HIV / AIDS Statistics in United Kingdom

June 28, 2009

It is estimated that there are more than 50,000 individuals currently living with HIV in the UK, about a third of whom are unaware of their condition. HIV rates continue to climb. Newly diagnosed cases reported for 2003 currently stand at 5,864. However, once all reports have been made, it expected that a record 7,000 new cases will be diagnosed for 2003 alone, a 20 per cent increase from 2002.

Estimated number of people living with HIV - > 50,000

HIV cases diagnosed in 2003 - 5,864

Increase in the number of cases from 2002 - 20%


There is a continuing epidemic among the homosexual community and men having sex with men, accounting for approximately 1,641 of cases reported so far for 2003. The main increase, however, is among heterosexuals, the majority of whom acquired the virus in Africa. Approximately 3,371 new heterosexual cases have been reported so far for 2003. Injecting drug use and mother-to-children transmission each accounted for about 100 cases in 2003.

More than two thirds of the HIV cases are diagnosed in London, however this figure can be misleading. People often travel to London for testing and treatment because there are established specialised services in London. Other areas with a higher prevalence of HIV cases are Brighton and Manchester.

Brief History


AIDS was first identified in the UK in the early 1980s. During the early years of the UK epidemic, HIV infections were concentrated in three groups: men the gay community and men having sex with men, injecting drug users (IDUs) and those receiving blood products, such as transfusions.

In the mid-1980s, the introduction of needle exchange programmes decreased the frequency in IDUs and heat treatments to kill the virus in blood products did the same for those receiving blood products. In the late 1980s and early 1990s, an aggressive public awareness campaign launched by the UK Government resulted in a decline in the number of cases reported each year, however the epidemic still simmered below the surface.

The introduction of anti-retroviral therapy, medications designed to prevent the progression to AIDS, dramatically decreased the number of AIDS-related deaths. Accordingly, the number of HIV cases continued to rise, while the death rate plummeted. AIDS-related deaths fell from 1,236 in 1996 to 395 in 1998 - approximately a 70 per cent drop. The figures since 1998 show a levelling off of this trend with around 400 deaths per year.

Despite these advancements in medical technology, HIV diagnoses have again begun to increase. These increases parallel increases in other STIs and unintended pregnancies across the UK. Unless safer sex messages are heeded, the UK could again see an increasing level of HIV transmission.

Who is affected by HIV?


Anyone can be infected with HIV, but some communities have been more affected than others.

The UK gay community and other men having sex with men have been the group most affected. Recent sharp rises in STIs among gay men have given rise to concern that high risk sexual behaviour amongst gay men is increasing.

There has also been an increase in the number of heterosexuals becoming infected by HIV reported in the UK. Since 1999 the number of new HIV diagnoses acquired heterosexually has been higher than the number of people diagnosed through sex between men. The majority of these cases - about 80 per cent - are thought to have been acquired abroad, particularly in sub-Saharan Africa.

Infections among IDUs have remained relatively low in recent years. Recently there has been a rise in sharing of injecting equipment. This has not directly led to an increase in HIV transmission, but there has been an increase in Hepatitis C and other blood borne viruses.

Published by:
National AIDS Trust (NAT)




Anticipated HIV cure a failure

June 28, 2009

A clinical trial testing the effectiveness of what was believed to be a promising new HIV vaccine has resulted in failure.

The vaccine, made by the pharmaceutical company Merck, offered no protection against infection by the Aids virus.

The Step Study showed that the vaccine did not prevent infection in those not previously infected with HIV, nor did the vaccine reduce the amount of virus in those study participants who became infected with HIV through exposure from an
infected person while in the trial.

Researchers also found that the likelihood of becoming HIV positive was highest among men who received the vaccine, compared to those who received a placebo.

In the comprehensive analyses of immune responses to the vaccine, the researchers analyzed study participants' blood samples to try to assess why the vaccine did not prevent infection and why some study participants who received the vaccine were more likely than others to develop HIV infection.

