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AIDS 邓子德 中山大学附属第三医院 传染病学教研室 Deng zide Department of Infectious Diseases The 3rd Hospital of Sun Yat-sen University A Acquired I Immuno D Deficiency S Syndrome AIDS • AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981 and has since become a major worldwide epidemic. • AIDS is caused by HIV (human immunodeficiency virus). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. • People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make healthy people sick. AIDS A I D S AIDS patient AIDS patient Timeline Post-Naming 1982 – First use of term “AIDS” 1983 – Virus isolated and identified Early to mid 80s – First wave of activism: community based groups securing visibility. 1985 – HIV Ab testing available Mid-80s – Border control regulations in more than 50 countries 1987 – First FDA approved drug, AZT. Also, birth of ACT UP and transition to activism focused on treatment. Late 80s – WHO produces “world mapping” Recognizing “New Frontiers” 1990 – Eastern Europe described as the new frontier of the AIDS epidemic; Signs of infection in China (in fact starting early to mid 80s) Always “the other” 'AIDS and drug addiction are still seen as consequences of contact with the West, AIDS being known as aizibing, the "loving capitalism disease".' -The Guardian 1993 – concern about underreporting China, mostly reporting IV drug users 1996 – China’s reported cases: 2/3 in southern province connected to drug use Etiology H Human I Immunodeficiency V Virus Etiology Pathogen 人免疫缺陷病毒 (HIV) (human immunodeficiency virus)∶HIV-1、HIV-2 Etiology 人免疫缺陷病毒 (human immunodeficiency virus,HIV) HIV-1、HIV-2 Etiology 透膜糖蛋白 包膜蛋白 逆转录酶 核酸蛋白 HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus HIV病毒破坏人体免疫系统 HIV infected CD4 HIV 生 活 周 期 急性期 HIV RNA 潜伏期 艾滋病期 Anti-Ab Anti-gp41/120 (anti-gp36) Anti-Ag Anti-P24 1周 2周…..1月 2月………………….1年 窗口期 2年 3年…………….10年……….. HIV抗原、抗体变化图 感染 死亡 Epidemiology 1985-2004年9月全国历年报告HIV/AIDS情况 30000 25000 20000 15000 10000 5000 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 AIDS 1 0 2 0 0 2 3 5 23 29 52 38 126 136 230 233 714 1028 6120 9620 HIV(+) 5 1 9 7 171 299 216 261 274 531 1567 2649 3343 3306 4677 5201 8219 9732 21691 29623 年 份 0 *上述数据为当年各省报告数汇总,本次筛查中有所变动,尚需根据筛 查情况不断调整。 中国1985年发现艾滋病的省份 中国1989年发现艾滋病的省份 中国1995年发现艾滋病的省份 中国1998年发现艾滋病的省份 截至2004年底全国累计报告HIV感染者按地理分布 The geographic distribution of cumulative reported HIV cases in China by the end of 2004 HIV cases 感染者数 1-50 51-100 101-500 501-1000 1001-10000 10001-20000 >20000 HIV prevalence in adults in Asia, 1990−2005 截至2004年底全国累计报告HIV感染者传播途径构成 Modes of transmission among HIV/AIDS cases by the end of 2004 血液/血制品 母婴传播 MTCT Blood and Blood products 0.9% 2.8% Not clear 不详 17.9% Commercial blood 采血 and plasma Donation 26.8% 静注毒品 IDU 43.2% 异性/同性 Heterosexual/MSM 8.3% 截至2004年底全国累计报告HIV感染者按性别分布 Proportions of male and female reported HIV cases in China by the end of 2004 Male 男 71.6% 不详 Not clear 0.5% 女 Female 27.8% Distribution of HIV Infections by Age 30-39岁 34.6% 40-49岁 15.6% 20-29岁 34.7% 〈2 0 岁 5.3% 不详 1.9% >50岁 7.9% HIV Transmission Brief Statistics on the HIV/AIDS Epidemic in China By the end of September 2004, • Cumulative reported HIV infections: 89,067 • Cumulative reported AIDS cases: 20,786 • Cumulative reported AIDS deaths: 5,024 China CDC and WHO estimated: • People Living with HIV/AIDS: 840,000 • AIDS patients: 80,000 Geographic Distribution of