A pdf of a presentation with notes

1. The History of HIV
With thanks to
Sarah Gamble, Raeleen Thompson and Rachel
Parmee
2009
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Many think HIV is under control - is not
-Africa
-Thailand
-India
-NZ
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2. AIDS ‘discovered’ in 1983
• HIV-1 and subtypes
– World wide epidemic
– ? From chimpanzees
• HIV-2
– Less virulent
– ? Sooty Mangabeys
2009
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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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3. Where did HIV come from?
• Simian Immunodeficiency
Virus (SIV)
• Zoonosis – Cats & Sheep
• Animal Person
Person.
– Avian flu
– Chicken flu
– Ebola virus
– Marburg filovirus
2009
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Simian – SIV causes an AIDs like disease in some species of monkey
Cats get feline immunodeficiency virus (FIV)
Sheep get Visna virus – causes pneumonia
Ebola and Marburg are haemorraghic fever
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4. 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
2009
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The polio link- theory been circulating since early 1990s
Edward Hooper identified that a polio vaccine developed by Hilary Koprowski from the
Winstar institute in Philadelphia was the source of HIV
Argued that this vaccine, administered in Central Africa in the late 1950s was cultured
from primates with a type of SIV, which subsequently infected humans
The “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 DNA
They were also able to determine that all of the WIstar samples wre grown in monkey
cell cultures rather than chimapanzee cell cultures
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5. 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
2009
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6. 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
2009
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Aquired Immunodeficiency Syndrome – Karposis Sarcoma and Opportunist infections
PCP

7. 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
2009
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8. 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 ??
2009
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1959 – blood sample kept and analysed in 1998
1930s suspected but not verified
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9. 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
2009
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10. 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’
2009
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11. 1983
• Heterosexual spread
• Africa- ?Slim
• People at risk asked
not to donate blood
• Epidemic of Fear
– ‘killer blood’
– ‘gay plague’
– ‘the killer in the
• ? Spread through casual contact
village’
• LAV (lymphadenopathy
associated virus)isolated in France
2009
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GRID
4 Hs
Child isolated from school
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12. 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
2009
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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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13. Public Reaction
• Disbelief
• Fear
• Blame
2009
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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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14. 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
2009
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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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15. 1986
• Illegal discrimination against nurse
• AZT (azidothymidine) had affect against virus
• First real hope for cure
• 38,401 cases of AIDS, mostly USA
2009
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Hospital dismissed nurse with AIDS and refused to offer another job. First case against
employer discrimination
Placebo all died –only one who had AZT – Trial stopped – unethical not to treat.
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16. 1987
• Public figures touched AIDS sufferers
• Major advertising campaigns
• 1:61 NYC babies HIV+
• HIV+ people refused entry to USA
2009
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Rock Hudson
President Reagan

17. 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
2009
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18. 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
2009
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19. 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
2009
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20. 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
2009
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Vatican Don’t use condoms Virus can still get through – WHO vs

21. 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
2009
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3 million being treated by 2005 in poor countries - WHO
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22. 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
2009
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23. Who is affected in
New Zealand?
• Adult men
• No particular ethnic group
• MSM
• North of North Island
• New Zealand Strategies
– Prevention
– monitoring
2009
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24. Future Issues- HIV and AIDS
• Current statistics
• Stigma and discrimination
• Drug resistance
• Vaccination
• AIDS, HIV and TB
2009
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