The vaccine was effective at producing an immune response: 77 percent of those vaccinated who later developed HIV infection while in the study had generated HIV-specific T-cells prior to infection.

Also, among those who received the vaccine, no major differences were found in the HIV-specific immune responses in those who developed HIV infection during the trial compared to those who did not.

Among those participants who became infected, vaccination was not associated with an effect on viral load; similar levels of circulating virus were detected among vaccine and placebo recipients.

The researchers believe that these findings mean that this type and level of production of an HIV-specific T-cell immune response alone may not be sufficient to prevent infection.

The study is published in an online edition of The Lancet medical journal.

Australian News.Net


Increased Rates of HIV among Asian Youth

June 25, 2009

ESCAP has urged reluctant governmental officials in the Asia Pacific region to address the rapidly increasing rates of HIV infection among its youth populations.

The United Nations Economic and Social Commission on the Asia Pacific (ESCAP) has urged Asian governments to promote AIDS awareness among its youth populations. Rates of infection among young people are growing exponentially; more than half of the new diagnosed cases of HIV/AIDS in the past year were among people under the age of 30. This increased vulnerability is attributable to high rates of drug use and sex trafficking in the area, as well as a lack of information about prevention.

ESCAP has urged government officials to increase education programs and preventative methods among the newly targeted populations by way of interactive education techniques and increased accessibility of condoms. However, despite the recent statistics, Asian governments are reluctant to integrate HIV/AIDS awareness into schools.




Some more facts about HIV and pregnancy

June 25, 2009

Hiv And Pregnancy

  • a baby born to a woman who has HIV has a one in four chance of being HIV-positive, without treatment or interventions to stop transmission of the virus
  • HIV and its treatment can increase the risk of premature birth
  • so far, the use of anti-retroviral drugs in pregnancy appears to be safe for babies - it has not been linked with increase in birth defects or any particular type of congenital abnormality
  • a caesarean section reduces the risk of a baby catching HIV during the birth
  • a combination of anti-retroviral therapy and caesarean section reduces the risk of your baby catching HIV to less than 1 per cent
  • a vaginal birth may not increase the risk to the baby in women with well-managed HIV and a low viral load
  • HIV can be passed onto your baby through breastfeeding so bottlefeeding is safer for a baby provided bottles and teats are carefully sterilised
Some couples, where one of the partners is HIV positive, plan their pregnancies well in advance. Some choose to use fertility techniques such as artificial insemination, IVF, sperm washing or sperm donation to help reduce the risk of transmitting the infection.

Men who donate their semen to infertility clinics have to be tested for HIV and then re-tested three and six months later to ensure that they are still negative.


How is a baby affected if its mother has HIV?

An unborn baby has about a one in four chance of catching HIV if his mother is HIV positive and does not receive any treatment or interventions to stop it. The virus can be transmitted to her baby:

  • during pregnancy via the placenta
  • during birth through contact with body fluids


In the UK, most women who are HIV-positive (nine out of 10) are identified before or during pregnancy. This means that in most cases steps can be taken during pregnancy, birth and after birth to prevent the virus being transmitted to their baby. As a result, there has been a dramatic fall in the proportion of babies who are infected with HIV, despite a significant increase in the proportion of HIV-positive women having babies.

Every baby whose mother has HIV is born with antibodies to the virus in his blood. However, these antibodies will disappear over time if a baby does not have HIV. Sometimes, it takes up to 18 months for this to happen. So you can't tell for certain that a baby is free from HIV until he is well into toddlerhood.





Initial treatment of HIV

June 24, 2009

INTRODUCTION

Being diagnosed with HIV can be an overwhelming experience, filled with worry about the future, concern for loved ones, and fears of dying. However, current treatment regimens have significantly improved the possibility of living with HIV. In fact, living with HIV is similar to living with other chronic diseases, such as diabetes or high blood pressure; when HIV is closely monitored and treated, it may be possible to control the disease for a lifetime.

This topic review discusses treatment options for HIV, including general information about when treatment should begin and issues to consider when beginning treatment. A discussion of treatments to prevent opportunistic infections is available separately.

