CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
Epidemiological studies permit us to know more about the parameters of HIV infection and transmission in different populations, and to make some deductions about the evolution of the HIV virus.
"Internet-Based Post-Marketing Surveillance System for Patients with HIV/AIDS: a Pilot Project" Lizanne Béïque (biography) English - 2005-01-06 - 34 minutes
Summary : The number of medications used in the treatment of HIV/AIDS is expanding rapidly. Effective methods for post-marketing surveillance are therefore increasingly important. Lizanne Béïque presents here the results of a pilot project for an internet-based post-marketing surveillance system that was sponsored by the Ontario HIV Treatment Network.
Because of the need to fast-track new HIV/AIDS drugs, there is often limited pre-marketing safety data for novel therapies. Adverse events are, as a result, not infrequently first encountered in the post-marketing period. Béïque and colleagues examined the feasibility and viability of developing and implementing a user-friendly adverse event reporting application for HIV/AIDS patients that could be accessed over the internet. How issues of security and patient acceptability were addressed is discussed. The benefit of such a system relative to the cost of maintaining and monitoring it is also examined in this presentation, as are the limitations of an internet-based reporting system.
This very interesting discussion of a new tool that may well become a mainstay of post-marketing surveillance in the 21st Century is certainly not to be missed.
Learning objectives : After viewing this presentation, participants will be able to discuss:
• The design and evaluation of an internet-based adverse event reporting application for HIV/AIDS patients
• The feasibility and viability, as well as the limitations of such a system
Summary : Recent epidemiological data point to certain parts of the world where HIV prevalence is increasing beyond the 10-15% rate. Sub-Saharan Africa is one such region. India and the Caribbean are also seeing high infection rates, and sadly, injection drug use seems to be driving the jump in new cases in Eastern European countries. Thailand is one of the few countries that seems to have controlled of the spread of AIDS throughout its population, and this in turn seems to be attributed to the direct involvement of the government in the early assessment of the epidemic and subsequent carrying out of extensive prevention activities. The goal of antiretroviral therapy in the absence of a cure remains to achieve long-term remission, and the decision of when to begin antiretroviral therapy is now based on the CD4 count. There are currently less than one million people on antiretroviral therapy, these being mostly in North America, Europe and Oceania. Access to care is notably poor in sub-Saharan Africa, where less than 10, 000 people are on antiretroviral therapy, and the HIV/AIDS death rate is over two million per year. Brazil provides a good example of how the estimated number of new HIV infections can be drastically reduced by increasing the number of patients on antiretroviral therapy. Additional benefits of the Brazilian access policy have been significantly reduced mortality and morbidity rates, reduced hospitalization and cost savings. Finally, AIDS is not only a global epidemic of an infectious disease, but a human security issue, affecting the fundamental conditions that are needed for people to live safe, secure, healthy and productive lives.
Learning objectives : The participant will review the epidemiological data indicating countries with a high prevalence of HIV, and be able to compare the high prevalence region of sub-Saharan Africa directly with countries which have gained a measure of control over the epidemic, such as Thailand and Brazil, where government involvement and better access policies have taken effect.
Bibliographic references : Access to antiretroviral treatment in Latin American countries and the Caribbean.
OBJECTIVES: To assess the access to antiretroviral therapy in the Latin America and Caribbean region and the main issues involved. METHODS: A review of National AIDS Programmes reports, published studies on HIV access to antiretroviral drugs, and personal communications from National AIDS Programmes in the region. RESULTS: Most countries have, or are in the process of developing, laws and regulations to ensure better access to antiretroviral drugs for people in need. However, there are still many countries that either have not implemented policies or do not have policies. There has been an important decrease in the cost of drugs, but prices are still too high for all countries to afford them. The benefits in decreased mortality and hospitalizations in the countries with high coverage are significant. The number of people receiving antiretroviral therapy has been estimated to be close to 170,000 individuals; however, this figure only represents a fraction of the people in need in the region. Some different strategies will have to be implemented in order to increase coverage. CONCLUSION: Renewed efforts are needed from both governments and international community organizations to strengthen the health services and increase access to antiretroviral drugs.
