-9’%-XBCD[XCVXDDXDCXBRXJJX‘VEXO>@lG66%$$leS!7#4’!IS!O6"*1:#6M!>S!L#$$%1.%&-!m9!,KT!31%0%’-&*’!1%$%#16.k!-#M&’=!$-*6M!#’4!-.%!;#2!F*1;#149! AIDS9!BCDChBJ!>533)!Jk>‘DHVB9!4*&kDC9DCVWXCD9#&4$9CCCC[VCWDC9CJBRR9B+9!

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[D9!! L*1)4!,%#)-.!_1=#’&]#-&*’9! Global Technical Strategy for Malaria 2016-‐‑20309!(%’%0#k!L*1)4!,%#)-.!_1=#’&]#-&*’h!BCDRkDHBV9!.--3kXX#33$9;.*9&’-X&1&$X+&-$-1%#:XDCEERXDWEWDBXDXVW‘VBJDREJVVDl%’=934Fy5#zD9!G66%$$%4!G5=5$-!BJS!BCDE9!

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! 27

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Documents

Clinical Background on HIV/AIDS, Malaria, and Tuberculosis · 2017-07-06 · Clinical’Background’ ’ GHD2C10 2’ Pathogenesis and Transmission of HIV/AIDS Human!Immunodeficiency!Virus!(HIV)!is!avirus!thatcauses!the!bodyas!immune!system