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Introduction
This review will discuss two types of diseases that fall under communicable and non-communicable
disease
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They are usually caused by infectious microorganisms
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They are also known as chronic diseases
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It is a lentivirus that infects CD4+ lymphocytes
(responsible in initiating the adaptive immunity) which can lead to the collapse of the immune
system, allowing opportunistic organisms to cause significant infections
...

Cardiovascular disease (CVD) is a group of diseases that affect the heart and blood vessels
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A waxy substance, plaque, builds up within the arteries that
supply oxygen rich blood to the heart
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This plaque can harden and narrow the arteries supplying the heart, therefore,
causing decreased blood flow to the heart muscle
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This can later
lead on to a heart attack or even death (NIH 2014)
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Acute CHD occurs
from the sudden rupture of the plaque
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Another common
disease of blood vessels is stroke, which is also caused by a build-up of plaque in blood vessels that
supply the brain
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5 million lives of
AIDS-related cause in 2013 and total of 39 million since the first known case in mid-1900s
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1 million are newly
infected
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8%
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Sub-Saharan African is the most affected, which
accounts for 24
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Table 1: Adults and Children estimated to be living with HIV (Global HIV/AIDS Overview 2014)
The life expectancy of a person who started treatment at early stage could be as long as 70 years
old
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HIV cannot be cured,
however, the virus can be suppressed and the progression into AIDS can be prevented with
Antiretroviral Therapy (ART)
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9 million infected people are receiving the
treatment worldwide (WHO 2014a)
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ART) became more accessible
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The accessibility to ART also decreased the infection rate (UNAIDS
2013)
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2 million are children under 15 years old and 240000
are newly infected
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In 2013, about 67% of pregnant
women who were HIV-positive received ART, which decreases the possibility of the transfer of
HIV to their children
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In 2013, 344 HIV-positive individuals were newly

diagnosed, of which 75% are male and 25% are female
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The median age of newly diagnosed
people was 34 years old
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This is followed by heterosexual contact which accounted for 131 new
diagnoses
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Thirty-one of new diagnoses were of unknown
cause
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Forty-one percent of the new diagnoses were born in Ireland, while 51%
were born abroad (including sub-Saharan Africa, America, central, eastern and western Europe) and
8% were of unknown origin
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Most of new diagnoses were living in eastern Ireland
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Table 2 shows
the incidence of new diagnoses in HSE area
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Table 2: New HIV diagnoses by probable route of transmission and HSE area (HPSC 2014)

CVD Epidemiology

Global
Conferring to World Health Organisation (WHO), CVD is the number one cause of death
globally
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5 million people died of heart disease of which 7
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7 million were due to stroke
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Most of these deaths were common in low income and middle income countries
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The people who live in low income and middle income countries therefore die young
(WHO 2015)
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It is however more common amongst older adults
(65+ years)
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In Northern Ireland there was estimated to be around more than 107,000 adults (18+) who were
dignosed with CHD
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Table 4
excludes those affected with CHD but were never diagnosed
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Table 4: Percentage of adults (18+) with CHD
in NI (IPH 2012)


Table 3: Percentage of adults (18+) with CHD
in ROI (IPH 2012)





HIV Risk Factors
HIV is a highly infectious organism, making everybody at all age group vulnerable to acquiring
HIV
...

•

Men who had sex with men
HIV infection continues to rise among MSM in most countries
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It was also
shown that unprotected is more common with MSM, which increases the chance of
infection
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•

People who inject drugs
It was reported that 158 countries have PWID and 78% of these countries have HIV
positive individuals who infect drugs
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7 million people worldwide were
injecting drugs, and 1
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The rates of HIV
transmission through this process is very high, and based on the study of 46 countries,

acquiring HIV is 22 times greater than the general population with drug injection and
needle sharing
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The prevalence of acquiring diseases (such as HIV, sexually transmitted infections,
hepatitis B/C and tuberculosis) in prison is two to ten times higher than the general
population
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The risk of acquiring HIV
is increased by activities, such as sexual activities/violence, drug injection and tattooing
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In some prisons, women have higher prevalence rate than men
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They have a high risk of
infection due to exposure to different sex partners and inconsistent use of condom
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In
sub-Saharan Africa, it was reported that women aged 15-24 living with HIV are two
times greater than young men
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Uncircumcised men
were found to increase the risk of infection and other STIs could lead to open sores into
the genitals that becomes an entry point for HIV (WHO 2014b)
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These include; unhealthy diet, physical inactivity,
tobacco use and alcohol abuse
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Also being overweight or obese poses a risk for developing heart disease and other
complications like heart failure
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There are risk factors however that cannot be changed such as;
increasing age, genetics and gender
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The major risk factors for CHD
are explained here;


