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HIV/AIDS. HIV in coltura di linfociti. Mirella Pontello Lezione aggiornata per AA 2007-08. Patogenesi e storia naturale. Tre fasi: Infezione primaria da HIV Latenza clinica Fase sintomatica . 1 a fase. Infezione primaria da HIV:

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Hiv aids
HIV/AIDS

HIV in coltura di linfociti

Mirella Pontello

Lezione aggiornata per AA 2007-08


Patogenesi e storia naturale
Patogenesi e storia naturale

  • Tre fasi:

    • Infezione primaria da HIV

    • Latenza clinica

    • Fase sintomatica


1 a fase
1a fase

  • Infezione primaria da HIV:

  • a 2-6 settimane dal contagio sindrome clinica acuta di tipo “influenzale” – comparsa di marcatori di replicazione virale – elevata viremia – disseminazione del virus negli organi linfatici– risposta immunitaria HIV-specifica (1 settimana-tre mesi)

Riduzione replicazione virale

+ comparsa risposta immunitaria


2 a fase
2a fase

  • Latenza clinica

  • 8-12 anni;graduale deterioramento del sistema immunitario – replicazione attiva nei linfonodi – diminuzione dei linfociti T CD4+

3a fase


3 a fase
3a fase

  • Fase sintomatica:

  • sintomi iniziali modesti (perdita di peso, astenia); replicazione virale nel sangue e nei linfonodi - T CD4+ < 200/l

  • comparsa di infezioni opportunistiche


Trasmissione
Trasmissione

  • per via parenteralecon emotrasfusioni ed emoderivati;

  • attraverso lo scambio di siringhe;

  • per contatto accidentale con aghi o strumenti contaminati

  • per via sessuale: omo ed eterosessuale

  • per via verticale: durante la gravidanza, al momento

  • del parto, dopo la nascita, con l’allattamento.


Rischio di trasmissione
Rischio di trasmissione

attraverso le trasfusioni > 90% (ma eliminato)

per omosessuali e tossicodipendenti: 15-70%

rapporti eterosessuali: 1%

trasmissione verticale: Africa 35%; Europa 14%

esposizione occasionale da parte di personale addetto all’assistenza di pazienti HIV+: 0,3%


Tre modelli epidemiologici
Tre modelli epidemiologici

Modello 1:maggior parte dei casi in omosessuali (70%) e tossicodipendenti (15-20%) Paesi: Nord America, Europa occidentale, …; incidenza maggiore nei maschi (85%); età: 15-49 anni. Eccezione: paesi area mediterranea (Italia , Spagna) 2/3 dei casi in tossicodipendenti; 5% in eterosessuali; maggior numero di casi di AIDS pediatrico.

Modello 2: soprattutto casi da contagio eterosessuale; alta prevalenza di infetti nella popolazione generale (fino al 36% nella classe di età 15-49 anni). Paesi: Africa subsahariana; Caraibi; Sud-Est asiatico.

Modello 3: paesi a bassa prevalenza. Paesi: Est Europa, Isole del Pacifico, …


Epidemiologia
EPIDEMIOLOGIA

QUALCHE DATO SULLE DIMENSIONI DEL PROBLEMA


Estimated number of people living with HIV globally, 1990–2007

40

Millions

30

Number

of people

living

with HIV

20

10

0

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year

This bar indicates the range

1


Estimated number of people newly infected with HIV globally, 1990–2007

Upper range

Estimate

6

Millions

Lower range

5

Number of people

newly infected with HIV

4

3

2

1

0

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year

4


Rapporto 2007
Rapporto 2007 1990–2007


Eastern Europe 1990–2007& Central Asia

1.6 million

[1.2 – 2.1 million]

Western &

Central Europe

760 000

[600 000 – 1.1 million]

North America

1.3 million

[480 000 – 1.9 million]

East Asia

800 000

[620 000 – 960 000]

