Current Status of the HIVAIDS Epidemic

1
Current Status of the HIV/AIDS Epidemic

• Hail M. Al-Abdely, MD
• Consultant, Infectious Diseases

2
History of HIV/AIDS
3
History of HIV Infection

• 1926
• Some scientists believe HIV spread from monkeys
  to humans between 1926 - 1946.
• Recent research indicates HIV most probably first
  jumped from chimpanzees to humans as early as
  1675 and didn't establish itself as an epidemic
  strain in Africa until 1930

4
History of HIV Infection

• 1959
• A man died in the Congo in what was the first
  proven AIDS death. Nature (02/05/98) Vol. 391,
  No. 6667, P. 594
• 1978
• Gay men in the US and Sweden -- and heterosexuals
  in Tanzania and Haiti -- begin showing signs of
  what will later be called AIDS.

5
History of HIV Infection

• 1981
• CDC (USA) notices an alarming rate of a rare
  cancer (Kaposi's Sarcoma) in otherwise healthy
  gay men. They first called the disease "gay
  cancer" but soon rename it GRID ("gay-related
  immune deficiency").
• 422 cases diagnosed in the U.S. 159 are dead.

6
History of HIV Infection

• 1982
• CDC (USA) links the new disease to blood.
• The term AIDS ("acquired immune deficiency
  syndrome") is used for the first time.
• The Gay Men's Health Crisis is founded in New
  York City.
• 1,614 cases of AIDS diagnosed in the U.S. 619
  are dead..

7
History of HIV Infection

• 1983
• CDC (USA) warns blood banks of a possible problem
  with the blood supply.
• Institut Pasteur (France) finds the virus (HIV).
• 4,749 cases of AIDS in the U.S. 2,122 are dead.

8
History of HIV Infection

• 1984
• Dr. Robert Gallo (US) claims he discovered the
  virus that causes AIDS however, this is about a
  year after the French discovery.
• 11,055 cases of AIDS diagnosed in the U.S. 5,620
  are dead.

9
History of HIV Infection

• 1985
• The FDA (US) approves the first HIV antibody
  test. Blood products begin to be tested in the US
  and Japan.
• The first International Conference on AIDS is
  held in Atlanta (US).
• 22,996 cases of AIDS diagnosed in the U.S.
  12,592 are dead.

10
History of HIV Infection

• 1987
• AZT (zidovudine, Retrovir) -- Glaxo Wellcome --
  becomes the first anti-HIV drug approved by the
  FDA.
• The recommended dose was one 100mg capsule every
  four hours around the clock.
• 71,176 AIDS cases diagnosed in the U.S. 41,027
  people are dead.

11
History of HIV Infection

• 1991-1994
• ddI (didanosine, Videx), ddC (zalcitabine,
  Hivid), d4T (Zerit) were approved by the FDA.
• 478,756 AIDS cases diagnosed in the U.S. 288,597
  are dead

12
History of HIV Infection

• 1995-2000
• The era of Highly Active Anti-Retroviral Therapy
  (HAART).
• Understanding of Viral dynamics
• Effective prevention of perinatal transmission

13
UN/AIDS data on the global epidemicJune 2000
14
End-1999 global HIV/AIDS estimates Children and
adults

• People living with HIV/AIDS
• New HIV infections in 1999
• Deaths due to HIV/AIDS in 1999
• Cumulative number of deaths due to HIV/AIDS

34.3 million 5.4 million 2.8 million 18.8 million
15
About 15 000 new HIV infections a day in 1999

• More than 95 are in developing countries
• 1 700 are in children under 15 years of age
• About 13 000 are in persons aged 15 to 49 years,
  of whom
• almost 50 are women
• about 50 are 1524 year olds

16
End-1999 global HIV/AIDS estimatesChildren (lt15
years)

• Children living with HIV/AIDS
• New HIV infections in 1999
• Deaths due to HIV/AIDS in 1999
• Cumulative number of deaths due to HIV/AIDS

1.3 million 620 000 480 000 3.8 million
17
Leading causes of death globally, 1999
Rank of total

• 1 Ischaemic heart disease
• 2 Cerebrovascular disease
• 3 Acute lower respiratory infections
• 4 HIV/AIDS
• 5 Chronic obstructive pulmonary disease
• 6 Perinatal conditions
• 7 Diarrhoeal diseases
• 8 Tuberculosis
• 11 Malaria

12.7 9.9 7.1 4.8 4.8 4.2 4.0 3.0 1.9
Source The World Health Report 2000, WHO
18
Leading causes of death in Africa, 1999
Rank of total

• 1 HIV/AIDS
• 2 Acute lower respiratory infections
• 3 Malaria
• 4 Diarrhoeal diseases
• 5 Perinatal conditions
• 6 Measles
• 7 Tuberculosis
• 8 Cerebrovascular disease
• 9 Ischaemic heart disease
• 10 Maternal conditions