WHO TREATS HIV?

Anyone who is diagnosed with HIV is best managed by a physician who specializes in the care of people with HIV or AIDS

People who are newly diagnosed with HIV are also encouraged to consider enrolling in a clinical trial. A clinical trial is a carefully controlled way to study the effectiveness of new treatments or new combinations of known therapies. Clinical trials are conducted all over the world.

WHEN TO START TREATMENT


The time to start antiretroviral treatments for HIV depends upon several factors, including the person's T cell count, age, underlying medical conditions, history of an AIDS-defining illness, and the person's willingness to commit to lifelong treatment. Each of these factors is discussed in detail below.

T cell count — T helper cells, also known as CD4 cells, are white blood cells that help to organize the immune system. A low T cell count indicates that the immune system is not healthy and that there is a significant risk of developing an opportunistic infection. An opportunistic infection is one that is uncommon in people with a healthy immune system, but which can develop as the immune system fails.

The normal T cell count in a person without HIV is between 600 and 1200 cells per microliter of blood (abbreviated cells/µL). A person with HIV gradually develops lower T cell counts over time as the immune system weakens. There are risks and benefits of starting ART, which will vary depending upon the T cell count.

Benefits of ART — People with a T cell count <200 cells are at a high risk of developing opportunistic infections. Starting ART can improve overall health, increase T cell counts, and suppress growth of the virus.

There are also significant benefits of starting ART if T cell counts are higher (200 to 350 cells/µL). Recommendations for earlier therapy are based in part upon the current availability of excellent drugs with fewer side effects and the need for fewer pills and doses per day than previously.

Risks of ART — The potential risks of ART include the following:

  • Once started, HIV treatment is usually lifelong. Medications must be taken regularly. Taking a "break" from treatment can significantly increase the risk of developing drug resistance and/or opportunistic infections. Be sure to tell your healthcare provider if there is a need to stop therapy because of an illness or surgery.
     
  • Some HIV medications have side effects, which can be serious or even life-threatening.

The benefits of starting treatment when the T cell count is greater than 350 cells/µL depend upon the individual's situation. (See "Patient preference" below).

Age — Studies have shown that patients over the age of 50 have a more rapid progression to AIDS and shorter overall survival after being infected with HIV compared to younger patients. As a result, people who are HIV+ and older than 50 should discuss the possibility of starting ART when the T cell count is higher than 350 cells/µL.

If the patient and healthcare provider decide to delay the use of ART, close follow up and laboratory testing (every three months) are recommended to monitor for new AIDS-related illnesses (eg, thrush, weight loss) or rapid decline in the CDT cell4 count, which would indicate the need to start treatment.

Pregnancy — ART is recommended to all HIV+ women who are pregnant, regardless of their T cell count. The reason for this recommendation is that use of ART can significantly decrease the risk that the woman will transmit HIV to her infant during pregnancy or birth.

There are several antiretroviral drugs that are not recommended during pregnancy, including efavirenz (Sustiva®), delavirdine (Rescriptor®), and the combination stavudine and didanosine. Nevirapine is not recommended for women with a T cell count >250 cells/µL. Detailed information about pregnancy and HIV treatment is available separately.

Sexually active individuals — People who are HIV+ and sexually active with a partner(s) who is HIV negative may want to start ART to decrease the risk of transmitting their infection, regardless of their T cell count. Earlier treatment (when the T cell count is >350 cells/µL) may reduce the risk of transmitting HIV to an uninfected sexual partner. However, it is important to understand all of the risks and benefits of this approach.

  • Practicing safe sex (eg, using condoms every time) significantly reduces the risk of transmitting the virus. This approach does not require the use of ART, which has the potential to cause side effects and increase risk of resistance. It is not clear that taking ART when the T cell count is higher than 350 cells/µL is any better than practicing safe sex.

