Epidemiology of HIV & TB Dr K. A. M. Ariyaratne, FPGIM, FSLCV Consultant Venereologist
Outline Global, regional and Sri Lankan • Epidemiology of HIV, • Epidemiology of TB • Epidemiology of HIV/TB co-infection
What is Epidemiology? • In Greek (Epi-"on or upon," Demos"people," logos, "the study of.“). ‘The study of what is upon the people’
• A branch of medical science that studies the distribution and determinants of disease in human populations
Epidemiology of HIV
Global Report on HIV - 2013 • 2.3 million New HIV infections in 2012 • 33% decline from 3.4 million in 2001
5 Source: UNAIDS Report 2013
More good news from the report 1. New HIV infections among children have declined by 52% since 2001 2. Around 9.7 million people living with HIV have access to ART in low and middle income countries. 3. HIV/TB related deaths in people living with HIV have fallen by 36% since 2004
Source: UNAIDS Report 2013
6
Estimated adult HIV prevalence, by WHO Region, 2010
Adults and children estimated to be living with HIV - 2012
Estimated HIV burden in the SouthEast Asia Region 2010
99% from 5 countries: India, Indonesia, Myanmar, Nepal and Thailand Source: WHO-HIV/AIDS in SEA Region: progress report 2011.
New HIV Infections 2001-2012
Myanmar
Reduction of New HIV Infections > 50 %
Cambodia
Source: UNAIDS Report 2013
10
New HIV Estimates for Sri Lanka as of end 2012 Adults + Children living with HIV - 3000 (2,000 -5,000) Children (0-14 years ) living with HIV - <100 Adult HIV prevalence (%) -< 0.1 % New Infections - <500 (<200- <1000) Source: UNAIDS Report 2013
Total HIV Reported Cases in Sri Lanka by 2nd Quarter 2013
Total reported number up to June 2013 is
1739 Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2013.
HIV Rate per 100,000 population by District (1987-2012) (N=1649)
New HIV case Rate by District in 2012 (N=187)
Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2012
Estimated Adult HIV prevalence in 2013
Estimated HIV prevalence in 2013 is
0.025%
Reported HIV Cases per year Up to end of 2012 Males
Females
Total 186
180
146 137 129 121 119 102 95 91
160 140 120 100 80
55
60 40 20
2 3
11 7 13
27
37
23 22 30
32
68 42
54 47 50
0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
N. of HIV cases reported
200
Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2012
Epidemiology of TB
Tuberculosis -Prehistoric Evidence
DNA evidence of TB present in the remains from the Neolithic era 9000 years ago. Source: Science Magazine
Robert Koch & Mycobacterium tuberculosis
Robert Koch
M. tuberculosis
Natural History of TB
TUBERCULOSIS – IN THE PAST
Notification of TB in England and Wales 1913 - 2004
Estimated TB incidence rates, 2011
Annually 54 million new TB infections & 8.8 million TB disease Source: WHO REPORT 20112| GLOBAL TUBERCULOSIS CONTROL
% of New TB cases with MDR-TB -2011
Countries that had notified at least one case of XDR-TB by the end of 2011
Source: WHO REPORT 20112| GLOBAL TUBERCULOSIS CONTROL
TB IN SRI LANKA TB Cases Estimated in 2012 13,383
TB Cases Detected 9,343 Source: NPTCCD
25.0
Hambantota Monaragala Matara Badulla Puttalam Nuwara Eliya Kurunegala Matale Mullaitivu Batticaloa Anuradhapura Polonnaruwa Ampara Gampaha Kandy Sri Lanka Galle Vavuniya Kegalle Ratnapura Kilinochchi Jaffna Kalutara Trincomalee Mannar Colombo
New TB cases/100,000 pop.
New TB Cases per 100,000 population by District 100.0 82.9
75.0 64.0
50.0
25.0 26.0 22.5 24.3 26.6 27.1 28.4 29.3 31.2 33.5 35.2 36.1 38.5 41.7 42.0 43.2 45.7 45.9 47.2 47.8 67.6
50.8 51.0
16.9
0.0
Source: NPTCCD
New TB Case Rate by District during 2012 (N=8507)
Source: NPTCCD
New TB cases Reported in Sri Lanka 2000-2012
Source: NPTCCD
MDR TB- SRI LANKA Year Number
2005
2006
2007
2008
2009
2010
2011
2012
2013*
16
16
8
8
4
8
12
5
4
MDR-TB Cases Since 2008
Anuradhapura Colombo
34%
Gampaha
18% 3% 6%
3% 3% 3%
12%
6%
3%
Jaffna Kalutara Kandy Kegalle
6%
Kurunegala
3%
Matara Ratnapura Trincomalee
Source: NPTCCD
Vavuniya
Epidemiology of HIV/TB Co-infection
Estimated HIV Prevalence in New TB Cases, 2011
Source: WHO REPORT 2012 | GLOBAL TUBERCULOSIS CONTROL
Incidence of HIV positive TB cases per 100,000 pop in South East Asia 77
80 60 40
Sri Lanka
<1 Timor-Leste
<1 Thailand
2.9 Nepal
<1 Myanmar
7.6
Maldives
9.2
Indonesia
<1 DPR Korea
0
<1
7.3 Bhutan
20
India
22
Bangladesh
Rate per 100,000
100
Source: HIV/AIDS in the South-East Asia Region: Progress Report 2011-WHO
New HIV case Rate by District during 2012 (N=187)
Source: NSACP
New TB Case Rate by District during 2012 (N=8507)
Source: NPTCCD
Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2013
HIV Prevalence Among TB Patients 2000 1800 1600 1400 1200 1000 800 600 400 200 0
1724 1566
1656
% HIV
1547 1543
1528 1332
1111
1233
889
0.11 0.00
0.00
0.06
0.13 0.00
0.13
0.08 0.08 0.00
1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00
% HIV Prevalence
No. of TB Patients tested
No tested
2000 2001 2002 2003 2004 2005 2006 2007 2009 2011 Source: HIV Sentinel Surveillance/NSACP
Summary of TB Data from HIV Clinics in Sri Lanka 2012 Number of PLHIV enrolled in HIV Care in 2012 149 Number of PLHIV On antiTB treatment at the diagnosis of HIV 4 (3%)
Number of PLHIV referred for TB screening 139 (96%)
9 Latent TB
4 Pul TB Smear +
1 Pul TB Smear -
5 Extra Pul TB
7%
3%
1%
4%
10 on INAH prophylasis therapy in 2012
Source: NSACP/SIM
Summary • HIV and TB will continue to be major Public Health challenges • Currently Sri Lanka is having low level HIV and TB epidemics • Need enhance surveillance to see emerging issues like MDR and XDR and HIV/TB coinfections
Acknowledgments • Dr Sudath Samaraweera, Dr Nirupama Pallewatta of NPTCCD
• Dr M.Y.M. Ajwath and Miss Nimali Magammana /SIM unit/NSACP