•

Tobacco smoke

According to American Heart Association, ‘smokers risk of developing coronary heart
disease is 2-4 times that of non-smoker’s’
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The risk of heart disease is even
increased in non-smoker’s who inhale smoke from smokers
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High density
lipoproteins (HDL) and low density lipoproteins (LDL) are two main components of
cholesterol that are measured in relation to determining risk of CHD
...
On the other
hand HDL, the good cholesterol, is better in high levels and low levels are associated
with higher risk of CHD
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•

High blood pressure

Under pressure this causes the heart to increase its workload thereby stiffening the
muscle
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•

Physical Inactivity and obesity

Excess body fat- especially around the middle- is associated with increased risk of heart
disease and stroke
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•

Diabetes


This is a major risk factor for cardiovascular disease and around 65% of people with diabetes die of
heart or blood vessel disease
...
Traditionally HIV testing was
performed using serology to diagnose a patient and confirmed using western blot, current laboratory
diagnosis of HIV employs the use of algorithms to increase the sensitivity and specificity of their
testing methodologies
...
Ideally these screening tests should report 2 separate HIV infection
associated parameters (e
...
p24 and anti-HIV Abs) and then confirmed using (Nucleic acid
amplification testing) NAATs
...
It (NAAT) also allows the degree of viraemia to be quantified
...


Figure 2: this is a model of an algoritm employed in laboratories for the diagnosis of HIV

The sensitivity and specificity of the ELISA assays in recent years has allowed for earlier detection
of HIV infection
...
The current 4th
generation assay which detect both HIV antigens and anti HIV Abs has the highest detection rates
when compared to previous assay generations, this improvement has shortened the infectious

window periods
...
Roper W L et al (2013)

Table 5: this table demonstrates the detection sensitivity of different assays as well as showing
window periods associated with false negative results
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The primary target
of the HIV virus is the CD4 T cells population
...
The
virus infects CD4 and CD8 T cells but the CD4 Lymphocyte Lineage does not have the same
regenerative capacity as the CD8 lineage
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Thus quantification of the CD4:CD8 ratio is important in
classification of the disease (i
...
AIDS) as well as providing information on the patients’ response to
treatment for HIV
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They have
advantages in that they provide an answer with a rapid turnaround time; they indirectly provide the
patient with their HIV serostatus and have applications external to the laboratory
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POCT lends itself particularly to areas and regions with minimal or reduced
access to cold chain or central labs, thus the HIV POCT circumvents the need for centralized testing in
areas of the developing world
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6-6
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Currently up to 4% of
American hospital Emergency departments utilize HIV POCT routinely
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Pilcher C D et al (2013) Stekler J D et al (2009)

Figure
3:
this
is
an
example
of
HIV
POCT
...



Lab measures/ Biomarkers of Cardiovascular disease:
In the prediction of the chance of developing Cardiovascular disease specific substances found in
blood are measured
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(www
...
org 2014)
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The lipid profile is composed of a measurement of a
few lipids including; Total cholesterol, Low Density Lipoprotein Cholesterol (LDL-Cholesterol),
high density Lipoprotein Cholesterol (HDL Cholesterol) and Triglycerides
...
2 mmol/L
...
4
mmol/L, LDL cholesterol concentration when increased in blood can result in fatty deposit
formation on the inner wall of an artery resulting in a condition known as atherosclerosis that would
bring about further complications leading to heart failure or a stroke
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6 mmol/L or greater
...

Triglycerides, usually elevated when an individual eats too many calories than the body needs
which puts the person at greater risk of developing cardiovascular disease
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7 mmol/L
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1 mmol/L or lower is considered as the “optimal” concentration”,
(www
...
org 2014)
...

According to the BBA journal in relation to heart failure, the B-type natriuretic peptide (BNP)
and the N-terminal pro BNP (NT-pro BNP) are considered to be the gold standard biomarkers of
diagnostic and prognostic value, (Gaggins H K, Jannuzi Jr 2013)
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The roles of these biomarkers has been only partly defined
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The BNP concentration produced in the normal
healthy state is about 10 pg/ml
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Both BNP
and NT-pro BNP have equal diagnostic value in suspected Heart Failure patients, (Gaggins H K,
Jannuzi Jr, 2013)
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The American Heart Association (AHA) suggests that the level of CRP can
be indicative of the risk of heart disease development
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0 mg\L

•

Average risk- CRP 1
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0 mg\L

•

High risk- CRP >3
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mayoclinic
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Insulin like growth factor 1 (IGF-1) is being studied as a potentially useful marker of Heart failure
in children and young adults following a Fontan Palltation procedure
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Age & Gender dependant Z scores were determined from the data collected
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Additional test/ assessments can be performed to assess the risk of cardiovascular disease
development
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In addition to a lipid panel glucose measurement to
assess risk of diabetes which can contribute to cardiovascular disease development,
(www
...
ie)
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A general consensus
about the global epidemic is that combination approaches is the best mode of action; behavioral,
structural and biomedical interventions
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Vaccination could be an option but not in the case of HIV
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As well as that the virus does not retain its antigenicity when processed for vaccine
development making vaccines an unsuitable prevention candidate for HIV at the present time
...

