HIVAIDS

1
HIV/AIDS

• Human Immunodeficiency Virus
• Acquired Immunodeficiency Syndrome

2
AIDS is Caused by HIV

• Is the one common denominator within a range of
  populations.
• Has been identified by electron microscopy.
• Antibodies, viral antigens, and HIV RNA have been
  found in HIV-Positive and AIDS patients.
• Many others

3
More Origins of HIV

• Unidentified Flying Objects (UFOs) coming from
  space
• Is a biological weapon designed to kill
  non-whites.
• Came from domestic cats. (Feline AIDS is
  similar to Human AIDS)
• HIV Contaminated _______ vaccines.
• Polio
• Smallpox
• Tetanus
• Hepatitis
• African Green Monkey
• African People
• African Cattle, Pigs, Sheep
• CIA and other spy agencies
• Biological Weapons Labs

4
Current Theory

• Hahn et al. (1999, 2000)
• Simian virus closely related to HIV jumped from
  chimps to humans .
• Virus then mutated into its current form.
• Evidence
• Genes from all four SIVcpz isolates cluster to
  their subspecies or origin
• Pan Troglodytes Troglodytes - West Africa
• Pan Trogldytes Scheinfurthii - East Africa
• All known HIV-1 strains cluster with W. Africa
  Chimp viruses
• Evidence of genetic recombination among SIVcpz
  strains of the Troglodytes lineage.
• Newer evidence indicates multiple jumpings
  different strains

5
Example

• HIV Strains have 11 distinct subtypes
• A-K
• Subtype B is dominant in US and Europe
• Subtype D is dominant in Africa
• Virus mutates rapidly.

6
United States HIV History

• Virus has been in the US since mid. 1970s.
• 1979-1981
• Physicians in New York and Los Angeles began
  reporting particular diseases in Gay males.
• Including
• Rare Pneumonias
• Cancers
• Other diseases
• Diseases were not usually found in people with
  healthy immune systems.

7
1982

• Public Health begins using term Acquired
  Immunodeficiency Syndrome (AIDS) to describe
  opportunistic infections in previously healthy
  men.
• Including
• Kaposis Sarcoma
• Pneumocystis Carni Pneumonia
• Surveillance of AIDS begins
• Diagnosis of cellular immune deficiency
• Absence of an underlying cause
• Reduced resistance to the disease

8
HIV Surveillance

• Definition modified in 1983
• Required to be reported to CDC

9
1983

• First cases of AIDS in heterosexuals are
  documented.
• Virus is isolated by various labs.
• Named
• HTLV-III (Human T-Lymphotrophic Virus-III)
• (Gallo)
• LAV (Lymphadenopathy Associated Virus)
• (Luc Montagnier Mont-Tan-Ya)
• ARV (AIDS Related Virus)
• Ultimately named
• HIV (Human Immunodeficiency Virus)
• (Sub-committee of the Committee on the
  Taxonomy of
• Viruses

10
1985

• Second type of HIV discovered
• HIV-2
• Related to SIV
• Not as related to HIV-1
• Does not seem as harmful as HIV-1
• Reproduces slower than HIV-1
• Screening tests become available
• Tests of stored blood samples indicate HIV was
  being transmitted in US and Europe in mid to late
  1970s.

11
Early Definitions of AIDS 1981-93

• Many definitions of AIDS
• Problem
• Social Security Administration (SSA)
• Used AIDS definition to determine disability
• Symptoms were based on opportunistic infections
  in men.
• Result
• 65 of women were excluded
• Other problems too

12
1993

• New definition of AIDS
• Emphasized the importance of T4 lymphocyte
  counts.
• Added other diseases
• System becomes simpler
• Also allowed one to become diagnosed with AIDS
  but remain symptom-free of diseases.

13
1987

• First case of HIV-2 in the U.S.
• First Anti - HIV drugs become available
• Zidovudine (AZT)

14
1988

• Protease Inhibitors are identified.
• Have problems with
• Absorption
• Have rapid liver metabolism
• Insolubility
• Result More development and clinical trials.

15
1992

• Protease Inhibitors (PI) become more developed
• First - Saquinavir Mesylate (Invirase)
• Was used in combination with other drugs
• Minimal clinical trial data
• Had poor absorption
• Was the least potent of other PIs that came on
  the market later.
• Second Ritonavir (Norvir)

16
More Protease Inhibitors are Developed

• Saquinavir (Fortovase)
• More easily absorbed by the body
• Indinavir (Crixivan)
• Most often used
• Nelfinavir (Viracept)
• Amprenavir (Agenerase)
• ABT 378 (Kaletra)
• Problem
• Drugs are expensive 450-700/month
• 5,400 - 8,400/yr

17
2000

• Drug Combinations (Cocktails)
• Uses multiple combinations of drugs
• Called Highly Active Antiretroviral Therapy
• (HAART)

18
2001

• Negotiations to reduce costs
• Generics are developed by outside countries
  despite patent laws.
• Is a major problem
• Costs go down
• Drug companies reevaluate staying in the HIV drug
  market
• When do you use (early vs. later)

19
Present

• HIV continues to mutate
• Currently getting HIV resistance to drugs
• People are returning to previous lifestyles
• Drugs are effective at helping people
• Can work
• Enjoy life

20
Also

• People are not taking drug combinations so they
  effectively block the virus
• Monotherapy
• People also stop taking drugs when they do not
  have money
• People stop taking drugs when they are feeling
  better
• People who are infected are having sex with other
  infected individuals
• Has spread into the IDU community which is
  spreading it into the general heterosexual
  population.
• Result

21
1. Drug Resistance

• 30 of newly infected individuals have viral
  forms that resistant to at least one drug.
• Drug resistant strains are becoming more powerful
• Result Salvage therapy
• Give everything you can
• 30-50 of HIV infected persons are in such
  therapy.

22
2. New Strains

• Are more powerful than previous strains
• Cause individuals who are doing well on drug
  cocktails to become ill again
• Has caused us to reevaluate the issues of
  vaccines
• Is going to become a real problem

23
Conclusions and Issues
24
HIV is a Unique Disease

• Affects mostly young and middle aged adults.
• Are sexually active
• Are in their prime productive and reproductive
  years
• Impact is demographic, economic, political, and
  social.

25
Problem

• Have forgotten the past
• STD rates are increasing again in some
  communities
• 1999-2002 number of males with new HIV infections
  increased 7.3 (CDC, 2003)
• Among MSMs increased 17

26
HIV Is A Preventable Disease

• To stop the disease, must change the
• behavior.
• Is a system of numbers.
• More people in a population that have it,
• The greater the likelihood YOU (or your
  offspring) will get it.
• 1/100 vs. 10/100 vs. 25/100 vs. 50/100
• 1/100 1/10 1/4 1/2
• 1 10 25 50