20.6 10.3 9.1 7.3 5.9 4.9 3.4 3.2 3.0 2.4
Source The World Health Report 2000, WHO
19
Adults and children estimated to be living with
HIV/AIDS as of end 1999
Eastern Europe Central Asia 420 000
Western Europe 520 000
North America 900 000
East Asia Pacific 530 000
North Africa Middle East 220 000
South South-East Asia 5.6 million
Caribbean 360 000
sub-Saharan Africa 24.5 million
Latin America 1.3 million
Australia New Zealand 15 000
Total 34.3 million
20
Children (lt15 years) estimated to be living with
HIV/AIDS as of end 1999
Eastern Europe Central Asia 15 000
Western Europe 4 100
North America 11 000
East Asia Pacific 5 200
North Africa Middle East 8 000
South South-East Asia 200 000
Caribbean 9 600
sub-Saharan Africa 1 million
Latin America 28 000
Australia New Zealand lt 200
Total 1.3 million
21
Estimated adult and child deaths due to
HIV/AIDSfrom the beginning of the epidemic to
end 1999
Eastern Europe Central Asia 21 000
Western Europe 210 000
North America 470 000
East Asia Pacific 52 000
North Africa Middle East 70 000
South South-East Asia 2.6 million
Caribbean 210 000
sub-Saharan Africa 14.8 million
Latin America 460 000
Australia New Zealand 6 600
Total 18.8 million
22
Estimated deaths in children (lt15 years) due to
HIV/AIDS from the beginning of the epidemic to
end 1999
Eastern Europe Central Asia 5 000
Western Europe 3 000
North America 5 000
East Asia Pacific 2 900
North Africa Middle East 6 000
South South-East Asia 440 000
Caribbean 24 000
sub-Saharan Africa 3.3 million
Latin America 24 000
Australia New Zealand lt 100
Total 3.8 million
23
Estimated adult and child deaths from HIV/AIDS
during 1999
Eastern Europe Central Asia 8 500
Western Europe 6 800
North America 20 000
East Asia Pacific 18 000
North Africa Middle East 13 000
South South-East Asia 460 000
Caribbean 30 000
sub-Saharan Africa 2.2 million
Latin America 48 000
Australia New Zealand lt 200
Total 2.8 million
24
Estimated deaths in children (lt15 years) from
HIV/AIDS during 1999
Eastern Europe Central Asia lt 500
Western Europe lt 100
North America lt 100
East Asia Pacific 900
North Africa Middle East 1 000
South South-East Asia 44 000
Caribbean 2 900
sub-Saharan Africa 430 000
Latin America 3 600
Australia New Zealand lt 100
Total 480 000
25
Estimated number of adults and childrennewly
infected with HIV during 1999
Eastern Europe Central Asia 130 000
Western Europe 30 000
North America 45 000
East Asia Pacific 120 000
North Africa Middle East 20 000
South South-East Asia 800 000
Caribbean 60 000
sub-Saharan Africa 4.0 million
Latin America 150 000
Australia New Zealand 500
Total 5.4 million
26
Estimated number of children (lt15 years) newly
infected with HIV during 1999
Eastern Europe Central Asia 500
Western Europe lt 500
North America lt 500
East Asia Pacific 2 400
North Africa Middle East 2 000
South South-East Asia 86 000
Caribbean 4 000
sub-Saharan Africa 515 000
Latin America 6 800
Australia New Zealand lt 100
Total 620 000
27
Cumulative number of children estimated to have
been orphaned by AIDS at age 14 or youngerat
the end of 1999
Eastern Europe Central Asia 500
Western Europe 9 000
North America 70 000
East Asia Pacific 5 600
North Africa Middle East 15 000
South South-East Asia 850 000
Caribbean 85 000
sub-Saharan Africa 12.1 million
Latin America 110 000
Australia New Zealand lt 500
Total 13.2 million
Children who have lost their mother or both
parents to AIDS before the age of 15 years
28
A global view of HIV infection 33 million adults
living with HIV/AIDS as of end 1999
Adult prevalence rate
15.0 36.0 5.0 15.0 1.0 5.0
0.5 1.0 0.1 0.5 0.0 0.1
not available
29
Spread of HIV over time in Asia, 1984 to 1999
2.0 5.0 1.0 2.0 0.5 1.0
0.1 0.5 0.0 0.1 trend data
unavailable outside region
30
Estimated annual number of new HIV infections by
region, 1980 to 1999
New infections
31
Estimated number of people living with HIV/AIDS
by region, 1980 to 1999
People living with HIV/AIDS
32
Estimated adult HIV prevalence in Kenya,
1990-1999
16
14
12
10
HIV prevalence ()
8
6
4
2
0
90
91
92
93
94
95
96
97
98
99
Source National AIDS and STD Control Programme,
1999 and UNAIDS
33
HIV prevalence among pregnant womenin South
Africa, 1990 to 1999
25
22.8
22.4
20
17
14.2
15
HIV prevalence ()
10.4
10
7.6
5
4
2.1
1.7
0.7
0
90
91
92
93
94
95
96
97
98
99
Source Department of Health, South Africa
34
Impact of HIV/AIDS on urban households, Côte
dIvoire
General population
Families living with AIDS
30 000 Francs CFA
25 000
Monthly income per capita
20 000
15 000
Monthly consumption per capita
10 000
5 000
Savings/Disavings
0
5 000
Source Simulation-based on data from Bechu,
Delcroix and Guillaume, 1997
35
Reduction in production in a household with an
AIDS death, Zimbabwe