Thus combination intervention strategies provide the most viable option in curtailing the spread of the
virus
...
g
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Combination
prevention programs can be implemented at the individual, community and population levels and its
use is recommended by UNAIDS
...
UNAIDS (2013)

Figure 4: demonstrates the various interventions that would help prevent the spread of HIV

HIV is linked to human behavior and its spread is associated with risky practices and behaviors, by far
the most common is sexual practices that increase transmission
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UNAIDS (2013)WHO (2014b) As these are reward
practices (psych) and provide gratification to the individuals, changing these particular habits is
difficult but could be modified to safer alternatives if they so wished to continue in those practices
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Kalichman S C (2003)
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Permeation of the infection can be found in a proportion of the population who has not received
testing
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Stigmas associated with HIV have allowed unfair and degrading laws to be put in place to penalize
those who have HIV, these include laws on travel and stay to and within certain countries
...
But conversely
the laws about HIV seroprevalence should be enforced to make it mandatory for an individual to
disclose their status and are often done so, with criminal penalties for those who knowingly infected
other
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These include punitive laws on petty drug use and same sex relationships
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Increasing public
awareness of the risk factors for cardiovascular disease and the complications involved
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Risk factors to be avoided should be clearly stated such as to avoid smoking
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Control of fat intake, avoid the foods high in cholesterol/LDL-cholesterol and
keep salt intake as moderate as possible (not more than 5g a day)
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Weight and BMI should be
monitored as being overweight or obese places the individual at a greater risk of developing
cardiovascular disease
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Screen for
lipids in blood, perform electrocardiography and measurement of glucose to assess the possibility of
diabetes which contributes to the development of cardiovascular disease
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lifelinescreening
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patient
...
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...
2014
...

[ONLINE] Available
at: http://www
...
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...
[Accessed 31 January 15]
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Usefulness of Insulin like Growth Factor 1 as a Marker of Heart
Failure in Children and Young Adults after the Fontan Palliation Procedure
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14, 2323-6
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ncbi
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nih
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Dimmock, N J, Easton, A J and Leppard, K N (2007) Introduction to Modern Virology, 6th ed,
Blackwell Publishing, Oxford
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Biomarkers and diagnostics in heart failure
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1832/12, 2442-50
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sciencedirect
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Global HIV/AIDS Overview (2014) The Global HIV/AIDS Epidemic [Online]
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aids
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2012
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[ONLINE] Available
at:http://chronicconditions
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info/sites/all/libraries/tinymce/files/CHRONIC_CONDI
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[Accessed 31 January 15]
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HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and
testing in a black township in Cape Town, South Africa
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79, 442–447
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bmj
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2014
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[ONLINE] Available
at:http://www
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ie/What-We-Do/What-We-Screen-For/Heart-Disease-RiskAssessment
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Manson JE, Bassuk SS, 2014
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Clinical and Experimental, [Online]
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Available
at: http://www
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nlm
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gov/pubmed/25487190[Accessed 26 January 2015]
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2014
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nhlbi
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gov/health/health-topics/topics/cad
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Patient
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Preventing Cardiovascular Disease
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patient
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Pilcher C D et al (2010) Public Health Rationale for Rapid Nucleic Acid or p24 Antigen Tests for
HIV, The Journal of Infectious Diseases, 201(S1), pp
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Available at:
WWW
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1-8 [Online]
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plosone
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Roper W L et al (2013) Detection of Acute HIV Infection in Two Evaluations of a New HIV
Diagnostic Testing Algorithm — United States, 2011–2013, Centers for Disease Control and
Prevention
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Morbidity Mortality Weekly Report
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498-512 [Online]
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cdc
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html#weekly
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Stekler J D et al (2009) HIV Testing in a High-Incidence Population: Is Antibody Testing Alone
Good Enough?, Clinical Infectious Diseases, 49(), pp
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Available at:
http://cid
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Available:
http://www
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int/mediacentre/factsheets/fs360/en/ [Accessed 25 January 2015]
WHO (2014b) Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for
Key Population, WHO, Geneva
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