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Biotechnology and Global Health > Lecture 4: Leading Causes of Mortality, 0-5 and 14-45 Years > Flashcards

Lecture 4: Leading Causes of Mortality, 0-5 and 14-45 Years Flashcards

1
Q

What are the leading causes of mortality in the developing world for ages 14-45?

A
  1. HIV/AIDS
  2. Unintentional injuries
  3. Cardiovascular diseases
  4. Tuberculosis
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2
Q

What are the leading causes of mortality in the developed world for ages 14-45?

A
  1. Unintentional injuries
  2. Cardiovascular diseases
  3. Cancer
  4. Self-inflicted injuries
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3
Q

What is the overall burden of AIDS?

A

Millions of people living with HIV/AIDS, highest number in Sub-Saharan Africa, leaving many children orphaned

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4
Q

What is the burden of AIDS in the US?

A

1.2 million people living with AIDS
$15 billion to treat a year
Affects ethnic minorities and women at a higher rate

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5
Q

What is a retrovirus?

A

A virus with a protein coat with RNA and important enzymes. Genetic flow is RNA –> DNA

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6
Q

Explain the steps of the Pathophysiology of HIV/AIDS

A
  • Attachment and entry
  • Reverse transcription
  • Genome integration
  • New viral RNA produces
  • Budding using host cell membrane
  • Virion maturation
  • Infection of other cells
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7
Q

What is the clinical course of HIV/AIDS?

A

Infection –> Clinically latent period –> AIDS

without Rx 50% patients develop AIDS, 40% develop illness associated with HIV

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8
Q

What diagnostics tools are used for HIV/AIDS?

A

HIV Diagnostic Tech
• Antibodies (ELISA, Western Blots)
• Viral RNA (PCR)
• Number of rapid tests– need to be confirmed with Western Blots

AIDS diagnosis
• HIV positive from antibody tests • CD4+ T-cells ‹ 200 cells/ul
• Opportunistic infection(s)

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9
Q

What do HIV/AIDS therapies target?

A
  • Fusion inhibitors
  • Reverse transcriptase inhibitors
  • Integration inhibitors
  • Fusion inhibitors
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10
Q

What type of therapy is used for HIV/AIDS?

A

Highly Active Antiretroviral Therapy (HAART) - which is a combination of three drugs. This therapy is used to the the rapid mutation rate of HIV which can lead to drug resistance.

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11
Q

What are some of the barriers with HAART?

A
  • Compliance
  • Cost (10K)
  • Access
  • Reservoir outside of blood (brain tissue)
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12
Q

How has access to ART changed?

A

In the past 12 months there has been a 21% increase in the access to ART.

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13
Q

When can Mother to Child transmission of HIV occur?

A

During pregnancy or delivery and while breast feeding (through milk or blood)

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14
Q

How does Mother to Child transmission of HIV occur?

A

– RNA (cell-free viral particles)
– Proviral DNA (cell-associated virus integrated in latent T- cells)
– Intracellular RNA (cell-associated virus in activated producing T-cells).

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15
Q

What are the interventions used for Mother to Child Transmission of HIV?

A

– Antiretroviral prophylaxis
– Safer delivery practices
– Safer infant-feeding practices

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16
Q

What is the status of the HIV vaccine?

A

There have been various clinical trials although non so far have been very effective. The HVTN 505 clinical trial was promising due to a similar vaccine regimen used for SIV in rhesus macaques (large number of animals and strong immune response against the virus)

17
Q

What are the issues and concerns about pre-exposure prophylaxis (PrEP)?

A

PrEP is not right for everyone, requires strict compliance and should only be used as an additional tool to other protective measures.

18
Q

What is the burden on unintentional injuries?

A

Millions on unintentional injuries, leading cause is road accidents

19
Q

What is the burden of tuberculosis?

A

Mycobacterium tuberculosis infects lung tissue, kills 600,00 people ages 15-15 each year.
1/3 of world infected with TB (greatest danger for those immunocompromised)
Follows poverty and urban crowding

20
Q

Explain the pathophysiology of tuberculosis.

A

Transmission is airborne (sneezing 40,00 droplets, 1 droplet causes infection)
Inhaled bacilli ingested by alveolar macrophages which are later lysed by the bacteria that multiple in the endosome

21
Q

What is the difference between latent and active TB?

A

Latent TB: granulomas can control infection bacteria becomes inactive

Active TB: granulomas become necrotic, bacteria spreads, lung tissue get destroyed –> hypoxia –> death

22
Q

What is chronic TB?

A

10% develop, TB leaves the lung and infects other organs. Symptoms include fever, night sweets, weight loss, weakness and cough (bloody sputum)

23
Q

What is the connection between TB and AIDS?

A

– People with AIDS are up to 34x more likely to develop active TB once infected
– TB is the leading cause of death among HIV positive individuals, accounting for 13% of AIDS deaths worldwide

24
Q

What diagnostic tools are used for TB?

A
  • Purified protein derivative (PPD)
  • Serum test
  • Sputum
  • Chest X-ray
25
Q

PPD (purified protein derivative)

A

Bacterial proteins are injected under patient’s skin

  • false positive, immunocompromised may not have reaction
26
Q

Serum test

A

– White blood cells of infected person will release
interferon-gamma (IGRA)

  • Negative for vaccinations
  • Cannot distinguish latent from active
27
Q

Sputum

A

– Manybacteriawhenstainedlosetheir dye when exposed to acid.

– Acid-fast bacilli (M. tuberculosis) have a thick lipid membrane helping it to retain dye

28
Q

Chest X-ray

A

– Showsnodules

– Used to confirm active infection

29
Q

What treatments are available for TB? And what are some of the problems?

A

Antibiotics, although they must be taken for a long time as the do not disperse well intracellularly.

Problems include compliance, duration, and cost.

30
Q

What is Directly Observed Therapy (DOT)?

A

A health care worker watches and helps as the patient swallows anti-TB medicines in his/her presence
• DOT shifts responsibility for cure from patient to health care system
• DOT works well in many developing countries

31
Q

What different types of drug resistance occur with TB?

A
  • Multi-Drug Resistant (MDR) TB - resistant to some first-line drugs
  • Extensive Drug Resistant (XDR) TB - resistant to first-line drugs and 3 or more second-line drugs

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