HIVAIDS 1981

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HIV/AIDS1981 - ????
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Origins

• first report June 5th 1981
• five gay men with rare pneumonias inSan Francisco

• originally called GRID
• then more cases in thefour Hs
  homosexuals,Haitians, heroin users,haemophiliacs
  it was not a gay plague

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Symptoms

• mild, flu-like symptoms 1-2 weeks post-infection
  (acute HIV)
• dormancy period (up to 10 years) with no outward
  symptoms
• then opportunistic infections
• e.g. Kaposis Sarcoma

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more opportunistic diseases

• pneumocystis pneumonia (PCP)
• tuberculosis (TB)
• toxoplasmosis (parasitic)
• ultimately
• severe weight loss, dementia, death

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What causes AIDS?

• the HumanImmunodeficiencyVirus (HIV)
• actually two HIVs HIV1 and HIV2(latter
  almostconfined to West Africa)
• its a lentivirus (slow-acting)

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What does HIV do?

• invades T-cells inthe immune system(lymph and
  blood)
• uses T-cells tomake new copies of itself
• virus then floods the system and invades new
  cells
• eventually, immune system fails

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How do you get HIV?

• sharing needles / blood transfusions
• unprotected sexual activity
• perinatal transmission
• there are avoidable RISK FACTORS

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Where did HIV come from?

• geographically central Africa
• biologically monkeys (SIV)
• how when did it cross to humans?

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The facts and figures

• 33 million people have HIV
• 2.1 million die each year(25 million total since
  1981)
• 75 of deaths are in Africa
• 2.5 million infections occur annually
• global morbidity rate 0.8
• mortality rate c.100

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2008 global HIV and AIDS estimates Children (lt15
years)

• Children living with HIV 2.0 million
• New HIV infections in 2008 370 000
• Deaths due to AIDS in 2008 270 000

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Regional variations

• HUGE!
• high profile in USA and Russia
• but vast majority of cases in LEDCs
• especially sub-Saharan Africa

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A global view of HIV infection 33 million people
3036 million living with HIV, 2008
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PeoplelivingwithHIV
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Over 7400 new HIV infections a day in 2008

• More than 96 are in low/middle income countries
• About 1000 are in children under 15
• About 6300 are in adults aged over 15 yearsof
  whom
• almost 50 are among women
• about 45 are among young people (15-24)

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Adults and children estimated to be living with
HIV, 2008
Eastern Europe Central Asia 1.5 million
Western Central Europe 730 000
North America 1.2 million
East Asia 740 000
Middle East North Africa 380 000
Caribbean 230 000
South South-East Asia 4.2 million
Sub-Saharan Africa 22.0 million
Latin America 1.7 million
Oceania 74 000
Total 33 million
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Estimated number of children (lt15 years) newly
infected with HIV, 2008
Total 370 000
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Changes in population structure Ghana and Lesotho
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Projected total number of HIV infections in
various population groups, Jakarta, Indonesia,
20002020
IDUs with HIV
Wives of IDU with HIV
Other heterosexuals infected with HIV in a chain
originating with IDU
Number of HIV infections
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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Number of people receiving antiretroviral drugs
in low- and middle income countries, 2002-2007
3.0
2.8
Millions
2.6
2.4
2.2
2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
end- 2002
end- 2004
end- 2003
end- 2005
end- 2007
end- 2006
Year
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Scale up of antiretroviral coverage over time
select group of generalized and concentrated
epidemic countries, 2004 to 2007
100
2004
2005
2006
2007
80
Percent Coverage
60
40
20
0
Kenya
Malawi
Nigeria
Angola
Zambia
Uganda
Namibia
Rwanda
Thailand
Ethiopia
Lesotho
Viet Nam
Swaziland
Papua New Guinea
Côte d'Ivoire
Mozambique
Central African Republic
United Republic of Tanzania
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Cure?

• NONE exists (and no vaccine), despite 25 years of
  research
• treatment HAART (highly active antiretroviral
  therapy)
• huge advances in recent years but HAART remains
  costly
• life expectancy up from 10 to about 25 years

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HIV prevalence in a shanty town in Kampala, Uganda
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Long-term epidemiology

• slow onset
• long latency period
• stigma associated with transmission
• serious global problem! HIV/AIDS has killed 25
  MILLION PEOPLE
• 68 MILLION may be dead by 2030