AIDS 2002 Dec;16 Suppl 3:S50-7
"HIV Infection among Marginalized Groups: People who use Illegal Drugs in Vancouver" Dr. Mark Tyndall (biography) English - 2002-04-15 - 25 minutes
Summary : The introduction of highly active antiretroviral therapy (HAART) has led to major reductions in morbidity and mortality, as well as an enhanced quality of life for many HIV-positive individuals. However, global disparities in access to potentially life-saving medications and HIV-directed health care remains a monumental public health challenge. In the Canadian context, access and adherence to antiretroviral therapy is also uneven and highly dependent on individual circumstances, co-morbidity's, and the concurrent use of illicit drugs. Injection drug users (IDUs), as a group, are less likely to access HAART and HIV care is inferior among IDUs when compared to men who had sex with men. Concerns regarding accelerated resistance in poorly adherent individuals may also delay the initiation and continuation of therapy.
Data collected in the Vancouver Injection Drug Users Study (VIDUS) has shown that approximately half of all HIV-positive participants have ever received therapy and only 24% were on HAART at their last follow-up visit. Female gender, heroin use, and unstable housing were associated with lower uptake of HAART, whereas those on methadone maintenance therapy were four-fold more likely to be receiving HAART. Furthermore, interruptions in HAART occurred in 59% of individuals who had initiated HAART and this was associated with younger age, recent incarceration, and binge patterns of drug use.
Physician education, simplified treatment regimes, programs to improve adherence through supervised distribution of drugs, and linking addiction treatment with HIV care are programs that may enhance uptake and sustainability of antiretroviral therapy. Access and utilization of prophylactic antimicrobials should also be included in these initiatives as evidenced by the large number of deaths due to PCP pneumonia.
HIV-related illness will greatly accelerate mortality rates among IDUs in the next few years. HIV prevention efforts should remain the focus of public health policy through safe injection practices, needle exchange programs, addiction treatments, enhanced social supports and the prevention of injection drug use. Optimizing access and adherence to antiretroviral medications through innovative programs can have a major impact on mortality.
"An Ounce of Prevention: Innate and Adaptive Mucosal Immunity in Defense Against Sexually Transmitted Viral Infections" Dr. Ken Rosenthal (biography) English - 2002-04-15 - 44 minutes
Summary : The innate immune system is the first line of defense against invading pathogens and is particularly important in protection against infections at mucosal surfaces. Although long ignored and believed to be nonspecific, recent studies indicate that the innate immune system is capable of rapidly recognizing and responding to pathogens or 'danger' signals and plays a decisive and instructive role in shaping the adaptive immune response. Despite nearly two decades of research directed at inducing adaptive immune responses to HIV, no successful immunologic therapy or vaccine has been developed. Therefore, it may be important to develop novel approaches to elicit innate immunity. Since HIV-1 is primarily a sexually transmitted infection, vaccines capable of protecting against this virus must be capable of inducing long-term effective mucosal immune responses, especially in the genital tract. However, it still remains unclear how to best achieve mucosal protection and what mechanisms contribute to this protection. For a number of years we have been developing mucosal vaccines capable of inducing specific adaptive immune responses in the genital tract and protection against intravaginal (IVAG) virus challenge. This work initially focused on induction of mucosal immune responses and protection against IVAG infection with herpes simplex virus type 2 (HSV-2). We recently extended this work to show that intranasal immunization with inactivated gp120-depleted HIV-1 immunogen plus the mucosal adjuvant CpG oligodeoxynucleotides (ODN) induced potent immune responses in the genital tract and protection against IVAG challenge. Since CpG ODN has been shown to activate potent innate immune responses against infectious agents and trigger Th1-like immune activation, we investigated whether transmucosal delivery of CpG ODN to genital mucosa could protect or treat intravaginal infection with HSV-2. Our results show that local delivery of CpG ODN to the genital tract is very effective at preventing genital viral infection and clearly indicatesthat CpG-induced innate mucosal immunity is involved.
