the history of hiv presentation with notes_2009

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2009licensed under a Creative Commons Attribution 3.0

The History of HIV

With thanks to Sarah Gamble, Raeleen Thompson and Rachel Parmee

Many think HIV is under control - is not-Africa-Thailand-India

-NZ

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AIDS ‘discovered’ in 1983

• HIV-1 and subtypes– World wide epidemic– ? From chimpanzees

• HIV-2– Less virulent– ? Sooty Mangabeys

HIV ‘discovered’ in 1983

23 years ago (2006)

Click one•Hiv1 and subtypes- now ww epidemic•Probably from chimpanzees- pan troglodytes troglodytes•Once very common in west-central africa•Interesting that chimps share large percentage of dna with humans- @97%•Probably the virus has crossed from one primate species to another b4 infecting humans, and may have crossed into the human population more than once. This may account (in part) for the presence of different viral strains

•Click 2•Less virulent•Sooty manabeys are probable vector•Beginning too spread outside west africas but much smaller presence than hiv1

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Where did HIV come from?

• Simian Immunodeficiency Virus (SIV)

• Zoonosis – Cats & Sheep• Animal Person

Person. – Avian flu– Chicken flu– Ebola virus– Marburg filovirus

Simian – SIV causes an AIDs like disease in some species of monkeyCats get feline immunodeficiency virus (FIV)Sheep get Visna virus – causes pneumoniaEbola and Marburg are haemorraghic fever

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How did HIV spread to Humans?

• Fighting and slaughter seems to have spread SIV• Monkeys and apes kept as pets• Monkeys were butchered for meat• A result of medical science

– Polio vaccines: implications for xenotransplantation

The polio link- theory been circulating since early 1990sEdward Hooper identified that a polio vaccine developed by Hilary Koprowski from the Winstar institute in Philadelphia was the source of HIVArgued that this vaccine, administered in Central Africa in the late 1950s was cultured from primates with a type of SIV, which subsequently infected humansThe “common sense” appeal of this theory relies on timing – administration of the vaccine 1957- 1960 coincided with the first confirmed case of HIV infection in Africa (Detected from blood stored in 1959 in Kinshasa).Three research groups have subsequently conucted independent analysis on the remaining stocks of the vaccine in Europe and the US . Findings are that there is nothing to support the theory, and that neirhte was there any evidence of SIV or HIV in the samples or any chimpanzee DNAThey were also able to determine that all of the WIstar samples wre grown in monkey cell cultures rather than chimapanzee cell cultures


Theories..

• HIV -1 and HIV -2 may have been in humans for 25 -100 years

• Believed that that HIV crossed the species barrier and lead to the current epidemic somewhere between 1940-1960, but others says 1910 and 1940 (Korber, 2000)

• Vandamme, (2000) says that HIV -1 appeared to separate from its closest monkey-virus relative in 1800, and HIV -1 group M emerged in about 1930

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How did HIV spread to Humans?

• HIV does not cause AIDS– Lifestyle, poor nutrition, effects of drugs

immunosuppression• Most evidence strongly links HIV with AIDS

Aquired Immunodeficiency Syndrome – Karposis Sarcoma and Opportunist infections PCP


1970’s- rapid spread of HIV

• From isolated rural disease to urban epidemic– Large scale urbanisation– Greater access to transport– Increase in sexual freedom

Image: urban landscape

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Sero-archeology

• 1959– Blood sample from man in Zaire

• 1968– 15 year old African American youth

• 1976– Norwegian sailor and family

• 1930’s and 1940’s ??