Middle East&North Africa

380 000

[270 000 – 500 000]

Caribbean

230 000

[210 000 – 270 000]

South & South-East Asia

4.0 million

[3.3 – 5.1 million]

Sub-Saharan Africa

22.5 million

[20.9 – 24.3 million]

Latin America

1.6 million

[1.4 – 1.9 million]

Oceania

75 000

[53 000 – 120 000]

Adults and children estimated to be living with HIV 2007

Total: 33.2 (30.6 – 36.1) million


Eastern Europe 1990–2007& Central Asia

150 000

[70 000 – 290 000]

Western &

Central Europe

31 000

[19 000 – 86 000]

North America

46 000

[38 000 – 68 000]

East Asia

92 000

[21 000 – 220 000]

Middle East&North Africa

35 000

[16 000 – 65 000]

Caribbean

17 000

[15 000 – 23 000]

South & South-East Asia

340 000

[180 000 – 740 000]

Sub-Saharan Africa

1.7 million

[1.4 – 2.4 million]

Latin America

100 000

[47 000 – 220 000]

Oceania

14 000

[11 000 – 26 000]

Estimated number of adults and children

newly infected with HIV, 2007

Total: 2.5 (1.8 – 4.1) million


Eastern Europe 1990–2007& Central Asia

55 000

[42 000 – 88 000]

Western &

Central Europe

12 000

[<15 000]

North America

21 000

[18 000 – 31 000]

East Asia

32 000

[28 000 – 49 000]

Middle East&North Africa

25 000

[20 000 – 34 000]

Caribbean

11 000

[9800 – 18 000]

South & South-East Asia

270 000

[230 000 – 380 000]

Sub-Saharan Africa

1.6 million

[1.5 – 2.0 million]

Latin America

58 000

[49 000 – 91 000]

Oceania

1200

[<500 – 2700]

Estimated adult and child deaths from AIDS, 2007

Total: 2.1 (1.9 – 2.4) million


Eastern Europe 1990–2007& Central Asia

3500

[2200 – 6400]

Western &

Central Europe

<1000

[630 – 3100]

North America

1600

[<1000]

East Asia

2100

[<1000 – 2100]

Middle East&North Africa

5500

[3800 – 8200]

Caribbean

2000

[1800 – 3400]

South & South-East Asia

24 000

[14 000 – 31 000]

Sub-Saharan Africa

370 000

[320 000 – 470 000]

Latin America

6700

[5500 – 12 000]

Oceania

<1000

[<1000 – 1400]

Estimated number of children (<15 years)

newly infected with HIV, 2007

Total: 420 000 (350 000 – 540 000)


Eastern Europe 1990–2007& Central Asia

12 000

[8700 – 15 000]

Western &

Central Europe

3000

[2400 – 12 000]

North America

11 000

[4500 – 20 000]

East Asia

9100

[2400 – 12 000]

Middle East&North Africa

28 000

[19 000 – 32 000]

Caribbean

10 000

[8300 – 16 000]

South & South-East Asia

120 000

[71 000 – 130 000]

Sub-Saharan Africa

2.2 million

[2.0 – 2.3 million]

Latin America

39 000

[33 000 – 51 000]

Oceania

1400

[1100 – 2800]

Children (<15 years) estimated to be living with HIV 2007

Total: 2.5 (2.2 – 2.6) million


Eastern Europe 1990–2007& Central Asia

1900

[1600 – 3000]

Western &

Central Europe

<1000

[<1000 – 2600]

North America

<1000

[<100 – 1300]

East Asia

1300

[<1000 – 1400]

Middle East&North Africa

4200

[3700 – 6100]

Caribbean

1500

[1300 – 5700]

South & South-East Asia

17 000

[12 000 – 20 000]

Sub-Saharan Africa

290 000

[280 000 – 340 000]

Latin America

4900

[4500 – 7100]

Oceania

<500

[<500 – 1400]