"The Global HIV/AIDS Epidemic : CURRENT CHALLENGES" Dr. Helene Gayle (biography) English - 2002-04-13 - 55 minutes
Summary : HIV is the most devastating disease humankind has ever faced. Since the beginning of the HIV epidemic more than 60 million people have been infected with HIV. Today, it is estimated that 40 million people are living with HIV/AIDS. Although, HIV continues to affect people throughout the world, 95% of new HIV infections are among people in developing countries. HIV/AIDS is now the 4th leading cause of death and the leading infectious cause. In 2001, 5 million people were newly infected with HIV and 3 million people died.
Sub Saharan Africa, has been the region of the world where HIV has had the greatest impact. There it is the leading cause of death. Africa accounts for 70% of all people living with HIV. Life expectancy has declined 15-20 years in the most heavily impacted countries going from an average of 62 to 47 years. Southern Africa has been the hardest hit, with South Africa the country with the largest number of people living with HIV in the world. Nigeria, the most populous country in sub Saharan Africa, has had a steadily escalating rate of HIV infection, with an estimated 5% infection rate among adults.
The transmission of HIV infection in Asia began more recently than in Africa, with Thailand, the first country experiencing major spread. However, India and China, the world's most populous countries are experiencing rapid growth of HIV in certain subpopulations and geographic areas. Although overall national rates of infection are relatively low, even small increases in infection rates translates into large number of people infected with HIV.
The Caribbean is the second-most affected region in the world; several countries have adult prevalence rates of at least 1%. There has been a major increase in HIV infection in Eastern Europe and the nations of the former Soviet Union. This region currently has the fastest rate of new infection in the world, with 250,000 new infections in 2001. The Russian Federation has reported a near doubling of new diagnoses annually since 1998 with 10,993 individuals with reported infection in 1998 and 129,000 individuals in 2001.
Though data suggests a trend towards increasing infection rates in North Africa and the Middle East, the rates remain at relatively low levels.
HIV prevention strategies can reduce the incidence of new infections and be cost-effective in developing countries. The most highly cost-effective strategies for prevention include condom promotion, STD control, voluntary counseling & testing, female condom promotion, injection drug user interventions, screening blood supply, and antiretroviral drugs to prevent mother-to-child transmission. These steps range in cost-effectiveness from actually saving funds to US$19 per disability-adjusted life year, or US$506 per HIV infection averted. Countries like Uganda, Thailand and Senegal have demonstrated that these efforts can be successful in reducing the transmission of HIV.
Although effective treatment, though not a cure, for HIV is widely available in rich countries, they are not in widespread use in poor countries where the problem is greatest. Major impediments to access to anti-HIV or antiretroviral drugs are the cost and the lack of stable health care infrastructures to administer and monitor what are rather complex treatment regiments. Many efforts are underway to explore affordable and appropriate use of antiretroviral therapies in resource poor setting. Absent antiretroviral drugs, treatment of associated infections can have a substantial impact of improving the health of people with HIV infection. For example, tuberculosis, a treatable infectious disease, is the leading cause of death for people with HIV in developing countries.
Most experts estimate that $7-10 billion is needed to effectively fight the global HIV/AIDS epidemic.
"Transmission of drug resistant HIV variants and response to initial in recently HIV-infected individuals in Canada and in USA" Dr. Jean-Pierre Routy (biography) English - 2001-06-02 - 19 minutes
"Escalating HIV and HCV Rates and Risk Behaviours Amoung Injection Drug Users in Russia" Dr. Liviana Calzavara (biography) English - 2001-06-01 - 19 minutes
"How to do HIV Prevention When AIDS isnt scary" Pr. Thomas J. Coates (biography) English - 2001-06-01 - 48 minutes
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