Cumulative Reported HIV Infections in China (1985-2004.9) HIV感染者数 1-100 101-500 501-1000 1001-5000 5001-10000 >10000 Features of the HIV/AIDS Epidemic in China The epidemic is characterized by a wide disparity between high and low prevalence regions The epidemic is becoming more severe The main HIV transmission route is through injecting drug use. The number of AIDS-related deaths is increasing HIV is spreading from high risk groups to the general population The proportion of female HIV cases are increasing Epidemiology 传染源 • 病人 • 无症状HIV携带者 – ☆HIV存在于∶ 血液 唾液 精液 眼泪 阴道分泌物 乳汁 Modes of Transmission SEXUAL ACTIVITY BLOOD-TO-BLOOD CONTACT VERTICAL TRANSMISSION Routes of Transmission of HIV Sexual Contact: Male-to-male Male-to-female or vice versa Female-to-female Blood Exposure: Injecting drug use/needle sharing Occupational exposure Transfusion of blood products Perinatal: Transmission from mom to baby Breastfeeding HIV Transmission • HIV enters the bloodstream through: – Open Cuts – Breaks in the skin – Mucous membranes – Direct injection HIV Transmission • Common fluids that are a means of transmission: – Blood – Semen – Vaginal Secretions – Breast Milk HIV in Body Fluids Blood 18,000 Semen 11,000 Vaginal Fluid 7,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids Epidemiology 传播途径 • 性接触 –同性恋 –异性恋 • 注射 –不洁注射 •输血及血制品 •母--婴 •其他 HIV Transmission: Sexual Transmission Highest risk activities Unprotected anal intercourse Unprotected vaginal intercourse Oral sex ? Condom efficacy: Consistent and correct use HIV and Sexually Transmitted Diseases HIV and Sexually Transmitted Diseases STDs increase infectivity of HIV – A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding – More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection HIV and Sexually Transmitted Diseases • STDs increase the susceptibility to HIV – Ulcerative and inflammatory STDs compromise the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV – Ulcerative STDs include: syphilis, chancroid, and genital herpes – Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis HIV and Sexually Transmitted Diseases • The effect of HIV infection on the immune system increases the the risk of STDs A suppressed immune response due to HIV can: • Increase the reactivation of genital ulcers • Increase the rate of abnormal cell growth • Increase the difficulty in curing reactivated or newly acquired genital ulcers • Increase the risk of becoming infected with additional STDs 艾滋病与性病相伴 HIV Transmission: Blood-to-Blood Contact Injecting drug users (IDUs) who share needles Recipients of contaminated blood products Healthcare workers with occupational exposure 静脉 注射毒品 Health Care Worker Risks Exposure By Health Care Categories Nurse 63% Housekeeping 3% Resp. Therapist 2% Phlebotomist 8% Lab Technician 10% Physician 14% Health Care Worker Risks Exposure by Type Needlesticks 79% Open Wound 6% Mucous Membranes 6% Cuts with Sharps 9% HIV Transmission: Vertical Transmission Transplacental transmission Intrapartum transmission Transmission through breast milk HIV Transmission: Perinatal transmission (mother-to-child transmission ) • Many children are infected perinatally; About 30-40 percent of babies born to infected mothers will be infected • They receive the infection from their mothers – during pregnancy, – at the time of birth – through breastfeeding. Perinatal transmission HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus