Term
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Definition
| UNAIDS 2008: 33 million PLWHA, 95% adults 15-49, 50% women, 2.7 new infection , 85% in adults, and 2 million deaths, 1.7 million deaths in adults. EPI peaked in 96 with 3.6 new infections. Qd 7K infected and 6 deaths |
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Term
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Definition
| Fastest growing epidemic. Only region with growing HIV prevalence.Ukraine is the country with the highest prev 1.6% in the region. 3/3 of cases were related to IDU. Russia reported 1 mill new cases in 2006. Recent increase in NSP but still low coverage. The course of the regional epidemic is still un predictable. |
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Term
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Definition
| UNAIDS-WB 1000-2000, most of them IDU and their partners |
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Term
| Kabul risk factors IDU (Todd) |
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Definition
| unprotected sex, needle sharing, paying for sex and MSM |
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Term
| Risk factors pregnant women (Todd) |
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Definition
awareness 51%
knowledge 19% |
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Term
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Definition
Among 1163, only 2 cases. Receiving injections by non-medical personel.
awareness and knowledge 25% |
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Term
| How many people have been infected since the beginning of the epidemic? |
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Definition
| The cumulative estimate is 60 million people |
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Term
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Definition
| 22 mill infected, 61% women (only region were women infection>men). 1.6 mill Africans died in 2007 (76% of global total) |
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Term
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Definition
| 22 mill infected, 61% women (only region were women infection>men). 1.6 mill Africans died in 2007 (76% of global total) |
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Term
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Definition
5 mill cases, with 4K new infection in 2007.
India: 2.5 million infected (prev 0.4%). IDU +F form of transmission in northeast (near Myanmar) where preve aomong IDU >70% |
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Term
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Definition
| Epi started in Yunnan province among FSW and moved into IDU. Current prev among estimated IDU (2.4 mill) in China is of 12%. 50% of infection in China are related to IDU. PRevalence in China 0.1%. Improved access through Four frees and one care program. provides ART and accesst to NSP. |
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Term
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Definition
Most hevely affected countries
Tahiland:Prev among SW rose from 3% in 1989 to 30% in 1996.IDU prev 30-50%
Myanmar: decline in epi as shown in preg women and military recruits.
Cambodia
All of htis epis are driven by IDU and CSW. |
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Term
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Definition
| Real potential exists for an African type generalized epidemic |
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Term
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Definition
Main mode of transmission in several Asian countries:
China: 2.5 mill IDU prev 12%
Vietnam: 0.25% prev of IDU, with HIV prev among IDU of 34%
Malaysia: prev IDU 1.3%, HIV prev in IDU 10% |
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Term
| Prevention in China for HIV among IDU |
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Definition
| HIV test 50%, 1/3 condom use during last sexual intercourse and 40% use steryle equipment last time. |
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Term
| What is the most important mode of HIV transmission? |
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Definition
| Sexual intercourse. VL of HIV has been shown to be the primary determinant of transmission in discordant couples |
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Term
| By what factor is the rate of trans. increased with an STI (chancroid, HSV, syphilis)? |
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Definition
| 3-8. DX and tx of STI can decrease HIV tans. by 30-40% (RCT in Tanzania), although later no improvement was found. Maybe STI tx is more effective early in an epidemic, or in a mature epidemic HSV dominates trans. |
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Term
| Mother to child infection of HIV |
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Definition
| 420 K cases/yr during pregnancy, delivery or BF. BF increase risk by 14%. Exclusive BF is associated with a decreased risk of transmission as compared with mixed.. 30% of women have access to preventive services. |
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Term
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Definition
| Esttimated to account for 1/3 of new HIV infections outside Africa. Spread associated in some places with change in drug using behavior. Approx 16 mill people inject drugs worldide. Highest number of injector in China, US and Russia, with prev of HIV among them being 12%, 16% and 37%. IT IS EST THAT 3 MILL IDU ARE HIV POSTIVE. IDU related HIV epidemics are heterogenic. Explosive epi have been reported in developed and developin countreis, with 20-30% increase in prev reported in one year |
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Term
| Preventive services for IDU? |
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Definition
NSP
Outreach
Methadone: associated with decrease in needle sharing and injection frequency, risky behavior and hiv seroconversion. 2007 37 countries with low-concentrated epi had this programs |
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Term
| Factors that affect the spread of HIV? |
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Definition
| Behavior, circumcision, social and demographic, gender |
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Term
| Demography and social context. Why it matters? |
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Definition
| There is increasing awareness that personal behavior is critically influenced and conditioned by the social, economical cultural and legal context within a society. |
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Term
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Definition
| there has been increased in rural-urban migration. in 2008, we reached the 50% mark of peolple living in urban setting. Evidence of this relationship comes from research in SSA and the Meckong and NEpal. Border crossing points are mtg places of high risk groups |
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Term
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Definition
| Fx that greatly influences HIV infection. This is especially true in SSA, where HIV affects dispproportionately Women 15-24, with this group being 3X more likely to be infected |
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Term
| Stigma and discrimination |
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Definition
| Observed since the start of the epi towards high risk groups. in 2007, 67 reported having laws that protect PLWHA from discrimination |
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Term
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Definition
| Lack of HIV knowledge, taboos on sexual and drug use, homophobia and blaming people for infection. Interventions that work with varying degrees of impacta dn magnitude are skill building w/ health info and communicaation |
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Term
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Definition
