Indications For Intravenous Zidovudine In Labor
Intravenous zidovudine, when given early in labor, rapidly crosses the placenta and thus can efficiently provide high systemic levels of zidovudine for the infant. Available data show the use of intravenous zidovudine in labor clearly reduces perinatal HIV transmission when the mother has an HIV RNA level greater than 1,000 copies/mL near the time of deliverydefined as 34 to 36 weeks gestation or 4 ot 6 weeks before delivery. Accordingly, the Perinatal Guidelines recommendation for the use of intravenous zidovudine during delivery for women depends on the maternal HIV RNA level near the time of delivery and whether there are any concerns for maternal antiretroviral medication adherence near delivery.
Global Hiv & Aids Statistics Fact Sheet
GLOBAL HIV STATISTICS
- 37.7 million people globally were living with HIV in 2020.
- 1.5 million people became newly infected with HIV in 2020.
- 680 000 people died from AIDS-related illnesses in 2020.
- 27.5 million people were accessing antiretroviral therapy in 2020.
- 79.3 million people have become infected with HIV since the start of the epidemic.
- 36.3 million people have died from AIDS-related illnesses since the start of the epidemic.
People living with HIV
- In 2020, there were 37.7 million people living with HIV.
- 36.0 million adults.
- 1.7 million children .
- 53% of all people living with HIV were women and girls.
People living with HIV accessing antiretroviral therapy
- At the end of December 2020, 27.5 million people were accessing antiretroviral therapy, up from 7.8 million in 2010.
- In 2020, 73% of all people living with HIV were accessing treatment.
- 74% of adults aged 15 years and older living with HIV had access to treatment, as did 54% of children aged 014 years.
- 79% of female adults aged 15 years and older had access to treatment however, just 68% of male adults aged 15 years and older had access.
New HIV infections
COVID-19 and HIV
New Hiv Diagnoses Among Gay And Bisexual Men In The Us And Dependent Areas By Race/ethnicity 2019
* Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for people of African descent with ancestry in North America. Hispanic/Latino people can be of any race.
From 2015 to 2019, HIV diagnoses decreased 9% among gay and bisexual men overall. But trends varied for different groups of gay and bisexual men.
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Challenges In Calculating A Number
It isn’t easy for researchers to calculate the risk of transmission from an exposure to HIV through sex. To do this effectively, a group of HIV-negative individuals need to be followed over time and their exposures to HIVboth the number of times they are exposed and the types of exposureneed to be tracked.
As you can imagine, accurately tracking the number of times a person is exposed to HIV is very difficult. Researchers ask HIV-negative individuals enrolled in these studies to report how many times they have had sex in a given period of time, what type of sex they had, how often they used condoms and the HIV status of their partner. Because a person may have trouble remembering their sexual behaviour or may not want to tell the whole truth, this reporting is often inaccurate.
Furthermore, a person does not always know the HIV status of their partner. For this reason, researchers usually enroll HIV-negative individuals who are in stable relationships with an HIV-positive partner . Researchers can then conclude that any unprotected sex reported by a study participant counts as an exposure to HIV.
How Hiv Infects The Body
HIV infects the immune system, causing progressive damage and eventually making it unable to fight off infections.
The virus attaches itself to immune system cells called CD4 lymphocyte cells, which protect the body against various bacteria, viruses and other germs.
Once attached, it enters the CD4 cells and uses it to make thousands of copies of itself. These copies then leave the CD4 cells, killing them in the process.
This process continues until eventually the number of CD4 cells, also called your CD4 count, drops so low that your immune system stops working.
This process may take up to 10 years, during which time you’ll feel and appear well.
Page last reviewed: 22 April 2021 Next review due: 22 April 2024
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Diagnosis Of Acute Hiv In Pregnancy Or In Breastfeeding Mothers
Women have an increased risk of acquiring HIV throughout pregnancy and during the postpartum period. Acute HIV that occurs in a woman during pregnancy or while breastfeeding confers a very high risk of HIV transmission to the child because of high HIV RNA levels in the mothers plasma, genital tract, and breastmilk that occur with acute infection. In one cohort study in New York state, investigators reported the rate of perinatal transmission was 22% among neonates born to mothers who acquired HIV during pregnancy compared to 1.8% of newborns whose mothers did not acquire HIV during pregnancy. Therefore, pregnant or breastfeeding women with symptoms of acute retroviral syndrome should undergo prompt evaluation for acute HIV infection. When acute HIV is suspected during pregnancy or while breastfeeding, the evaluation should include an HIV RNA assay in combination with antibody testing . If acute HIV is diagnosed, an HIV drug resistance genotype should be ordered, the mother immediately started on antiretroviral therapy, and contact initiated with a pediatric HIV expert.
The Global Hiv/aids Epidemic
HIV, the virus that causes AIDS, is one of the worlds most serious public health challenges. But there is a global commitment to stopping new HIV infections and ensuring that everyone with HIV has access to HIV treatment.
According to UNAIDS:
Number of People with HIVThere were approximately 37.6 million people across the globe with HIV in 2020. Of these, 35.9 million were adults and 1.7 million were children .