Estimated deaths in children (<15 years) from AIDS 2007

Total: 330 000 (310 000 – 380 000)


Over 6800 new HIV infections a day in 2007 1990–2007

  • More than 96% are in low and middle income countries

  • About 1200 are in children under 15 years of age

  • About 5800 are in adults aged 15 years and older

  • of whom:

    • almost 50% are among women

    • about 40% are among young people (15-24)


2007 global HIV and AIDS estimates 1990–2007

Children (<15 years)

  • Children living with HIV2.5 million[2.2 – 2.6 million]

  • New HIV infections in 2007420 000[350 000 – 540 000]

  • Deaths due to AIDS in 2007330 000 [310 000 – 380 000]


Sub-Saharan Africa 1990–2007

Middle East & North Africa

South and South-East Asia

East Asia

Latin America

Caribbean

Eastern Europe & Central Asia

Western & Central Europe

North America

Oceania

TOTAL

Regional HIV and AIDS statistics and features, 2007

Adults & children living with HIV

Adults & children newly infected with HIV

Adult prevalence (15‒49) [%]

Adult & child

deaths due to AIDS

22.5 million

[20.9 – 24.3 million]

1.7 million

[1.4 – 2.4 million]

5.0%

[4.6% – 5.5%]

1.6 million

[1.5 – 2.0 million]

380 000

[270 000 – 500 000]

35 000

[16 000 – 65 000]

0.3%

[0.2% – 0.4%]

25 000

[20 000 – 34 000]

4.0 million

[3.3 – 5.1 million]

340 000

[180 000 – 740 000]

0.3%

[0.2% – 0.4%]

270 000

[230 000 – 380 000]

800 000

[620 000 – 960 000]

92 000

[21 000 – 220 000]

0.1%

[<0.2%]

32 000

[28 000 – 49 000]

1.6 million

[1.4 – 1.9 million]

100 000

[47 000 – 220 000]

0.5%

[0.4% – 0.6%]

58 000

[49 000 – 91 000]

230 000

[210 000 – 270 000]

17 000

[15 000 – 23 000]

1.0%

[0.9% – 1.2%]

11 000

[9800 – 18 000]

1.6 million

[1.2 – 2.1 million]

150 000

[70 000 – 290 000]

0.9%

[0.7% – 1.2%]

55 000

[42 000 – 88 000]

12 000

[<15 000]

760 000

[600 000 – 1.1 million]

31 000

[19 000 – 86 000]

0.3%

[0.2% – 0.4%]

1.3 million

[480 000 – 1.9 million]

46 000

[38 00 – 68 000]

0.6%

[0.5% – 0.9%]

21 000

[18 000 – 31 000]

75 000

[53 000 – 120 000]

14 000

[ 11 000 – 26 000]

0.4%

[0.3% – 0.7%]

1200

[<500 – 2700]

33.2 million [30.6 – 36.1 million]

2.5 million[1.8 – 4.1 million]

0.8%

[0.7% - 0.9%]

2.1 million [1.9 – 2.4 million]

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.


Italy dati stimati unaids
ITALY – dati 1990–2007stimati UNAIDS


Prevenzione
Prevenzione 1990–2007

  • Esclusione dei donatori con comportamenti a rischio

  • Controllo unità di sangue e trattamento termico degli emoderivati

  • Iniziative di carattere informativo/educativo sui soggetti con comportamenti a rischio: difficile valutazione

  • Allestimento di vaccini: sperimentazioni in corso, ma ancora in fasi iniziali

  • Precauzioni “universali” per operatori sanitari


Sistema di sorveglianza europeo euro hiv

sistema di sorveglianza europeo (EURO-HIV) 1990–2007

“In Western Europe, thousands of new infections are occurring every year and large numbers of HIV-infected persons are unaware of their HIV status. A large share of new HIV diagnoses are in people originating fromcountries with serious epidemics.”


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