| That the epi can be reversed or prevented is pr the most important lesson of the past 20 yrs. 10 countries with evidence of prevalence decrease due to behavioral change. Structural interventions are the best approach, for prevention, this intervetnions aim the underlying determinants and the proximate. |
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Term
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Definition
| Crucial in prevention. Has increased with rapid testing. In 2007, only 20% of people who wanted to get a test had access. Central to fight this is fight discrimination. |
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Term
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Definition
| 50% of PLWHA die of TB. Only 1/3 goets treatment for both diseases |
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Term
| What is the ling term demographic effect of HIV? |
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Definition
| Leading cause of burden of disease in adults in many African countries. Thirs cause in L-MIC. Reverse of life-expectancy obs in Africa and negativ population growth. |
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Term
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Definition
| In 2007, less people died of AIDS and fewer got new infections compared with the previous 5 yrs |
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Term
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Definition
| A result of the 2001 declaration of commitment, w/ support of G8 and UN SG. By 2008, $11.3 billion to 136 countries, 70% to AIDS activities. |
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Term
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Definition
| Bush 2003. Is the largest funder of ADIS eforts in devloping counteis and the major financier of the Global Fund. 2008 congress apporved $48 billion for 5 yrs to fight HIV,TB and malaria. AIMS: prevent 12 mill infections, tx 3 mill and care for 12 mill in 15 countries. |
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Term
| Globally, % of comprehensive HIV knowledge between gender? |
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Definition
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Term
| Access to prevention services globally for high risk groups? |
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Definition
|
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Term
| How many wks after initial infection would we see development of Ab vs HIV Ag? |
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Definition
| 3-12 wks a seen in studies with MSM, IDU and SW. |
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Term
| Which method should be used to dx primary HIV infection? |
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Definition
| HIV RNA assay. Sens 100% sp 97.4%. p24 test is less sens (88%) but more sp (100%) for dx of primaryy infectin |
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Term
| Median time to AIDS development w/o tx? |
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Definition
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Term
| What is a long term non-progressor? |
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Definition
| PLWH tath shows normal CD4 w/o clinical symptoms after 8 yrs of infection. |
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Term
| Why are differences in disease progression obs? |
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Definition
| Hypo: mode of tansmission, size of inoculum, pathogenicity of the virus and individual characteristics. |
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Term
| What are the most commonly used and better predictors of disease progression? |
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Definition
CD4 count: how long I will get to AIDS
VL: how fast I will get there. This is the single best predictor of disease progression |
|
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Term
| how many modes of transmission are there for HIv? |
|
Definition
Basically three:
Sexual
Blood contact: IDU, blood transfussion
MTC |
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Term
| Sexual contact and hiv infection correlates |
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Definition
| # of partners, type of sex. Inefficient mode of transmssion that is heavely influenced by prev in the pop. and by behavior and social factors |
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Term
| Risk of infection per coital act (CA) as seen in cohorts in Africa? |
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Definition
early infection: 8.2 /1000 CA
established infection: 1/1000 CA
advanced infection: 2.8/1000 CA
The best predictor of infection is VL of the partner. risk can be as high as 1/50 CA. |
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Term
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Definition
| infection w/ HIV was independently associated with serologic evidence of prior syphilis infection or HSV-2 infection |
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Term
| Name correlates of hiv infection among idu? |
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Definition
time of being of IDU
frequency of needle sharing
Needle sharing frequency
prev hiv in area |
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Term
| Is risk of infection thorugh idU the same with any drug? |
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Definition
| No, higher risk has been observed when heroin and cocaine are used in combinatino given the higher frequency of injection when cocaine is used or more likelihood of exchange of sex |
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Term
| How is blood tested in the US? |
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Definition
| Nucleic Acid Testing wince 2002. Reduce windomw period to 12 days |
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Term
| Risk of HIV infection by needlestick injury? |
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Definition
|
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Term
| How effective are condoms? |
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Definition
| Consistent condoms use has been estimated to have an effectiveness of 87% |
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Term
| What is the probability of hiv infection per anal sexual contact? For vaginal (men to women)? |
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Definition
0.0082 or 82/10000
20/10,000 and W to M 3/10000 |
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Term
| What is the effect of NSP? |
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Definition
Decrease in needle sharing
Reduce transmission among IDU
There is no increase use of drug among IDU
no recruitment of first time users |
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Term
| Name the two major benefits from HIV testing? |
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Definition
Referral for tx and care
counseling for behavior change (it has been shown that VCT reduces risky behavior) |
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Term
| What are ELISA detecting? |
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Definition
| They detect IgM and IgG. The detect them by the use of immobilized HIV Ag |
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Term
| Can bDNA or PCR be used as confirmatory HIV test? |
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Definition
| No they are not FDA approved, and can just add confusion to the diagnosis in the early stage. Best to Repeat WB or ELISA with a fresh blood sample |
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Term
| What is included in pre-test counseling? |
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Definition
Discuss the test
what is a positve test
discuss behavior to reduce risk |
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Term
| What should be include in post test-cunseling? |
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Definition
Discuss +/- result
ways to prevent transmission or infection
accuracy of the test |
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