Incubation/survival times: HIV seroconversion to death

1
Incubation/survival times HIV seroconversion to
death
homosexual men, US cities, pre-HAART 12.1 year
median survival large effect of age in data
sets from Europe, Australia, USA (e.g. 15-24 yr
age group had 12.5 yr median survival 45-54 yr
age group had 7.9 yr median survival) median
survival times appear to be higher in
industrialized countries, even in the absence of
HAART (e.g. reported average survival times of
5-10 years in Tanzania, 6-8 years in
Kenya) definite increase in incubation time with
HAART therapy
reviewed in R.A. Coutinho (2000) Some aspects
of the natural history of HIV infection. Tropical
Medicine and International Health 5 a22a25
2
Cascade Collaboration (2003) Determinants of
survival following HIV-1 seroconversion after
the introduction of HAART. Lancet 3621267-74.
3
regarding CCR5 alleles and geographic
distribution...
"Population frequencies in Africa and Asia are
negligible, but are predicted to increase if the
HIV pandemic continues"
Michael P.H. Stumpf and Hilde M.
Wilkinson-Herbots (2004) Allelic histories
positive selection on a HIV-resistance
allele TREE vol. 19 page 166
4
What's the evidence that HIV has evolved?
1. comparison of sequence types from last 50
years 2. growing resistance to once-effective
drugs (esp. AZT) 3. comparison of sequences in
newly infected HIV patient, with those in the
patient after he/she develops AIDS symptoms
5
from Freeman Herron Evolutionary Analysis
(2004)
6
from Freeman Herron Evolutionary Analysis
(2004)
7
from Freeman Herron Evolutionary Analysis
(2004)
8
"ZR59" is the HIV-like sequence obtained from the
blood sample of an african man taken in 1959. He
was also tested as seropositive by
antibody-antigen testing.
9
"We assessed cost effectiveness in a hypothetical
cohort of 20,000 pregnant women in sub-Saharan
Africa. Our main outcome measures were programme
cost, paediatric HIV-1 cases averted, cost per
case averted, and cost per disability-adjusted
life-year (DALY). We compared HIVNET 012 with
other short-course antiretroviral regimens. We
also compared two implementation strategies
counselling and HIV-1 testing before treatment
(targeted treatment), or nevirapine for all
pregnant women (universal treatment, no
counselling and testing). We did univariate and
multivariate sensitivity analyses. FINDINGS For
universal treatment with 30 HIV-1
seroprevalence, the HIVNET 012 regimen would
avert 603 cases of HIV-1 in babies, cost
US83,333"
Marseille E, Kahn JG, Mmiro F, Guay L, Musoke P,
Fowler MG, Jackson JB. Lancet. 1999 Sep
4354(9181)803-9. Cost effectiveness of
single-dose nevirapine regimen for mothers and
babies to decrease vertical HIV-1 transmission in
sub-Saharan Africa.