1 / 24

HIV/AIDS

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:

elia
Download Presentation

HIV/AIDS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HIV/AIDS HIV in coltura di linfociti Mirella Pontello Lezione aggiornata per AA 2007-08

  2. Patogenesi e storia naturale • Tre fasi: • Infezione primaria da HIV • Latenza clinica • Fase sintomatica

  3. 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

  4. 2a fase • Latenza clinica • 8-12 anni;graduale deterioramento del sistema immunitario – replicazione attiva nei linfonodi – diminuzione dei linfociti T CD4+ • … 3a fase

  5. 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

  6. 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.

  7. 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%

  8. 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, …

  9. EPIDEMIOLOGIA QUALCHE DATO SULLE DIMENSIONI DEL PROBLEMA

  10. 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

  11. 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

  12. Rapporto 2007

  13. Eastern Europe & 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

  14. Eastern Europe & 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

  15. Eastern Europe & 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

  16. Eastern Europe & 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)

  17. Eastern Europe & 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

  18. Eastern Europe & 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)

  19. Over 6800 new HIV infections a day in 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)

  20. 2007 global HIV and AIDS estimates 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]

  21. Sub-Saharan Africa 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.

  22. ITALY – dati stimati UNAIDS

  23. Prevenzione • 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

  24. sistema di sorveglianza europeo (EURO-HIV) “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.”

More Related