1BIOE 301Geoff PreidisMD/PhD candidateBaylor College of [email protected] 3:Leading Causes of Mortality, Ages 15-44Review of Lecture Two:Leading Causes of Mortality, Birth-Age 4 Developing world1. Perinatal conditions2. Lower respiratory infections3. Diarrheal diseases4. Malaria Developed world1. Perinatal conditions2. Congenital anomalies3. Lower respiratory infections4. Unintentional injuries1. Perinatal Conditions Question: What is the #1 way to prevent septicemia in a newborn in the developing world?1. Perinatal Conditionshttp://www.path.org/projects/clean-delivery_kit.php2. Lower Respiratory Infections Question: How can a busy health worker (or a parent) quicklyscreen for pneumonia in a child?2. Lower Respiratory Infections23. Diarrheal Diseases Question: What is the #1 way to prevent diarrheal illness in a newborn?3. Diarrheal Diseases4. Malaria Question: How was malaria eradicated from the southern U.S.? What are the challenges with implementing this technology in less developed countries? Challenges for implementing vector control technologies in developing countries Mapping areas that are difficult to access Poor communication Direction – Transfer of vector control efforts from malaria control authorities to local primary health care center Financial support – decreased standard of living from wars, environmental factors, migration Corruption, graft4. Malariahttp://www.cdc.gov/malaria/history/Leading Causes of Mortality Ages 15-44 Developing World1. HIV/AIDS2. Unintentional injuries3. Cardiovascular diseases4. Tuberculosis Developed World1. Unintentional injuries2. Cardiovascular diseases3. Cancer4. Self-inflicted injuries1. HIV/AIDS Burden of HIV/AIDS Pathophysiology of HIV Clinical course of HIV/AIDS Highly Active Antiretroviral Therapy Prevention of Mother to Child Transmission (PMTCT)3Burden of HIV/AIDS Worldwide 33.2 million people are living with HIV/AIDS 20 million people have been killed by the disease 2007: 2.1 million deaths 2.5 million new HIV infections 17% of new infections occurred in children (<15 yrs) 2/3 of those with AIDS and 3/4 of all AIDS deaths are in sub-Saharan Africa 6800 new infections per day 96% in low- and middle-income countries 1200 childrenSource: 2007 AIDS Epidemic Update, UNAIDS/WHOAIDS has Reduced Life ExpectancyBurden of HIV/AIDS in the U.S. 1.2 million people have HIV/AIDS (prevalence) 30,000-40,000 new infections per year (incidence) Only 7 countries in the world have more people living with HIV than the U.S. Routes of transmission: Unsafe sex between men (53%) Unprotected heterosexual intercourse (32%) Non-sterile drug injection equipment (18%)Source: 2007 AIDS Epidemic Update, UNAIDS/WHOBurden of HIV/AIDS in the U.S. Racial and ethnic minorities are disproportionately affected: 48% of AIDS diagnoses are African-Americans (15% pop) The rate of new HIV diagnoses was 21x higher in African-American women than in Caucasian women Women are increasingly affected: The proportion of women among new HIV/AIDS diagnoses have risen from 15% to 26% in 10 years Question: Why is the prevalence of HIV in the U.S. continuing to increase?Source: 2007 AIDS Epidemic Update, UNAIDS/WHOBurden of HIV/AIDS in the U.S. Anti-retroviral therapy has accounted for an 80% decrease in AIDS death rates in the last decade Annual cost to treat: $15 billionPathophysiology of HIV/AIDS4Pathophysiology of HIV/AIDShttp://bayloraids.org/curriculum/Integrase InhibitorsFusion InhibitorsPathophysiology of HIV/AIDShttp://bayloraids.org/curriculum/Clinical Course of HIV/AIDS HIV Infection Spread by sexual contact with infected person or sharing needles with infected person or by transmission from mother to child Virus deposited on mucosal surface Acute infection (flu like symptoms) Viral dissemination HIV-specific immune response Replication of virus Destruction of CD4+ lymphocytes Rate of progression is correlated with viral load Latent PeriodClinical Course of HIV/AIDSClinical Course of HIV/AIDShttp://hivinsite.ucsf.edu/topics/aids_basicsClinical Course of HIV/AIDShttp://bayloraids.org/curriculum/5Clinical Course of HIV/AIDS AIDS Immunologic dysregulation Opportunistic infections and cancers Risk of infections is correlated with number of CD4+ lymphocytes Average patient with AIDS dies in 1-3 years Within 10 years of infection (w/o Rx): 50% of patients develop AIDS 40% develop illness associated with HIV 5-10% remain asymptomaticHIV/AIDS Therapy Reverse Transcriptase Inhibitor enzymes (1987) Enzyme is specific to HIV Combinations of RTIs appear effective HIV Protease Inhibitors (1995) HIV proteases are distinct from mammalian proteases Most significant advance in HIV therapy yet Highly Active Antiretroviral Therapy (HAART) Combination of three or more drugs Fusion inhibitor (2003) Integrase inhibitor (2007)HIV/AIDS Therapy HIV can rapidly mutate to quickly develop resistance to a single drug Resistance develops much more slowly to drug combinations Goal of HAART: Reduce viral levels to undetectable levels Has reduced death rate in US and Europe by 80%http://www.npr.org/templates/story/story.php?storyId=47243686 million people living with AIDS in developing countries are in need of HAART. 90% are in just 34 countriesPrevention of Mother to Child Transmission (PMTCT) 3 routes of transmission: Parentally (during pregnancy) Perinatally (during delivery) Breast feeding (through milk) 4 Core interventions: HIV testing and counseling ARV prophylaxis (ZDV, NVP) Safer delivery practices Safer infant-feeding practices Reduces transmission from 30-40% to 4-6%62. Unintentional Injuries Burden of Unintentional Injuries Accident Physics Slowed Driver Reaction Time Prevention of Road Accidents2. Unintentional InjuriesBurden of Unintentional Injuries More than 1.25 million people ages 15-44 die from unintentional injuries each year 1 million deaths in developing countries, 1/4 million in developed countries 40x this number are injured Major cause of disability Leading cause is road accidents: 500,000 deaths per year in this age group 90% of these deaths occur in developing countries Road Accidents in the U.S. Rates declining steadily A leading
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