Window Period • This is the period of time after becoming infected when an HIV test is negative • 90 percent of cases test positive within three months of exposure • 10 percent of cases test positive within three to six months of exposure HIV Infection and Antibody Response ---Initial Stage---- ---------------Intermediate or Latent Stage-------------Flu-like Symptoms Or No Symptoms Symptom-free ---Illness Stage--- AIDS Symptoms ---- Virus Antibody Infection Occurs ---< 6 month ~ Years ~ Years ~ Years ~ Years Symptoms and signs EARLY SYMPTOMS OF HIV INFECTION • a flu-like illness within a month or two after exposure to the virus. This illness may include – – – – Fever Headache Tiredness Enlarged lymph nodes (glands of the immune system easily felt in the neck and groin) • These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids. 临床表现 潜伏期∶2-10年 1期 急性HIV感染 2期 无症状HIV感染 3期 持续性全身性 淋巴结肿大综合征 4期 艾滋病 —— CDC关于HIV感染的分 类 AIDS 3期 持续性全身性 淋巴结肿大综合征 persistent generalized lymphadenopathy (PGL) 2期 无症状HIV感染 1期 急性HIV感染 临床表现 • 艾滋病 – 全身性症状∶发热、乏力、不适、盗汗、厌食、 消瘦、腹泻 – 神经症状∶+头痛、癫痫、痴呆、瘫痪 – 机会性感染∶结核杆菌、病毒等感染、寄生虫、 真菌、 – 恶性肿瘤∶卡波济肉瘤、淋巴瘤 – 其他∶慢性淋巴性间质性肺炎 Symptoms of opportunistic infections • • • • • • • • • • • Coughing and shortness of breath Seizures and lack of coordination Difficult or painful swallowing Mental symptoms such as confusion and forgetfulness Severe and persistent diarrhea Fever Vision loss Nausea, abdominal cramps, and vomiting Weight loss and extreme fatigue Severe headaches Coma 临床表现 • 消瘦综合征 • 卡氏肉瘤 临床表现 • 病毒感染∶ – 带状疱疹 • Herpes Zoster 临床表现 • Human Papiloma Virus感染∶疣 临床表现 • 寄生虫----隐孢子虫感染 Cryptosporidiosis • 真菌----孢子丝菌病 各系统临床表现 [一] 1.呼吸系统 • 卡氏肺孢子虫(肺囊虫)肺炎 • 肺结核 • 巨细胞病毒感染 • 真菌性肺炎 • 卡氏肉瘤 Pneumocystis carinii grossly in lung 卡氏肺囊虫肺炎 CMV inclusions in lung 巨细胞病毒肺炎 肺部弓形虫感染 Toxoplasmosis 各系统临床表现 [二] 2.消化系统 • 口腔与食道炎 • 口腔毛状白斑 • 感染性腹泻 • 肛周、直肠疱疹病毒感染 • 肝损害 小肠隐孢子虫感染 Cryptosporidiosis 肝脏组织浆胞菌感染(Histoplasmosis ) 各系统临床表现 [三] 3.神经系统 • 机会性感染∶ 隐球菌脑膜炎等 • 机会性肿瘤∶原发性淋巴瘤等 • HIV直接感染∶痴呆综合征等 弓形虫脑脓肿 各系统临床表现 [四] 4.皮肤粘膜 • 卡氏肉瘤 • 念珠菌感染 • 外阴疱疹、 尖锐湿疣 (genital warts) 皮肤卡氏(Kaposi’s)肉瘤 各系统临床表现 [五] 5.眼部 • • • • 视网膜炎(CMV感染) 眼底棉絮状白斑(CMV感染) 弓形虫脉络膜炎 卡氏肉瘤 Opportunistic Infections ("OIs"). Opportunistic Infections ("OIs"). Bacterial and Mycobacterial • • • • • Mycobacterium Avium Complex (MAC, MAI) Salmonellosis Syphilis and Neuroshyphilis Turberculosis (TB) Bacillary angiomatosis (cat scratch disease) Opportunistic Infections ("OIs"). Fungal Infections • • • • • Aspergillosis Candidiasis (thrush, yeast infection) Coccidioidomycosis Cryptococcal Meningitis Histoplasmosis Opportunistic Infections ("OIs"). Protozoal Infections • • • • • Cryptosporidiosis Isosporiasis Microsporidiosis Pneumocystis Carinii Pneumonia (PCP) Toxoplasmosis Opportunistic Infections ("OIs"). Viral Infections • • • • • • • • Cytomegalovirus (CMV) Hepatitis Herpes Simplex (HSV, genital herpes) Herpes Zoster (HZV, shingles) Human Papiloma Virus (HPV, genital warts, cervical cancer) Molluscum Contagiosum Oral Hairy Leukoplakia (OHL) Progressive Multifocal Leukoencephalopathy (PML) Malignancies • Kaposi's Sarcoma • Lymphoma -– Systemic Non-Hodgkin's Lymphoma (NHL) – Primary CNS Lymphoma DIAGNOSIS • By testing your blood for the presence of antibodies to HIV. • HIV antibodies generally do not reach noticeable levels in the blood for 1 to 3 months following infection. HIV Testing • Requires a blood or oral fluid sample • HIV test detects the body’s antibody response to HIV infection • The test does NOT detect the HIV virus HIV Testing • Those recently exposed should be retested at least six months after their last exposure • Screening test (EIA/ELISA) vs. confirmatory test (IFA) EIA/ELISA (Reactive) Repeat EIA/ELISA (Reactive) IFA (Reactive) Positive for HIV HIV Testing EIA/ELISA Test Positive Negative No HIV Exposure Low Risk Repeat Positive HIV Exposure High Risk Negative Repeat ELISA Every 3 months for 1 year Repeat every 6 months for continued High risk behavior End Testing Negative Positive Indeterminate Repeat at 3 weeks Run IFA Confirmation Negative Repeat at 2-4 months Positive HIV + 全国艾滋病筛查实验室分布图(截至2003年12月) 56 检疫系统 164 军队系统 201 81 59 54 28 59 37 62 9 40 106 9 1 32 Lanzhou Tianjin 39 263 51 80 30 截至2003年12月,全国已经通 过验收的艾滋病筛查实验室 总数为2382个,其中CDC系统 700个,医院系统966个,检疫 系统164个,军队系统201个, 性防系统87个,计生5个,妇 幼系统92个,其它系统167个。 80 25 86 147 92 18 85 72 34 273 10 全国艾滋病确认实验室分布图(截止2004年10月) Haerbin Changchun Urumchi Shenyan g Huhehaote Beijing Tianjin baoding Taiyuan Yinchuan Xining Jinan Lanzhou Lanzhou Tianjin Xian Nanjing Zhengzhou Lhasa Shanghai Hefei Wuhan Chengdu Hangzhou Chongqing Changsha 图例 防疫站 35 检疫局 11 医院 3 医科院 2 Nanchang Guiyang Fuzhou Kunming Nanning Guangzhou 军科院 1 参比室 1 Haikou Treatment of AIDS 关于抗HIV – 至今无特效药 现有药物只能抑制病毒复制,停药后病毒可恢复复制。 – 新的HIV/AIDS治疗方案 早期联合用多个逆转录酶和蛋白酶抑制剂,使血中HIV病毒含量降至 最低,可使患者得以长期存活。(改良治疗方法) – 联合用药----cocktail(鸡尾酒)疗法 两种或两种以上药物合用,可选两种逆转录酶抑制剂如AZT, DDI, DDC,3TC和D4T中的两种(AZT不能和D4T合用--有拮抗作用),再加一 种蛋白酶抑制剂。 Treatment of AIDS • 药物治疗 –抗HIV药物的应用:highly active antiretroviral therapy, or HAART. –免疫治疗 –治疗各种机会感染和肿瘤 highly active antiretroviral therapy ( HAART) • Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS. • HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. • Researchers, however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated. Goals of Antiretroviral Therapy (ART) • Eradication of HIV? Not possible with currently available antiretroviral medications ART Goals & Tools to Achieve Them • Improvement of quality of life • Reduction of HIV-related morbidity and mortality • Restoration and/or preservation of immunologic function • Maximal and durable suppression of viral load • Selection of ARV regimen • Preservation of future treatment options • Rational sequencing of therapy • Maximizing adherence • Use of resistance testing in selected clinical settings nucleoside reverse transcriptase inhibitors (NRTI) nucleoside analogs: – – – – – – – – AZT (Azidothymidine) ddC (zalcitabine) ddI (dideoxyinosine) d4T (stavudine) 3TC (lamivudine) Abacavir (ziagen) Tenofovir (viread) Emtriva (emtricitabine) non-nucleoside reverse transcriptase inhibitors (NNRTIs) • Delavridine (Rescriptor) • Nevirapine (Viramune) • Efravirenz (Sustiva) (in combination with other antiretroviral drugs) protease inhibitors (PI) interrupt the virus from making copies of itself at a later step in its life cycle. They include • Ritonavir (Norvir) • Saquinivir (Invirase) • Indinavir (Crixivan) • Amprenivir (Agenerase) • Nelfinavir (Viracept) • Lopinavir (Kaletra) • Atazanavir (Reyataz) • Fosamprenavir (Lexiva) PIs interrupt the virus from making copies of itself at a later step in its life cycle. fusion inhibitors • Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with HIV-1's ability to enter into cells by blocking the merging of the virus with the cell membranes. Current Antiretroviral