1959 – blood sample kept and analysed in 1998 1930s suspected but not verified

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1980s

• 1981- first reports of gay men in US with opportunist infections, unusual cancers

• ? Cause CMV (cytomegalovirus), drug taking ‘immune overload’

• MSM (men having sex with men) first affected• Then IVDU (Intravenous drug users) affected

Image by Jonrawlinson

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1982

• Up till now the illness was still un-named• Haemophiliacs affected• Called AIDS (Aquired Immune Deficiency Syndrome)• Death of child following blood transfusion• ? Mother child transmission• No longer ‘gay epidemic’

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1983• Heterosexual spread• Africa- ?Slim• People at risk asked

not to donate blood• Epidemic of Fear

– ‘killer blood’– ‘gay plague’– ‘the killer in the

village’ • ? Spread through casual contact• LAV (lymphadenopathyassociated virus)isolated in France

GRID4 HsChild isolated from school

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1984

• “Patient Zero”• HTLV-III (human T cell lymphotrophic virus) isolated

USA• “we hope to have a vaccine…in about two years”• LAV = HLTV-III • First case reported in NZ

Centre for Disease Control (CDC) in 1981 traced the sexual contacts of a small group of 40 patients suffering from Karposis Sarcoma and Pneumocystis carinii pneumonia ( PCP) All cases could be traced to the single index case called Patient Zero, a French Canadian flight attendant Gaetan Dugas. Not first to show symptoms of HIV –was the centre of a cohort.

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Public Reaction

• Disbelief

• Fear

• Blame

Examples

Florence Nightingale’s era Disease is product of sin – She said environment – Change in attitudes – Challenged the church

DVD – 1.02-1.06

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1985

• Blood tests- antibodies found• Social/ethical issues around testing• WHO- international action• Prejudice- ‘innocent victims’• Paramedics won’t resuscitate• ‘Common cup’ fear• Breastfeeding transmission?• First report in China

Confidentiality meaning of a positive test informed consent food counselling and confidentiality – insurance companies,employers,schools

First report in China – now world wide

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1986

• Illegal discrimination against nurse• AZT (azidothymidine) had affect against virus• First real hope for cure• 38,401 cases of AIDS, mostly USA

Hospital dismissed nurse with AIDS and refused to offer another job. First case against employer discriminationPlacebo all died –only one who had AZT – Trial stopped – unethical not to treat.

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1987

• Public figures touched AIDS sufferers• Major advertising campaigns• 1:61 NYC babies HIV+• HIV+ people refused entry to USA

Rock Hudson President Reagan


1988-1990s

• Period of relative quiet• $millions spent on research• $$drugs, restricted access• Hope that AIDS will become ‘treatable’ rather than ‘fatal’• Romanian orphanages and hospitals• HIV in China- ‘aizibing’• Magic Johnson• Major progress- combination drugs

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1990s

• AIDS- leading cause of death US males 25-44yo• Triple combination therapy effective• Safer sex new cases• More new drugs side effects• 1:100 aged 15-49 affected worldwide• 1:10 of those affected know• Nearly half of deaths are women and children

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1998-2000

• Improvements in health related to drug use• Drug costs cut• Trial of vaccine• Fourth biggest killer worldwide• ? Vaccination may late onset AIDS• 33,000,000 people around world affected

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2000 plus…

• Female to female transmission• No effective vaccine yet• Women equal to men in infections• World Bank loan for Russia• Vatican report and WHO response

Vatican Don’t use condoms Virus can still get through – WHO vs


2000 plus… cont’d

• Reduction in drug prices• Free drugs in some areas• 14000 new HIV infections daily• 40,000,000 total estimated number of people living with

HIV/AIDS• “3 by 5” programme• Media coverage

3 million being treated by 2005 in poor countries - WHO

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AIDS in New Zealand

• 1984– first person diagnosed in NZ– 523 people with AIDS

• 1986-1989– Numbers rise rapidly then decline

• December 2000– 729 people with AIDS- 687 m, 42 f– 1478 people HIV+- 1270 m, 189 f

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Who is affected in New Zealand?

• Adult men• No particular ethnic group• MSM• North of North Island

• New Zealand Strategies– Prevention– monitoring

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Future Issues- HIV and AIDS

• Current statistics• Stigma and discrimination• Drug resistance• Vaccination• AIDS, HIV and TB

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the history of hiv presentation with notes_2009

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