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

3 More Origins of HIV Unidentified Flying Objects (UFO’s) coming from space Unidentified Flying Objects (UFO’s) coming from space Is a biological weapon designed to kill non-whites. Is a biological weapon designed to kill non-whites. Came from domestic cats. (Feline AIDS is similar to Human AIDS) Came from domestic cats. (Feline AIDS is similar to Human AIDS) HIV Contaminated _______ vaccines. HIV Contaminated _______ vaccines.PolioSmallpoxTetanusHepatitis African Green Monkey African Green Monkey African People African People African Cattle, Pigs, Sheep African Cattle, Pigs, Sheep CIA and other spy agencies CIA and other spy agencies Biological Weapons Labs Biological Weapons Labs

4 Current Theory Hahn et al. (1999, 2000) Hahn et al. (1999, 2000) Simian virus closely related to HIV jumped from chimps to humans. Simian virus closely related to HIV jumped from chimps to humans. Virus then mutated into its current form. Virus then mutated into its current form. Evidence 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 Newer evidence indicates multiple jumpings – different strains

5 Example HIV Strains have 11 distinct subtypes 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. Virus mutates rapidly.

6 United States HIV History Virus has been in the US since mid. 1970’s. Virus has been in the US since mid. 1970’s. – –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.

Public Health begins using term Acquired Immunodeficiency Syndrome (AIDS) to describe opportunistic infections in previously healthy men. Public Health begins using term Acquired Immunodeficiency Syndrome (AIDS) to describe opportunistic infections in previously healthy men. –Including  Kaposi’s Sarcoma  Pneumocystis Carni Pneumonia Surveillance of AIDS begins 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 Definition modified in 1983 Required to be reported to CDC Required to be reported to CDC

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

Second type of HIV discovered 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 Screening tests become available Tests of stored blood samples indicate HIV was being transmitted in US and Europe in mid to late 1970’s. Tests of stored blood samples indicate HIV was being transmitted in US and Europe in mid to late 1970’s.

11 Early Definitions of AIDS Many definitions of AIDS Many definitions of AIDS Problem 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

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

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

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

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

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

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

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

19 Present HIV continues to mutate HIV continues to mutate –Currently getting HIV resistance to drugs People are returning to previous lifestyles 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 1. Drug Resistance 30% of newly infected individuals have viral forms that resistant to at least one drug. 30% of newly infected individuals have viral forms that resistant to at least one drug. Drug resistant strains are becoming more powerful Drug resistant strains are becoming more powerful Result – Salvage therapy 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 Are more powerful than previous strains Cause individuals who are doing well on drug cocktails to become ill again Cause individuals who are doing well on drug cocktails to become ill again Has caused us to reevaluate the issues of vaccines Has caused us to reevaluate the issues of vaccines Is going to become a real problem Is going to become a real problem

23 Conclusions and Issues

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

25 Problem Have forgotten the past Have forgotten the past STD rates are increasing again in some communities STD rates are increasing again in some communities number of males with new HIV infections increased 7.3% (CDC, 2003) 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 To stop the disease, must change the behavior. behavior. Is a system of numbers. 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 1/1001/10 1/4 1/2 1% 10%25% 50% 1% 10%25% 50%