Underlying medical conditions — HIV treatment is often recommended for people with certain underlying medical conditions, regardless of their T cell count. This includes the following conditions:

  • HIV-associated nephropathy (kidney disease)
  • HIV-associated changes in brain functioning
  • Hepatitis B or hepatitis C
  • Severe cardiovascular disease
AIDS-defining illnesses — AIDS-defining illnesses are diseases or conditions that are uncommon in people with a healthy immune system, but can develop in people with a severely weakened immune system (as a result of AIDS). A list of these conditions is available in the table (show table 1)

Antiretroviral treatment is recommended for anyone who has a current or past history of one or more of these illnesses, regardless of their T cell count.

Patient preference — There are risks and benefits of starting antiretroviral treatment when the T cell count is above 350 cells/µL:

  • The chances of becoming ill or dying from an HIV-related condition are small when the T cell count is greater than 350 cells/µL. Thus, the benefit of antiretroviral treatment is likely to be small. No trial has shown that people live longer or better as a result of treatment when the T cell count is greater than 350 cells/µL.
     
  • Once ART is started, it is usually continued for a lifetime. Treatment interruptions have no clear benefit and some people will develop an increased viral load and/or decreased T cell count.

  • The long term effects of ART are still unknown, especially with the newer medications.

  • Taking HIV drugs inconsistently (eg, not on time every day) can sometimes lead to the development of drug resistance, which may eventually limit the number of drugs that are effective. The likelihood of drug resistance depends upon the individual patient, the drugs being taken, and how many days or weeks pills were missed.
For these reasons, the decision to start antiretroviral treatment when the T cell count is greater than 350 cells/µL depend upon the person's age, underlying medical conditions, and personal preferences. An experienced HIV provider can help to make this decision.


Factors affecting HIV progression

June 24, 2009

INTRODUCTION

From early in the HIV epidemic, it was clear that some patients rapidly progressed to AIDS, while others experienced relative immunologic stability.

Laboratory measurements, such as numbers of CD4 cells and levels of plasma HIV RNA, are helpful in determining the stage of infection and may serve as prognostic markers. Other factors may also influence outcome. This topic covers the demographic, viral, and host factors that may play a role in disease progression as well as describing the important impact antiretroviral therapy has had over the past decade.

LABORATORY MARKERS OF PROGRESSION

Two important laboratory determinants of the rate of progression are the CD4 cell count and the plasma viral load.

CD4 counts and levels of HIV RNA — The average rate of decline of CD4 cells ("CD4 slope") is about 50/mm3 per year and the average viral burden (without therapy) is 30,000 to 50,000 copies/mL. The CD4 cell count and the viral load are independent predictors of progression. This is illustrated by the following natural history studies prior to the era of HAART:

  • The five-year risk of progressing to AIDS in 522 injection drug users ranged from zero percent in those with a baseline viral load <500 copies/mL and a CD4 cell count ≥500/mm3 to 81 percent in those with a baseline viral load ≥10,000 copies/mL and a CD4 cell count <200/mm3.

  • The Multicenter AIDS Cohort Study (MACS) is a database of men who have sex with men (MSM) that was initiated prior to the availability of HAART. After nine years of follow-up, 100 percent of patients with CD4 cell counts <200/mm3 and a viral load >55,000 copies/mL by RT-PCR had an AIDS-defining condition compared to 12.7 percent of patients with CD4 cell counts >350/mm3 and a viral load ≤1500 by RT-PCR.




Ingredient in Green Tea May Block HIV

June 21, 2009

Researchers are looking to find a vaginal gel that would protect a woman from HIV infection. The researchers are looking at a substance which could be the last piece in the puzzle to develop such gel in green tea. Green tea, long noted for its health benefits, contains a substance that appears to block HIV infection.

The biggest hurdle in finding an effective anti-HIV vaginal gel is that such a gel must not be irritating to vaginal mucousa. Such irritation can actually increase the risk of HIV infection. In addition, any effective gel would have to remain stable in the very acidic environment of the vagina. A substance in green tea, EGCG seems to fit all those requirements. Researchers also noted that not only does EGCG block the process that results in HIV infection, it also has anti-HIV activity on its own. If green tea and EGCG does prove effective it could lead to an inexpensive and effective anti-HIV vaginal gel.


