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Acquired Immunodeficiency Syndrome AIDS

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Title: Acquired Immunodeficiency Syndrome AIDS


1
Vincent Keane
2
National Association of Community Health Centers
  • Vince Keane is a former Catholic priest who has
    dedicated himself to the issue of health care for
    the homeless in D.C. He is a previous winner of
    NACHC's John Gilbert award for his championing of
    community health care.

3
National Association of Community Health Centers
  • Among his successful achievements are increased
    services for homeless patients raising the
    profile of non-profit clinics through his
    leadership role in DC Primary Health Care
    Association (DCPCA) and the Non-Profit Clinic
    Consortium turning around the fate of Federally
    Qualified Health Centers in the city and more
    recently taking on the gargantuan task of
    assuring service amidst the change, once again,
    of the citys public health system.

4
Acquired Immunodeficiency Syndrome (AIDS)
  • Stuart Henochowicz, M.D., M.B.A., F.A.C.P.

5
AIDS- Basic Facts
  • Retrovirus that infects T Lymphocytes
  • Progression from virus infection to full blown
    AIDS can be 10 years
  • Severity of infection correlates with CD4 count
    (T helper cell)
  • Destruction of T cells predisposes patients to
    opportunistic infections

6
AIDS-Basic Facts
  • Opportunistic infections
  • Viral- CMV,EBV
  • Mycobacterial- TB
  • Fungal- Candida, Aspergillus
  • Parasitic- Pneumocystis
  • Cancers
  • Kaposis Sarcoma, Lymphoma, Cervical

7
AIDS-Basic Facts
  • Transmission-
  • Sex- anal more effective route than vaginal
  • more effective transmission in presence of
    other STDs
  • Blood- 1980s- Transfusion of blood products
  • Infected Needles- IV Drug use, Needlestick
    injuries

8
AIDS- Basic Facts
  • Origin-
  • Equatorial Africa
  • 1959-HIV positive blood sample- Congo
  • Transmission to North America in the late 1970s-
    Homosexual activity
  • Transmission accelerated by promiscuous sex in
    Gay bathhouses
  • Patient Zero- Gaetan Dugas- male airline steward

9
Source New York Times, Jan. 30th, 2005
10
And The Band Played OnRandy Shilts
  • African origins of AIDS-
  • Kinshasa, Congo-
  • Grete Rask- surgeon contracts AIDS
  • Dies in 1977
  • Family from Kinshasa dies in Belgium- 1978

11
And The Band Played OnRandy Shilts
  • Portuguese veteran of Angolan Civil war treated
    in Paris- Dies in 1980
  • 2 women from Zaire die of Pneumocystis at
    Claude-Bernard hospital- 1980

12
And The Band Played OnRandy Shilts
  • Patient Zero-
  • Gaetan Dugas- flight attendant
  • 40/248 gay men diagnosed with GRIDS had direct
    or indirect sexual contact with Dugas
  • CDC- Los Angeles Cluster Study

13
Knowledge about contact patterns leads to insight
into transmission routes
  • Contact network AIDS cases (Auerbach et al. 1984)
  • Probability that cluster of cases is connected by
    contact on the basis of random events
  • timing of contacts and onset of disease
  • Hypothesis AIDS is transmitted by homosexual
    contact

Source dimacs.rutgers.edu/Workshops/
WGVaccination/slides/kretzchmar.ppt
14
Cluster of cases of the acquired immune
deficiency syndrome. Patients linked by sexual
contact Auerbach et. al. Am. J. Med. 1984
  • The possibility that homosexual men with the
    acquired immune deficiency syndrome (AIDS) had
    been sexual partners of each other was studied.
    Of the first 19 homosexual male AIDS patients
    reported from southern California, names of
    sexual partners were obtained for 13. Nine of the
    13 patients had sexual contact with one or more
    AIDS patients within five years of the onset of
    symptoms.

15
Cluster of cases of the acquired immune
deficiency syndrome. Patients linked by sexual
contact Auerbach et. al. Am. J. Med. 1984
  • Four of the patients from southern California
    had contact with a non-Californian AIDS patient,
    who was also the sexual partner of four AIDS
    patients from New York City. Ultimately, 40
    patients in 10 cities were linked by sexual
    contact.

16
Cluster of cases of the acquired immune
deficiency syndrome. Patients linked by sexual
contact Auerbach et. al. Am. J. Med. 1984
  • On the basis of six pairs of patients, a mean
    latency period of 10.5 months (range seven to 14
    months) is estimated between sexual contact and
    symptom onset. The finding of a cluster of AIDS
    patients linked by sexual contact is consistent
    with the hypothesis that AIDS is caused by an
    infectious agent.

