1. HIV/AIDS: An Overview Andrea A. Howard, MD, MS Montefiore Medical Center

2. Overview 3 rd decade of the epidemic 60 million have been infected 20 million have died Half of newly infected under age 25 HIV is preventable

3. The Basics

4. What is HIV? Human Immunodeficiency Virus Causes AIDS Harms the immune system Attacks helper T cells (CD4+ cells)

5. What is AIDS? Acquired Immunodeficiency Syndrome Most advanced stage of HIV disease Immune system very weakened by HIV Opportunistic Infections—take advantage of weakened immune system Cd4+ count falls to <200 cells/mm 3

6. How does someone get HIV? Unprotected sexual contact Sharing a needle to inject drugs Pregnancy, delivery, and breast milk Blood products (unlikely) NOT by hugging, shaking hands, coughing, toilets, water fountains…

7. ANYONE can look healthy and still be infected

8. Signs and Symptoms Acute Retroviral Syndrome Clinical latency Constitutional symptoms AIDS

9. Acute Retroviral Syndrome

10. Aphthous Ulcer

11. Rash Kahn and Walker, N Engl J Med 1998; 339:36.

12. Clinical Latency No signs and symptoms Viral replication T helper cell destruction 8-10 years without meds Reservoirs of latently infected cells

13. Constitutional Symptoms Swollen glands (neck, underarm, groin) Fevers, night sweats Rapid weight loss Fatigue Diarrhea, poor appetite White spots in mouth

14. Thrush

15. AIDS Infections Neoplasms Neurologic manifestations Wasting CD4+ count <200 cells/mm 3

16. Pneumocystis pneumonia http://aidshistory.nih.gov/first_encounters/rayx.htm l

17. Herpes Simplex Virus

18. Varicella zoster virus

19. Toxoplasma gondii

20. Kaposi’s Sarcoma

21. What are ways to reduce the risk of getting HIV? Choose not to have sex Agree to be faithful with HIV- partner Use latex condoms, dental dams Get prenatal care Do not share needles or syringes Get Tested! Ask partners to do the same.

22. HIV & other Sexually Transmitted Diseases (STDs) Increases risk of contracting HIV Increases risk of transmitting HIV

23. HIV Testing HOW? –HIV test is quick, free, confidential WHY? –Know your status –Keep yourself and others safe –Get treated

24. WHAT does an HIV test tell you? Positive test –Person is infected with HIV –Person can infect others –Does not mean person has AIDS Negative test –Probably not infected –Does not mean person can’t get infected

25. HIV Testing: WHERE? 718-881-TEST BRONX –Montefiore 718-882-0023 BROOKLYN –Project HEAT 718-467-4446 MANHATTAN –GMHC 800-AIDS-NYC –Mt Sinai 212-423-2971 –NY Presbyterian 212-342-3201

26. How is HIV treated? No cure No vaccine Highly Active Antiretroviral Therapy (HAART) –keep infected persons healthy longer –Dietary requirements –Side effects –Importance of adherence

27. Statistics

28. HIV/AIDS in the US >500,000 Americans have died 1 million are living with HIV One-quarter do not know they are HIV+ 40,000 new infections each year # deaths down since the mid 1990’s, but has remained steady in recent years

32. HIV/AIDS in the Young Half of new infections in those under 25 Most infected through sex People of color represent the majority of: –New HIV infections –New AIDS cases –People living with AIDS Survival after AIDS is lower among African Americans

34. HIV/AIDS in Women 8% of AIDS in 1985, to 27% in 2003 New AIDS cases among women in 2003 –67% African American –16% Latina

36. Global HIV/AIDS Epidemic 40 million people living with HIV/AIDS 20 million have died Sub-Saharan Africa –2/3 of people with HIV/AIDS –3/4 of deaths Next wave –Russia (860,000) –India (5.1 million) –China

37. For more information ahoward@montefiore.org 1-800-342-AIDS (CDC AIDS Hotline) 1-800-458-5231 (National AIDS Information Clearinghouse) www.AdolescentAIDS.org www.GettinBusy.org

40. People living with HIV, end 2004 Western & Central Europe 610 000 [480 000 – 760 000] North Africa & Middle East 540 000 [230 000 – 1.5 million] Sub-Saharan Africa 25.4 million [23.4 – 28.4 million] Eastern Europe & Central Asia 1.4 million [920 000 – 2.1 million] South & South-East Asia 7.1 million [4.4 – 10.6 million] Oceania 35 000 [25 000 – 48 000] North America 1.0 million [540 000 – 1.6 million] Caribbean 440 000 [270 000 – 780 000] Latin America 1.7 million [1.3 – 2.2 million] East Asia 1.1 million [560 000 – 1.8 million] Prevalence (range) Source: UNAIDS 39.4 M living with HIV/AIDS; 50% women 4.9 M new HIV infections in 2004 3.1 M deaths due to HIV/AIDS in 2004

41. Distribution of 50,886 Persons Living with AIDS in NYC (2004) Bronx 22% Manhattan 34% Queens 15% Brooklyn 27% Staten Island 2%

42. Structure of HIV Particle matrix capsid Adapted from http://osms.otago.ac.nz/main/bursary/hiv.html