Lecture 12: Prevention and control of HIV/AIDS Flashcards
what are the current issues is HIV?
- test and treat vs treatment as prevention
- pre-exposure prophylaxis (PrEP)
- stigma and discrimination on people living with HIV
some background on HIV?
- 40 million living with HIV and 2 million newly infected every year
what are the goals for HIV?
UNAIDS has a guidance on goals for ending AIDS epidemic:
- 90% infected know their status, 90% who know status start treatment, and 90% who are treated achieve viral suppression
- these targets suggest AIDS epidemic could end by 2035
what is the overview of HIV globally?
- the groups most at risk of HIV are dependent on the region
- in some areas of world the biggest risk is hetersexuals, while others are intravenous drugs users, and other areas the biggest risk group is men who have sex with men
what does elimination of aids look like, maybe something that NZ can do?
- start with some targets - could use 90-90-90
- cascade of care
- treatment as prevention
- PrEP
what are the effects of test and treat strategies?
- study found that universal testing and treating had no effect on HIV incidence
- real-world deployment of universal testing and treatment is complicated
how has antiretroviral therapy for HIV changed overtime?
depends on CD4 count
2009 - CD4 less than 200
2013 - CD4 less than 350
2014 - CD4 less than 500
NOW: treat all patients
WHO changed their policy in 2010
- treatment initiation for people living with HIV was those with less than 350, which was updated from 2006 policy of CD4 less than 200
following the serodiscordant review, WHO changed policy again in 2012: treatment initiation of ALL discordant couples regardless of severity of illness (CD4 count)
but basically the vibe is that we realised that we should be preventing the worsening of the condition and everyone should be treated regardless of CD4 count
what was the serodiscordant couple review?
a review of couples where 1 person had HIV and the other doesnt
- study found that treating the infected partner greatly reduced the risk of infection the other partner.
what is HIV cascade of care?
so UNAIDS provided the guidelines on the goals for ending AIDS epidemic:
- 90% of infected know their status
- 90% of known status are treated
- 90% of treated achieve viral suppression
the cascade of care encompasses additional stages of care: diagnosis, linked to physician care, attend regular appointments, start ART, adhere to ART regine, viral load suppression
this is essential to achieving a healthy clinical outcome (starting treatment early and continuing care) - can be measured by cascade of care
- military case study in US
what makes it difficult to measure cascade of care in NZ?
- some people drop out of the cohort
- move overseas, die, unknown data, clinical data unavailable
- varied data collection methods
- stigma and discrimination
- mobile populations
- access to healthcare
- resource limitations (imagine countries with high rates of HIV)
- privacy issues
- difficult to estimate undiagnosed cases without testing everyone
how is HIV testing in NZ?
- 19% of men who have sex with men have never tested for HIV
- only 33% heard of the home testing option
how has ART changed in NZ?
until july 2017, people with HIV in NZ couldnt access HIV medication until CD4 dropped below 500
but now can access at anytime
what is PrEP?
pre-exposure prophylaxis
- a very effective form of prevention treatment
WHO recommends that PrEP should be an additional prevention choice for people at risk of HIV
- NZ was one of the first countries to launch publicaly funded PrEP programme and it seems to be working!