17
Cluster of AIDS patients
number order of diagnosis 0 index case
A.S. Klovdahl. Social networks and the spread of
infectious diseases The AIDS example. Soc. Sci.
Med. 21 (1985) 1203-1216.
A.S. Klovdahl. Social networks and the spread of
infectious diseases The AIDS example. Soc. Sci.
Med. 21 (1985) 1203-1216.
18
Small World Networks
  • Milgram- 1967- He selected random people from
    locations like Kansas or Nebraska, and had them
    start a chain of letter-forwarding. The targets
    of the letters were in Cambridge, MA and Boston.
    Each starter was to send a folder through the
    mail to the target person.

19
Small World Networks
  • But the game had rules. The starters could only
    mail the folder to someone they knew on a
    first-name basis. That person was to mail the
    folder on to another first-name acquaintance,
    etc.Returned tracer postcards tracked the
    progress of each chain.

20
Small World Networks
  • Milgram found that the very first folder reached
    her in just four days and took only two
    intermediate acquaintances. In the second study,
    the starters were located in Nebraska, and the
    target was from Sharon, MA, working in Boston.
    Milgram reported that chains varied from two to
    ten intermediate acquaintances, with the median
    at five. Any person appeared to be able to reach
    the target with an average of six jumps.

21
Progressive transition between regular and random
graphs
Source Watts and Strogatz 1998
22
Maybe Its not such a Small World After
All Spatial Networks and Complex
Contagions Michael Macy Cornell
University Based on Complex Contagion and the
Weakness of Long Ties with Damon Centola,
Cornell University
23
A few long ties
  • A few bridge ties between otherwise distant nodes
  • Create shortcuts across the graph
  • While preserving the clustering of a small
    world.
  • Spread of disease

Infectious diseases spread more easily in
small-world networks than in regular lattices.
-- Watts Strogatz, 1998
24
A few long ties
  • A few bridge ties between otherwise distant nodes
  • Create shortcuts across the graph
  • While preserving the clustering of a small
    world.
  • Spread of disease

Infectious diseases spread more easily in
small-world networks than in regular lattices.
-- Watts Strogatz, 1998
25
CDC Revised Recommendations for HIV Testing of
Adults, Adolescents, and Pregnant Women in
Health-Care Settings
  • For patients in all health-care settings
  • HIV screening is recommended for patients in all
    health-care settings after the patient is
    notified that testing will be performed unless
    the patient declines (opt-out screening).

26
CDC Revised Recommendations for HIV Testing of
Adults, Adolescents, and Pregnant Women in
Health-Care Settings
  • Persons at high risk for HIV infection should be
    screened for HIV at least annually.
  • Separate written consent for HIV testing should
    not be required general consent for medical care
    should be considered sufficient to encompass
    consent for HIV testing.?

27
CDC Revised Recommendations for HIV Testing of
Adults, Adolescents, and Pregnant Women in
Health-Care Settings
  • Prevention counseling should not be required with
    HIV diagnostic testing or as part of HIV
    screening programs in health-care settings.

28
AIDS in the City
  • I heard a presentation on HIV/AIDS management.
    Much of the discussion revolved around getting
    the patients to come for their clinic visits, and
    thinking through techniques where important
    interventions such as PAP smears and dental care
    could be accomplished all in one day.

Source http//burkemed.blogspot.com/2006/10/aids-
in-city.html
29
AIDS in the City
  • To my surprise, I learned that dental care,
    offered for free to a population in desperate
    need of such care, is frequently skipped, even
    when a same day appointment is arranged.

Source http//burkemed.blogspot.com/2006/10/aids-
in-city.html
30
AIDS in the City
  • We heard a wonderful and comprehensive
    presentation from the HIV/AIDS service at Unity.
    A few interesting facts emerged from this
    presentation
  • One out of every twenty people in the District of
    Columbia are HIV positive (a number comparable to
    that of the developing world).
  • 30 of HIV positive patients in D.C. are women.
    Women generally get infected from sexual contact
    with men who are either IV drug users or MSMs
    (men who have sex with men) who are on the down
    low (new terms for closeted gays).

Source http//burkemed.blogspot.com/2006/10/aids-
in-city.html
31
AIDS in the City
  • There are a growing number of HIV positive
    patients who are over the age of 50. Part of the
    growth represents a positive development-
    patients with HIV/AIDS are surviving for more
    than a decade now. They are actually able to age.
    But the other reason for the growth is truly
    disturbing. It was explained to us that young,
    drug addicted HIV positive patients are
    prostituting themselves to older people who have
    money to spare, thereby exposing the older folks
    to the virus.

Source http//burkemed.blogspot.com/2006/10/aids-
in-city.html
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