New HIV InfectionsAn estimated 1.5 million individuals worldwide acquired HIV in 2020, marking a 30% decline in new HIV infections since 2010. Of these new HIV infections:
- 1.3 million were among adults
- 160,000 were among children
HIV TestingApproximately 84% of people with HIV globally knew their HIV status in 2020. The remaining 16% still need access to HIV testing services. HIV testing is an essential gateway to HIV prevention, treatment, care and support services.
HIV Treatment AccessAs of the end of 2020, 27.4 million people with HIV were accessing antiretroviral therapy globally. That means 10.2 million people are still waiting. HIV treatment access is key to the global effort to end AIDS as a public health threat. People with HIV who are aware of their status, take ART daily as prescribed, and get and keep an undetectable viral load can live long, healthy lives and have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
- 84% knew their HIV status
- 73% were accessing ART
- 66% were virally suppressed
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How Have Deaths From Hiv/aids Changed Over Time
Global deaths from HIV/AIDS halved within a decade
The world has made significant progress against HIV/AIDS. Global deaths from AIDS have halved over the past decade.
In the visualization we see the global number of deaths from HIV/AIDS in recent decades this is shown by age group. In the early 2000s 2004 to 2005 global deaths reached their peak at almost 2 million per year.
Driven mostly by the development and availability of antiretroviral therapy , global deaths have halved since then. In 2017, just under one million died from the disease.
You can explore this change for any country or region using the change country toggle on the interactive chart.
HIV/AIDS once accounted for more than 1-in-3 deaths in some countries, but rates are now falling
Global progress on HIV/AIDS has been driven by large improvements in countries which were most affected by the HIV epidemic.
Today the share of deaths remains high: more than 1-in-4 deaths in some countries are caused by HIV/AIDS. But in the past this share was even higher.In the visualization we see the change in the share of deaths from HIV/AIDS over time. From the 1990s through to the early 2000s, it was the cause of greater than 1-in-3 deaths in several countries. In Zimbabwe, it accounted for more than half of annual deaths in the late 1990s.
We see that over the past decade this share has fallen as antiretoviral treatment has become more widely available.
Children living with HIV
New HIV infections of children
Information And Consultation Resources
This topic review will highlight key points from the Perinatal Guidelines. The full text of the Perinatal Guidelines should be consulted for all management decisions and for further reading. In addition, expert consultation can be obtained by calling the National Clinician Consultation Centers Perinatal HIV/AIDS Line at 448-8765 that provides information and clinical consultation to medical providers caring for pregnant women with HIV and their infants.
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Evaluation Of Patients Presenting For Pep
All patients who present for PEP should have evaluation of the following:
determination of HIV status of person presenting for PEP before starting PEP and 3 months after completion of PEP
timing and frequency of exposure
HIV status of source
transmission risk from the exposure
evaluation for sexually transmitted infections, hepatitis, and emergency contraception at initial presentation and during follow-up period
advice regarding safer sex and risk reduction strategies
follow-up to evaluate adherence and side effects of medication.
PEPSE provides one aspect of a larger HIV prevention strategy and should be provided in the context of other preventative measures, including promotion of condom use, counseling, and support around behavior modification in order to reduce future risk.
Awareness of PEP and its availability for both clinicians and those who are eligible to receive it are crucial to ensure that PEP is used to its full potential in any HIV prevention strategy. A recent study among an HIV-positive cohort in London showed that there was only 50% awareness of the availability of PEP overall, and 64% in those who had a detectable HIV viral load. Data from the CDC assessing HIV providers prescription of PEPSE in two US districts for their patients were poor, with 59.7% and 39.3% having ever prescribed PEPSE.
Hiv And Aids In South Africa
- South Africa has the biggest HIV epidemic in the world, with 7.7 million people living with HIV.
- HIV prevalence among the general population is high at 20.4%. Prevalence is even higher among men who have sex with men, transgender women, sex workers and people who inject drugs.
- South Africa has made huge improvements in getting people to test for HIV in recent years. It has now met the first of the 90-90-90 targets, with 90% of people living with HIV aware of their status in 2018.
- The country has the worlds largest ART programme, which has undergone further expansion with the implementation of test and treat guidelines.
- South Africa was the first country in sub-Saharan Africa to fully approve PrEP, which is now being made available to people at high risk of infection.
Explore this page to find out more about , , , , , , and .
South Africa has the biggest and most high-profile HIV epidemic in the world, with an estimated 7.7 million people living with HIV in 2018.1
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Methylergonovine For Postpartum Hemorrhage
Methylergonovine and other ergot alkaloids, which are generally the first-line treatment for postpartum hemorrhage due to uterine atony, are metabolized primarily by the P450 CYP3A4 enzyme system. Potent CYP3A4 inhibitors, such as ritonavir or cobicistat, significantly increase systemic levels of methylergonovine whereas CYP34A inducers, such as efavirenz or nevirapine, lower systemic levels of methylergonovine. Coadministering methylergonovine with medications that may cause a drug interaction can lead to over treatment or undertreatment of uterine atony, respectively. Accordingly, other treatment options for uterine atony and bleeding should be considered if the mother is taking a cytochrome P450 CYP3A4 enzyme inhibitor or inducer.
