Sex Lies and Reality
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Reality lies AIDS Out | Life In The HIV/AIDS Epidemic Saga Sex
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The global response to AIDS has achieved significant results since the first case was reported 30 years ago, with a record number of people having access to treatment and rates of new HIV infections falling by nearly 25 per cent, the United Nations says in a new report. While the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7,000 per day. In addition, gender inequalities remain a major barrier to effective HIV responses. HIV is the leading cause of death among women of reproductive age, and more than a quarter of all new global HIV infections are among young women between the ages of 15 and 24. According to the report, investments in the HIV response in low- and middle-income countries rose nearly 10-fold between 2001 and 2009, from $1.6 billion to $15.9 billion. However, in 2010, international resources for HIV declined. “I am worried that international investments are falling at a time when the AIDS response is delivering results for people,” said Mr. Sidibé. “If we do not invest now, we will have to pay several times more in the future.”
Transcript of Sex Lies and Reality
Reality lies
AIDS Out | Life In
The HIV/AIDS Epidemic Saga
Sex
AIDS stands for “ Acquired Immunodeficiency Syndrome ”. AIDS is caused by the Human Immunodeficiency Virus (HIV), which weakens the body's immune system.
Credits: FlickR/Steev M
Once established an HIV infection, individuals are infected for life and will probably succumb to serious opportunistic infections caused by the weakening of their immune system.
Credits: FlickR/Steev M
What Have We Learnt
Where Are We Going
85 million infected worldwide
Credits: UN AIDS | 2011 epidemiology
85 million infected worldwide “ ” . Over 30 million deaths from HIV/AIDS so far, approximately 2 million deaths per year
Credits: UN AIDS | 2011 epidemiology
85 million infected worldwide
“ ” . Over 33 million are living with HIV infection in 2009, 2.6 million new HIV infections in 2009; approximately 7,000 new infections per day
Credits: UN AIDS | 2011 epidemiology
85 million infected worldwide
“ ” .
# 1 cause of infectious mortality worldwide
Credits: UN AIDS | 2011 epidemiology
85 million infected worldwide
# 4 cause of all mortality worldwide
“ ” .
Credits: UN AIDS | 2011 epidemiology
The Good News
The Good News
Credits: UN AIDS | 2011 epidemiology
The Good News
The Good News
The global AIDS epidemic appears to have stabilized, and the annual number of new HIV infections has been steadily declining since the late
1990s
Credits: UN AIDS | 2011 epidemiology
The Good News
The Good News
The global AIDS epidemic appears to have stabilized, and the annual number of new HIV infections has been steadily declining since the late
1990s
Although the number of new infections has been falling, new infections are still high, and with reductions in mortality, the number of people living with
HIV worldwide has increased.
Credits: UN AIDS | 2011 epidemiology
AZT, a drug that had failed in early cancer trials, shown to have anti-HIV activity and to be tolerated by patients over 6 weeks (1986).
Controlled trial in 282 subjects with advanced HIV infection (1986-87) 19 deaths on placebo and 1 on
AZT CD4 cell elevations in AZT group Substantial bone marrow toxicity
observed in the AZT group
The Zidovudine Promise (AZT, ZDV)
Credits: Fischl MAetal; Richman DD et al, NEJM 1987
Individual drugs provided only temporary benefit, and resistance could develop.
Sequential single drug therapies not much better, as second responses were usually less sustained
Would combination drug strategies, as had proven useful in some infections (e.g., tuberculosis) and some cancers be more effective?
Overcome Drug Resistance
Favorable Pharmacokinetic
Interactions
Additive or Synergistic Interactions
Multiply Targets Increased Efficacy Decreased Toxicity
Genesis and Conduct of ACTG 175
Dinner meeting in Montreal in 1989 during an AIDS
conference (Merigan, Hirsch, Lagakos)
Development of a clinical protocol to compare therapy with 1 drug to that with a
combination
Enlistment of Scott Hammer and David Katzenstein to
direct the study
Long discussions (ACTG, pharmaceutical companies,
FDA, and community representatives)
Lessons from ACTG 175
Antiretroviral therapy improves survival for HIV-infected persons.
Treatment with 2 active drugs (ddI + ZDV) slows HIV disease progression when compared to treatment with one drug (ZDV).
The risk of progression, as well as drug efficacy, correlate with reductions in plasma HIV RNA levels.
Credits: Corbis/ Robin Bain
Subsequent Developments
Development of Protease Inhibitors (PIs) and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Clinical trials showing that 3-drug regimens (HAART) are better than 2-drug regimens (ACTG 320, Merck 035, Merck 039)
Low dose ritonavir boosts the activity of protease inhibitors (Abbott 542)
NOW Concerted efforts to rollout ARV programs with appropriate monitoring in developing countries (PEPFAR, WHO, UN-AIDS, etc.)
2004 - 2011
NOW Over 5 million now on ARVs (52% of those with <200, and 36% of those with < 350 CD4 cells/uL)
2004 - 2011
NOW Reduced prevalence in several countries (e.g., Botswana, Tanzania, Rwanda, Kenya) because of changes in sexual behaviors.
2004 - 2011
NOW And yet, for every new person treated worldwide with ARVs, more than one becomes newly infected.
2004 - 2011
Major advances in antiretroviral pre- and post-exposure prophylaxis
Increased test-and-treat efforts
Further reductions in worldwide incidence of new infections
Further increases in persons living with HIV
Credits: FlickR/George Gates
Continued efforts to develop prophylactic and therapeutic vaccines and immunotherapies
Credits: Google Image Search
Reality lies Sex
Shout for life. NOW
Spread the message Credits: FlickR/Steev M
