The following slides and audio are taken from a public HIV health and treatments update forum held in Sydney,

Australia on 25 November 2008. The slides and audio have been edited for presentation on the web.

The speaker is Bill Whittaker, NAPWA Health, Treatments and Research portfolio co-convenor.

For more presentations from this event, visit the sponsor organisations’ websites:

HIV Treatment and Health UpdateHIV Treatment and Health Update25 November 2008

Part 1

HIV in 2008 and HIV Treatment

Trends

.2

HIV in 2008 – Facts & Figures

A global view of HIV infection33 million people [30–36 million] living with HIV

4

Global summary of the HIV epidemic

Total 33 million [30 – 36 million] Adults 30.8 million [28.2 – 34.0 million] Women 15.5 million [14.2 – 16.9 million] Children under 15 years 2.0 million [1.9 – 2.3 million]

Total 2.7 million [2.2 – 3.2 million]Adults 2.3 million [1.9 – 2.8 million]Children under 15 years 370 000 [330 000 – 410 000]

Total 2.0 million [1.8 – 2.3 million]Adults 1.8 million [1.6 – 2.1 million]Children under 15 years 270 000 [250 000 – 290 000]

Number of people living with HIV in 2007

People newly infected with HIV in 2007

AIDS deaths in 2007

5

Over 7400 new HIV infections a day in 2007

• More than 96% are in low and middle income countries

• About 1000 are in children under 15 years

• About 6300 are in adults aged 15 years and older of whom:

— almost 50% are among women— about 45% are among young people (15-24)

Access to high quality treatment & care remains out of reach for most people with HIV in the world

Diagnoses of HIV infection and AIDS1 in Australia

0

500

1000

1500

2000

2500

19811983198519871989199119931995199719992001200320052007

Year

Number

HIV diagnoses AIDS diagnoses

1 AIDS diagnoses adjusted for reporting delays. Source: State and Territory Health Depts & NCHECR

• Around 19,000 Australian’s currently living with HIV infection.

• 1000 new HIV infections annually, an increase of around 50% since 1999.

Newly acquired HIV infection

82%

4%

9%2%3%

HIV in 2008 – Facts & Figures

12.9%

54%

4.1%

21.4%

5.6%

Where we liveEstimated % of people living with HIV infection in 2007 by State/Territory

1%

0.7%

0.7%

Source: State/Territory Health Depts

Australian AIDS related deaths continue to decline – halved from 141 in 1999 to 67 in 2007.

Approx 13,000 of 19,000 Australians with HIV taking treatment – around 70%.

Australian HIV positive population is across a widening spectrum of age.

HIV in 2008 – Facts & Figures

Clinical Infectious Diseases 2008 47(4):542–553

Age distribution of HIV positive people in USAE

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HIV in 2008 – Facts & Figures

Source: NCHECR

Age distribution MSM with HIV in AustraliaE

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HIV in 2008 – Facts & Figures

5 major HIV scientific conferences.

Important HIV research findings presented + published.

New life expectancy estimates for people with HIV

More news about the impact of living long term living with HIV infection.

Important changes in HIV treatment and care.

An avalanche of new information which challenges both doctors and treatment activists to keep on top of.

Much of the news is good, but some is not so good.

Major Shifts – 18 months

New debates emerging about HIV and treatment.

Shift away from using the term AIDS – non classical AIDS is now the biggest problem – “HIV disease, HIV related”.

Move to earlier HIV antiviral treatment

New treatment options

Pill count down on one side, but could be going up on the other.

Good results for rescue situations.

Cardiovascular (heart) links to HIV and treatment .

Health delivery for HIV – long term – choice, gps.

Major Shifts – 18 months

Shift in how the experience of HIV living is being talked about……….

Changed focus: from surviving AIDS – to making HIV part of “long term, more normal living” .

Simplistic clinical categorizations of HIV positive people as either “well or sick”.

Lived experience is different for everyone.

Variety of experiences of living with HIV –

“Living well’

“Living well – isolated/disconnected”

“Living long, but not well”

“Doing it tough – in trouble”

Major Shifts – 18 months

HIV & AIDS 1981 to 1996

HIV & AIDS 1981 to 1996

“Before 1996, doctors who saw patients with HIV had to give bad news almost daily.

We tried to restore hope by telling patients the cold hard facts that only 50% would progress to AIDS or death within 10 years.

But at the same time we were often acknowledging to ourselves that the tell-tale clinical features of immune deficiency had already appeared and the inevitable demise would surely be sooner rather than later.”

Dr David Cooper 2008

Early years of HIV Treatment (88-95) gave most people only 1 or 2 years of extra life.

More potent drugs and protease inhibitors arrived in 1995

Dramatic increase in life expectancy since 1996.

Why???• Overwhelmingly it’s HIV treatment impact + treatment

improvement.• Better adherence and less treatment breaks.• Scientific and clinical advances (viral load and resistance

tests).

Life Expectancy

The Antiretroviral Therapy Cohort Collaboration.

Large multi-national study of life expectancy in 43,355 HIV+ taking HIV treatment between 1996 and 2005.

Key findings:

• marked decrease in deaths and potential years of life lost from HIV.

• corresponding increases in life expectancy.

• bottom line - a 20-year-old starting HIV treatment can expect to live for another 43 years on average, whereas a 35-year-old can

expect 32 more years of life.

• “These figures are startling and will surely help doctors raise the hopes and expectations of patients during discussion of life

choices and goals.”

Life Expectancy

Among HIV positive people starting treatment, life expectancy varies a lot between different groups –

– Starting HIV Treatment at a low CD4 T cell count is estimated to shave an extra 10 to 20 years off life expectancy.

– Life expectancy influenced by other factors, particularly age, lifestyle, family history.

A large gap still remains in life expectancy between the general population, and the HIV positive population.

Even in the best scenarios with the most recent experience with HIV Treatment, about 10 years is shaved off a normal lifespan.

But this absolutely remarkable turnaround in life expectancy is to be celebrated – the task now is to extend the quantity and quality of life further.

There’s always a qualification……

Life Expectancy

HIV treatment has greatly increased life expectancy for many.

So HIV+ people are now aging while receiving HIV treatment.

Are at risk of developing chronic diseases associated with advancing age (hypertension, heart problems, diabetes, bone disease, etc) that rest of population experiences.

Issues of mental health and cognitive function (brain).

Suggestions that HIV infection “compresses” the aging process, perhaps accelerating other health problems.

Impact of long-term living with HIV

“HIV and ageing” – a hot research topic.

Why? - long-term HIV living is a recent phenomenon – not a lot is known.

We’re not just talking about reaching old age – we’re talking about the impact of living with HIV over time.

So the impact of HIV and ageing applies if you're 20, 40 or 60 now.

Impact of long-term living with HIV

Death is increasingly due to serious non-AIDS illnesses, such as cardiovascular disease, cancers, end-stage liver, and kidney disease.

Uncontrolled HIV could cause a good proportion of these problems – in addition to traditional risk factors (lifestyle, family history)?

Studies are finding that HIV viral load and CD4 count levels are associated with risk of developing cancers and other illnesses.

Impact of long-term living with HIV

So keeping a high CD4 count and undetectable viral load may be important to help prevent other illnesses such as cancers.

So earlier HIV treatment? (more shortly)

Growing research focus on understanding the link between HIV and other illnesses – strategies to manage them (bone disease)

Impact of long-term living with HIV

For more presentations from this event, visit

www.napwa.org.au

or

www.acon.org.au