The Global Distribution Of Deaths From Hiv/aids
In some countries HIV/AIDS is the cause of more than a quarter of all deaths
Globally, 1.7% of deaths were caused by HIV/AIDS in 2017.
This share is high, but masks the wide variations in the toll of HIV/AIDS across the world. In some countries, this share was much higher.In the interactive map we see the share of deaths which resulted from HIV/AIDS across the world. Across most regions the share was low: across Europe, for example, it accounted for less than 0.1% of deaths.
But across some countries focused primarily in Southern Sub-Saharan Africa the share is very high. More than 1-in-4 of deaths in South Africa and Botswana were caused by HIV/AIDS in 2017. The share was also very high across Mozambique Namibia Zambia Kenya and Congo .
Death rates are high across Sub-Saharan Africa
The large health burden of HIV/AIDS across Sub-Saharan Africa is also reflected in death rates. Death rates measure the number of deaths from HIV/AIDS per 100,000 individuals in a country or region.
In the interactive map we see the distribution of death rates across the world. Most countries have a rate of less than 10 deaths per 100,000 often much lower, below 5 per 100,000. Across Europe the death rate is less than one per 100,000.
Across Sub-Saharan Africa the rates are much higher. Most countries in the South of the region had rates greater than 100 per 100,000. In South Africa and Mozambique, it was over 200 per 100,000.
Obstetric Procedures And Risk Of Hiv Transmission
Although limited data exist regarding the impact of obstetrical procedures on HIV transmission risk, the Perinatal Guidelines recommend against the routine use of the following procedures: artificial rupture of membranes, invasive fetal scalp monitoring with scalp electrodes, and operative delivery with forceps or vacuum extractor. If, however, any of these procedures are deemed to have a clear obstetrical indication, they should be performed. The possible risk of HIV transmission from these procedures is likely lower in women who have an undetectable HIV RNA level at the time of delivery. Epidural anesthesia is considered safe for women with HIV infection in labor, regardless of the antiretroviral regimen the woman is receiving. In addition, the indications for episiotomy should be the same for women with or without HIV.
Hiv Care & Viral Suppression
92% of people newly diagnosed with HIV in 2019 entered care within one month of their diagnosis .
Between January and June 2020, 77% of persons diagnosed were virally suppressed within six months .
Among all people living with HIV in San Francisco, 67% have their virus under control in 2020. . People who are virally suppressed have better health outcomes and do not transmit HIV to other people.
The proportions of persons with HIV who received care and were virally suppressed in 2019 were higher in San Francisco than in California and the U.S. .
Black/African Americans had a lower proportion of linkage to care and viral suppression. Trans women, persons aged 30-39 years, MSM-PWID, and persons experiencing homelessness at diagnosis had a lower proportion of viral suppression. .
Among persons diagnosed with AIDS in the years 2012-2019, survival probability at 36 months was lower among Black/African Americans and Whites compared to Latinx and Asians/ Pacific Islanders. .
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Is The World Making Progress In Its Fight Against Hiv/aids
The 1990s saw a substantial increase in the number of people infected with HIV and dying of AIDS.
Between 1996 and 2001 more than 3 million people were infected with HIV ever year. Since then the number of new infections began to decline and in 2017 it was reduced to below 2 million. The lowest number of new infections since 1990.
The number of AIDS-related deaths increased throughout the 1990s and reached a peak in 2005, 2006 when in both years close to 2 million people died. Since then the annual number of deaths from AIDS declined as well and was since halved. 2017 was the first year since the peak in which fewer than 1 million people died from AIDS.
The chart also shows the continuing increase in the number of people living with HIV. The rate of increase has slowed down compared to the 1990s, but the absolute number is at the highest ever with more than 36 million people globally living with HIV.
Hiv Diagnoses In Canada
How many people are newly diagnosed with HIV in Canada each year?
There were 2,122 HIV diagnoses in Canada in 2019. This represents a 4% increase over the past 5 years .
Among new HIV diagnoses in 2019 where sex was known , 30.2% were in females and 69.8% were in males.
Among the HIV diagnoses in adults where the likely exposure is known , 39.7% were in gbMSM, 28.3% were from heterosexual sex and 21.5% were in PWID in 2019.
Among females, 38.4% of HIV diagnoses were in women who injected drugs and 48.0% were from heterosexual sex in 2019.
Among males, 56.2% were in gbMSM, 4.8% were among gbMSM who also injected drugs, 14.6% were in men who injected drugs and 20.0% were from heterosexual sex in 2019.
Just over a quarter of all HIV diagnoses in males were in male youth in 2019. Just under a quarter of all HIV diagnoses in females were in female youth in 2019
Where are HIV diagnoses rates the highest?
There are four provinces with HIV diagnoses rates above the national average of 5.6 per 100,000 people in 2019:
- the territories
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