The Health Benefits of Green Tea

For many years, green tea has been associated with positive health benefits. In a recent study by researchers at Purdue University, the nature of these benefits was identified. The researchers found that epigallocatechin gallate (EGCg), a compound found in the tea, inhibited the growth of cancer cells. A study from the University of Tokyo has shown that EGCg binds to CD4 cells, preventing HIV from binding to and destroying the cell in the process.

Experts feel that the substances found in green tea, specifically EGCg, could lead to the development of new HIV medications.





HIV infection through medical equipment

June 20, 2009

HIV infection through medical devices, blood products and procedures is thankfully very rare in the Western World.

A number of countries including most of Europe and the
UK did have problems with an HIV and then Hepatitis C contaminated blood and blood product supply chain some 20 years ago but elaborate screening of donors and also screening of blood products has now eliminated this in the UK.

Yesterday saw the release of information from the Department of Veteran Affairs in the
USA confirming the contamination of three patients in different facilities around the
USA with HIV after inadequate sterilisation of re-useable medical equipment.

There have been a number of episodes worldwide where devices which have been resterilised have resulted in infection with Hepatitis B, C or HIV. These are really fantastically rare episodes, particularly if you count the number of procedures performed each year.



From HIV to AIDS

June 01, 2009

In the early years when the disease was first discovered, researches were only concentrating on the end result i.e. AIDS. They were unaware and were missing out on an entire stage leading to the development of AIDS following the initial infection. More correctly, the concentration should have been on the infection causing HIV itself. As found out later, AIDS is the end stage of HIV infection.

A person can be HIV positive (i.e. infected by the HIV virus), without having AIDS. Once HIV infects an individual, the virus alters the genetic makeup of the white blood cells (CD4), binding its self to the cells, and then lies dormant. After a period ranging from 5 to 10 years following the initial infection, the HIV virus tricks the infected cell into producing viral proteins, which results in the formation of a huge number of viral particles inside the white cell eventually causing the cell to burst, releasing thousands of new viruses within the blood. These new viruses will now function as a mean to infect new white cells. This cycle goes on and on, and eventually the immune system of the body is overwhelmed and is no longer capable of fighting the infections.

Eventually the infected person may lose weight and become ill with diseases and infections like persistent severe diarrhea, fever, pneumonia, or skin cancer. At this point, the patient is considered to have developed AIDS. Patients with AIDS can be helped with medicines for the different infections. However, sooner or later, because of a lack of cure for the HIV, it is almost certain that individual affected by AIDS will die.

Let us describe the progression of the disease.



HIV disease progression chart
HIV infection is a chronic (continuing over a long time), progressive (continually getting worse) disease. It destroys the immune system and produces a wide range of symptoms.

The first stage of HIV infection is the initial exposure. Exposure to HIV can be from sexual contact, needle sharing or other blood exposure, or from mother to infant. About three to six weeks after exposure to HIV, many individuals develop flu like illness. This is the early HIV infection stage. It is also called the acute stage. This flu like symptoms can range from mild to very severe. This stage lasts from 3 to 14 days and sometimes longer. As with the flu, the symptoms, as bad as they may be, do go away, leaving the person thinking wrong assuming that it was just a regular case of flu.

When the flu-like symptoms disappear, the person enters the second stage, the asymptomatic stage. At this time there are no symptoms, and the person looks and feels perfectly healthy. This asymptomatic stage can last for 10 years and sometimes even longer. Unfortunately, during early HIV infection and the asymptomatic stage, the disease can be highly infectious.

When the asymptomatic stage ends, the flu-like symptoms return. This time, however, large swollen glands are usually the most pronounced symptom. For that reason the stage is often called the PGL (persistent generalized lymphadenopathy) stage. This stage lasts generally from three months to a year.


The final stage is AIDS. Unfortunately there is no cure, no immunity, and no vaccine. The average life expectancy from time of AIDS diagnosis to death is about three years. Some get to live longer thanks to the new medical treatments.



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