488549
Ecology of HIV
and TB
- TB
- Mycobacterium tuberculosis
- > lungs; hide inside
macrophages (innate); form
tubercle; hidden
- w/out treatment > eye, nerve tissue,
spleen, GI tract, kidney.. death
- suffer undernutrition
- vertebrae collapse
- suffer undernutrition
- bone lesions follow spread of
bacilli in blood stream: spine, hip,
knee
- seen in arch record
- diagnosis using lipid markers
- diagnosis using lipid markers
- seen in arch record
- w/out treatment > eye, nerve tissue,
spleen, GI tract, kidney.. death
- timetable of progression in adolescents
(UK Medical Council, 1972)
- 10% of total
infected; 4.3%
developed clinical
symptoms after 1
year; 2.1% 1 -2 yrs;
1.7% 2 - 10 yrs; 8%
in total after 10 yrs
- immune system
'walls off'
- immune system
'walls off'
- 10% of total
infected; 4.3%
developed clinical
symptoms after 1
year; 2.1% 1 -2 yrs;
1.7% 2 - 10 yrs; 8%
in total after 10 yrs
- globalisation
- est to have emerged approx 40,000
yrs ago coinciding w expansion out
of Africa; demographic expansion in
almost all lineages coincide w human
expansion in last 200 yr (Wirth et al.,
2008)
- est to have emerged approx 40,000
yrs ago coinciding w expansion out
of Africa; demographic expansion in
almost all lineages coincide w human
expansion in last 200 yr (Wirth et al.,
2008)
- historical records: interpret w caution; different names and understandings e.g. consumption;
classical hindu, Babylonian, Chinese and Roman texts all describe the signs n symptoms of TB
- public health
- 1882: Koch - bacterial cause understood
- 1922: vaccination w BCG
- 1943: streptomycin, antibiotic
- Post WWII British vaccination program;
demolition of slums; mass chest x rays
- successful public health response (Swerdlow, 1987)
- BUT resurgence in UK in those born overseas; Lancet
targeted Indians but also SSA, Pakistan
- TB - higher incidence in homeless, alcoholics, injected drug
users and those w HIV (reemergence linked to HIV epidemic)
- multiple drug resistant TB (MDR TB) e.g. to isoniazid, rifampicin
- multiple drug resistant TB (MDR TB) e.g. to isoniazid, rifampicin
- TB - higher incidence in homeless, alcoholics, injected drug
users and those w HIV (reemergence linked to HIV epidemic)
- BUT resurgence in UK in those born overseas; Lancet
targeted Indians but also SSA, Pakistan
- successful public health response (Swerdlow, 1987)
- Post WWII British vaccination program;
demolition of slums; mass chest x rays
- 1943: streptomycin, antibiotic
- 1922: vaccination w BCG
- DOT - directly observed therapy
- detection of infection; 6 - 8 months directly observed medication
- detection of infection; 6 - 8 months directly observed medication
- 1882: Koch - bacterial cause understood
- >1 mil new cases
reported in India & China
in 2007
- HIV prev in new TB cases
above 50% in Southern
Africa (WHO)
- Mycobacterium tuberculosis
- Human Immunodeficiency Virus
- primarily spread through unprotected
anal or vaginal sex (95% of cases in UK)
but also from mother during pregnancy,
through sharing needles
- transmitted in bodily fluids (semen,
vaginal, anal, breast milk)
- end of 2012
just under
100,000 w HIV
in UK
- high risk groups are
gay an bisexual men
and African men and
women
- WHO est 34 mil
- 2.7 mil new infections in 2010; 21%
below peak of epidemic in 1997
- 2.7 mil new infections in 2010; 21%
below peak of epidemic in 1997
- WHO est 34 mil
- high risk groups are
gay an bisexual men
and African men and
women
- symptoms: flu like
symptoms 2 - 6
weeks post infection
aka 'seroconversion
illness';
- after often no
symptoms for several
years aka
'asymptomatic HIV
infection'; spreads
and damages
immune system
- late stage: diarrhoea, white
spots on tongue, swollen
glands; at risk of TB, pneumonia
- AIDS - syndrome not disease; collection of
signs and symptoms all caused by HIV
- AIDS - syndrome not disease; collection of
signs and symptoms all caused by HIV
- CD4 T cell count per cubic mil of blood;
strength of immune system
- man: 400 -1600; women
slightly higher; sharp drop
following infection; stabilise at
500
- even when well millions of
CD4 cells infected every day
and lost, millions more
produced to replace; w/out
treatment CD4 will fall over
time
- even when well millions of
CD4 cells infected every day
and lost, millions more
produced to replace; w/out
treatment CD4 will fall over
time
- T cells part of adaptive immune system;
HIV attaches to CD 4 receptor; copies;
causes lysis of CD4 cell invades others
- man: 400 -1600; women
slightly higher; sharp drop
following infection; stabilise at
500
- viral load test
- 'copies' of HIV per mil of blood
- high viral load usually correlates w low CD4
- high viral load usually correlates w low CD4
- 'copies' of HIV per mil of blood
- late stage: diarrhoea, white
spots on tongue, swollen
glands; at risk of TB, pneumonia
- after often no
symptoms for several
years aka
'asymptomatic HIV
infection'; spreads
and damages
immune system
- SSA: in some countries over
20% of adults; fastest spread
happening in E Europe & C Asia
(increased by 250% between
2001 - 2011)
- over 50% of those eligible for
treatment are not recieveing it
- increasing HIV + 50+s; 21% in 2010
- increasing HIV + 50+s; 21% in 2010
- over 50% of those eligible for
treatment are not recieveing it
- primarily spread through unprotected
anal or vaginal sex (95% of cases in UK)
but also from mother during pregnancy,
through sharing needles
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