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Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit...

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Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and challenges”
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Page 1: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Dr Emmanuel NsutebuConsultant Infectious Diseases

PhysicianTropical and Infectious Diseases Unit

Royal Liverpool Hospital

HIV “Myths, controversies and challenges”

Page 2: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

“10 questions ....”1. What is the difference b/w HIV and AIDS2. What is the origin?3. How is it transmitted?4. Does the risk of transmission vary?5. Can you know when a person got infected?6. Is lengthy pretest counselling needed

before a test is done?7.How is HIV treated?8. Can it be cured?9. What is the life expectancy?10. What about a vaccine and is there hope?

Page 3: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

How many people are affected? Globally 34 million PLHAs, 1.7M deaths a year, 2.5M

new infections a year 15 million eligible for treatment and 8 million on

treatment. 24 million cases in Africa 5% adult prevalence in Cameroon (2011) – 900000

PLHA

UK – 70000 PLHA

No. Of new cases and deathsFalling due to success of treatment

Page 4: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

1. What is the difference b/w HIV and AIDS?

Not the same thing but related. AIDS is a stage of HIV infection.

Page 5: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

NOT ALL HIV INFECTION = AIDS

Page 6: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Most people with HIV have no symptoms

Page 7: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

2. Origin? Jump from chimpanzees to humans - SIV

Page 8: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Figure 1

Source: The Lancet Infectious Diseases 2011; 11:45-56 (DOI:10.1016/S1473-3099(10)70186-9)

Terms and Conditions

Page 9: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

3. How is HIV transmitted?Unprotected sex – 70% of infectionsMother to child transmission – mum must

be positive – during pregnancy, at birth or during breastfeeding!

Intravenous drug use – sharing needlesBlood transfusion and other blood productsMedical equipment

Page 10: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Mother to child transmission

30% risk of transmission reduced to <2% with ARVS

Page 11: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

How is HIV not transmitted?CutleryMosquitoesKissingHugging

Page 12: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

4. Does the risk of transmission vary?Varies depending on

Positive personNegative personRoute of transmission

Sex 3/1000 but can happen with first contact

Transmission to women easierIV drug user high risk

Page 13: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

5. Can you know when a person acquired the infection?No but can guess!!!

Page 14: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Apr 18, 2023Understanding HIV Treatment and adherence.

4-8 wks Up to 12 years 2-3 years

No symptoms Symptoms AIDS

Death

1000

500

0

CD4 count HIV viral load

200

2-12 mo

2 million

0

Viral load & CD4 after HIV Infection[without treatment]

Time

Page 15: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

HIVinfection

J. Coffin, XI International Conf. on AIDS, Vancouver, 1996

Development of AIDS is like an Development of AIDS is like an impending train wreckimpending train wreck

Viral Load = Speed of the train Viral Load = Speed of the train CD4 count = Distance from cliffCD4 count = Distance from cliff

Page 16: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Infections and cancer!

Page 17: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

6. Is lengthy pretest counselling needed?An HIV test is a routine test!!!

Page 18: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

7. How is HIV treated and it is effective?

Page 19: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

HIV Replication Cycle and Sites of Drug Activity

clinicaloptions.com/hiv

Capsidproteinsand viral

RNA

CD4Receptor

Viral RNA

New HIVparticles

Protease

Attachment Uncoating ReverseTranscription

Integration Transcription Translation

ReverseTranscriptase

Unintegrateddouble strandedViral DNA

Integratedviral DNA

ViralmRNA

Integrase

gag-polpolyprotein

1 2 3 4 56

Assembly andRelease

Protease InhibitorsNRTIs

NNRTIs

Nucleus

Cellular DNA

CCR5or

CXCR4co-receptor

HIV Virions

nRTI

Fusion Inhibitors

At least 3 drugs to stop the virus from multiplying

Page 20: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

HIV Medication TimelineBetween ’87 and ’95 (9 years), 4 antiretrovials were launched.

Since ’95 (11 years), 25 new products have been introduced!!

NNRTI

’’8787 ’’9191 ’’9292 ’’9494 ’’9595 ’’9696 ’’9797 ’’9898 ’’9999 ‘‘0000’’8888 ’’8989 ’’9090

NRTINRTI

FIFI

saquinavirsaquinavir

indinavirindinavirKaletraKaletra

zalcitabinezalcitabine

stavudine

’’0101

emtricitabine/emtricitabine/tenofovirtenofovir

enfuvirtideenfuvirtide

‘‘0202 ‘‘0404’’9393

amprenaviramprenavir

‘‘0505 ‘‘0606‘‘0303

zidovudine

emtricitabineemtricitabine

abacavir/lamivudine/zidovudine

lamivudine/zidovudinelamivudine/zidovudine

delavirdine

nevirapine

abacavir

efavirenztenofovirtenofovir

ritonavir

saquinavirsaquinavir

atazanaviratazanavir

fosamprenavirfosamprenavir

nelfinavirnelfinavir darunavirdarunavir

tipranavirtipranavir

PIPI

didanosinedidanosine

didanosinedidanosine

Corrections Curriculum Development, NY/NJ AETC

lamivudine

Many drugs available and more in development – outlook is good!

Page 21: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Treatment & Treatment as prevention

Most patients on one or two tablets a day!

Page 22: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Apr 18, 2023Understanding HIV Treatment and adherence.

After HIV treatment (ARVs): effect on CD4 and viral load

1-12 yrs +1-6 moChronic

Infection

Start treatment

1000

500

0

CD4+ cells/mm3

viral load (RNA)copies/mL

200

2 million

0

+ 1-40+ years !!

< 50 copies/mL

Viral load <50 copies/mL

Time

Page 23: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

8. What is life expectancy like?We don’t know for sure however we have

estimates....HIV survival similar to other chronic

diseases!Life expectancy at 25 years diagnosis

estimated to be 70 years

Page 24: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

9. What about a cure?

Page 25: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

10. What about a vaccine?Problem is variability of the virus!!!Stays one step ahead of immune system!!!

Page 26: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

What are challenges?

Early diagnosisAccess to treatment in developing

countries

Page 27: Dr Emmanuel Nsutebu Consultant Infectious Diseases Physician Tropical and Infectious Diseases Unit Royal Liverpool Hospital HIV “Myths, controversies and.

Thank you [email protected]


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