Medications PI NRTI • • • • • • • • Abacavir Didanosine Emtricitabine Lamivudine Stavudine Zidovudine Zalcitabine Tenofovir ABC DDI FTC 3TC D4T ZDV DDC TDF NNRTI • Delavirdine • Efavirenz • Nevirapine DLV EFV NVP • • • • • • • • Amprenavir Atazanavir Fosamprenavir Indinavir Lopinavir Nelfinavir Ritonavir Saquinavir APV ATV FPV IDV LPV NFV RTV SQV – soft gel – hard gel – tablet SGC HGC INV • Tipranavir TPV Fusion Inhibitor • Enfuvirtide T-20 Initial Treatment for Previously Untreated Patients: Choosing Regimens • Three categories: – 1 NNRTI + 2 NRTIs – 1 PI + 2 NRTIs – 3 NRTIs • Few clinical endpoints to guide choices • Advantages and disadvantages to each type of regimen • Individualize regimen choice Initial Treatment: Preferred Regimens NNRTI-Based # pills /day 2-5 Efavirenz* + (lamivudine or emtricitabine) + (zidovudine or tenofovir) PI-Based Lopinavir/ritonavir (Kaletra) + (lamivudine or emtricitabine) + zidovudine 8-10 *Avoid in pregnant women and women with high pregnancy potential. Side effects • The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. • In addition, protease inhibitors can interact with other drugs resulting in serious side effects. • Fuzeon may also cause severe allergic reactions such as pneumonia, trouble breathing, chills and fever, skin rash, blood in urine, vomiting, and low blood pressure. Local skin reactions are also possible since it is given as an injection underneath the skin. Control of HIV Transmission Prevention Body Fluids to which Universal Precautions Apply BLOOD SEMEN VAGINAL SECRETIONS AMNIOTIC FLUID PLEURAL FLUID PERITONEAL FLUID PERICARDIAL FLUID CEREBROSPINAL FLUID SYNOVIAL FLUID Body Fluids to which Universal Precautions need not Apply * SALIVA BREAST MILK (?) FECES URINE NASAL SECRETIONS SPUTUM SWEAT TEARS VOMITUS (*) UNLESS THEY CONTAIN VISIBLE BLOOD HIV Infection Control HOSPITAL-BASED MEASURES Heat sterilization (autoclaving) Various antiseptic products HIV Infection Control HOUSEHOLD AVAILABLE PRODUCTS Clorox bleach (undiluted) Hydrogen peroxide (undiluted) Alcohol (various types) Thorough use of soap and water Can I get HIV from casual contact (shaking hands, hugging, using a toilet, drinking from the same glass, or the sneezing and coughing of an infected person)? • Answer: No. • HIV is not transmitted by day-to-day contact in the workplace, schools, or social settings. 以预防为主。 ——毛主席语录 PREVENTION --- FIRST! HIV Risk Reduction • Avoid unprotected sexual contact • Use barriers such as condoms and dental dams • Limit multiple partners by maintaining a long-term relationship with one person • Talk to your partner about being tested before you begin a sexual relationship HIV Risk Reduction • Avoid drug and alcohol use to maintain good judgment • Don’t share needles used by others for: Drugs Tattoos Body piercing • Avoid exposure to blood products Condoms Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV Condoms = Safer sex Condoms ≠ Safe sex Condom Use • Should be used consistently and correctly • Should be either latex or polyurethane • Should be discussed with your partner before the sexual act begins • Should be the responsibility of both partners for the protection of both partners • Male and female condoms are available “When you have sex with someone, you are having sex with everyone they have had sex with for the last ten years.” Former Surgeon General C. Everett Koop 预 防(1) •广泛宣传和普及HIV/AIDS的常识 •切断各种传播途径,包括严禁毒品,卖淫嫖娼等 预 防(2) • 控制医源性感染,重点是献血员的管理 • 暴露后预防∶建议用AZT次/d;DDC 0.75次/d(或3TC次/d) 加上一种蛋白酶抑制剂如indinavir, 三种药联合应用4~6周。 • 疫苗? HIV Post Exposure Prophylaxis HIV Occupational Exposure • Review facility policy and report the incident • Medical follow-up is necessary to determine the exposure risk and course of treatment • Baseline and follow-up HIV testing • Four week course of medication initiated one to two hours after exposure • Liver function tests to monitor medication tolerance • Exposure precautions practiced Chinese President Hu Jintao shakes hands with an AIDS patient in a Beijing hospital on Nov. 30, 2004. On December 1st 2003, Premier Wen Jiabao and Vice Premier Wu Yi went to Beijing Ditan Hospital to meet AIDS patients and health workers “Four Frees and Care” Free ARV drugs to AIDS patients who are rural residents or people with financial difficulties living in urban areas; Free Voluntary Counseling and Testing (VCT); Free drugs to HIV infected pregnant women to prevent mother-to-child transmission, and HIV testing of newborn babies; Free schooling for children orphaned by AIDS; Care and economic assistance to the households of people living with HIV/AIDS. 政策--“四免一关怀” Policy – Four Frees and One Care • 在全国范围内为自愿接受艾滋病咨询检测的人员免费提供咨询 和初筛检测; Free Voluntary Counseling and Testing (VCT) • 对农村居民和城镇未参加基本医疗保险等医疗保障制度的经济 困难人员中的艾滋病病人免费提供抗病毒治疗药物; Free ARV drugs to AIDS patients who are rural residents or people with financial difficulties living in urban areas • 为感染艾滋病病毒的孕妇提供免费母婴阻断药物及婴儿检测试 剂; Free ARV drugs to HIV infected pregnant women to prevent mother-to-child transmission, and HIV testing of newborn babies 政策--“四免一关怀” Policy – Four Frees and One Care • 对艾滋病病人的孤儿免收上学费用; Free schooling for children orphaned by AIDS • 将生活困难的艾滋病病人纳入政府救助范围,按照国家有关规定 给予必要的生活救济。积极扶持有生产能力的艾滋病病人开展生 产活动,增加其收入。 Care and economic assistance to the households of people living with HIV/AIDS World AIDS Day What is World AIDS Day? • World AIDS Day is observed annually on December 1 to strengthen global efforts to address the challenges of the AIDS pandemic that continues to spread throughout every region of the world. • The World Health Organization (WHO), supported by the United Nations General Assembly, declared December 1 as World AIDS Day in 1988. With the creation of UNAIDS in 1996, World AIDS Day was remodeled as a campaign to build on the momentum created by the international day, and to encourage more concerted and sustained responses to the epidemic. 12月1日 世界艾滋病日 妇联“面对面” 宣传 全面宣传 Comprehensive AIDS Campaign “Face-to-face” Education by Women Federation • 多部门参与预防艾滋病宣传,如教委 、妇联等 Multi-sector participation of AIDS Campaign 学生知识竞赛 Knowledge test 上街宣传 Street campaign by students 全面宣传 Comprehensive AIDS Campaign 多种形式并用(电视、报纸、海报、 标语等) Multiple formats (TV, newspapers, posters, banners) 400万套宣传海报发到每村、校 、社区。 4 million copies of AIDS posters for each village, school and community in the country. 文艺和体育界名人 Celebrities in Sports, Literary and Art Circles 文艺和体育界名人通过他们的名人 效应在艾滋病宣传和动员方面起到 了很大的作用。 Celebrities in literary and art circles have played an important role in publicizing HIV/AIDS knowledge and mobilizing HIV/AIDS-related activities. Thank you ! The End (or is it The Beginning?) FDA-approved Drugs • Entry and Fusion Inhibitors • Non-nucleoside Reverse Transcriptase Inhibitors • Nucleoside Reverse Transcriptase Inhibitors • Opportunistic Infection and Other Drugs Protease Inhibitors