• Crops
• Maize
• Cotton
• Vegetables
• Groundnuts
• Cattle owned

Reduction in output 61 47 49 37 29
Source Stover Bollinger, 1999
36
Projected population structure with and without
the AIDS epidemic, Botswana, 2020
80
Projected population structure in 2020
75
70
Males
Females
Deficits due to AIDS
65
60
55
50
Age in years
45
40
35
30
25
20
15
10
5
0
0
20
40
60
80
100
120
140
0
20
40
60
80
100
120
140
Population (thousands)
Source US Census Bureau, World Population
Profile 2000
37
Prevention Campaigns can be effective
38
HIV prevalence rate among 13 to 19-year-olds,
Uganda, 1989 to 1997
5
girls
4
boys
3
HIV prevalence ()
2
1
0
1989/90
1990/91
1991/92
1992/93
1993/94
1994/95
1995/96
1996/97
Source Kamali et al. AIDS 2000, 14 427-434
39
HIV prevalence rate among pregnant 15-24
year-olds by educational status, Uganda
Source Kilian A et al. AIDS 1999, 13 391-398.
40
Changes in life expectancy in selected African
countries with high HIV prevalence, 1950 to 2000
65
60
Botswana
Uganda
55
South-Africa
Life expectancy at birth, in years
Zambia
50
Zimbabwe
45
40
35
1950-55
1955-60
1960-65
1965-70
1970-75
1975-80
1980-85
1985-90
1990-95
1995-00
Source United Nations Population Division, 1998
41
HIV prevalence in military personnel in Africa

• Nigeria 11 among peacekeepers returning from
  Sierra Leone and Liberia vs 5 in adult
  population
• South Africa 60-70 in military vs 20 in adult
  population

Source Nigeria AIDS bulletin No 15, May 20,
2000 The Mail Guardian, Pretoria,
March 31, 2000 UNAIDS/WHO
1999 estimate
42
Trend in HIV prevalence in 21 year old military
conscripts in Thailand
Source Armed Forces Research Institute of
Medical Sciences, Thailand
43
I.V drug injection a growing problem in eastern
Europe
44
Proportion of all new HIV infections that are
in injecting drug users, selected countries,
1998-1999
100
90
80
70
60
Percentage
50
40
30
20
10
0
Canada
China
Latvia
Malaysia
Moldova
Russian
Ukraine
Viet Nam
Federation
Source National AIDS Programmes
45
Annual number of newly registered HIV infections,
Russia, 1993 to 1999
18,000
15,462
16,000
14,000
12,000
10,000
8,000
Number of HIV infections
6,000
4,399
3,947
4,000
1,546
2,000
108
158
196
0
93
94
95
96
97
98
99
Year of registration
Source Russian Federal AIDS Centre, Moscow
46
Heterosexual transmission is taking over even in
the West
47
Annual number of reported HIV infections in the
UK, by mode of transmission, 1983 to 1999
Source PHLS Communicable Disease Surveillance
Centre UK, July 2000
48
Effective therapy epidemiological effects
49
AIDS patients, AIDS deaths and patients on HAART
among homosexual men, San Francisco, USA, 1980 to
1998
Source San Francisco Department of Public Health
(California), USA, 1999
50
Trends in Age-Adjusted Rates of Death due to HIV
Infection, USA, 1982-1998
Using the age distribution of the projected
year 2000 US population as the standard.
Preliminary 1998 data
51
Annual number of deaths due to AIDS, Canada,
1990 to 1999
1600
1400
1200
1000
Number of AIDS deaths
800
600
400
200
0
90
91
92
93
94
95
96
97
98
99
Source Health Canada, HIV and AIDS in Canada.
Surveillance Report to December 31, 1999
52
The Middle-East Good luck with an accurate
data!
53
Estimates of HIV/AIDS Cases in the Middle-East-
end of 1999
54
Reported AIDS Cases in Saudi Arabia WHO data
Total 414
55
KFSH Experience
56
Number of New Patients Reported from KFSH
57
Sex Distribution
Total of 168 patients
58
Age Distribution - 1998
59
AIDS EpidemiologyKFSH Experience
60
Mode of Transmission
1993-1998
1985-1998
Others homosexual, bisexual, drugs, OTx,
Unknown
61
Source of Infection
62
Conclusion

• HIV epidemic continues to expand.
• Poorer countries are more affected with enormous
  detrimental consequences medically, socially and
  economically.
• HAART may lead to prolonged survival and larger
  pool of HIV infected patients.
• Our country is not immune against HIV, hence
  preventive measures need to be adopted with great
  emphasis on education.
• HIV is not going away any soon. Be prepared to
  manage HIV patients.