HIV/AIDS HIV HUMAN IMMUNODEFICIENCY VIRUS INFECTION AIDS ACQUIRED IMMUNE DEFICIENCY SYNDROME

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1 SESSION SIX

2 HIV/AIDS

3 HIV/AIDS HIV HUMAN IMMUNODEFICIENCY VIRUS INFECTION AIDS ACQUIRED IMMUNE DEFICIENCY SYNDROME

4 HIV/AIDS A SPECTRUM OF CONDITIONS CAUSED BY INFECTION WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV). FOLLOWING INFECTION, THE PATIENT MAY BE ASYMPTOMATIC, BUT AS THE INFECTION PROGRESSES, INCREASINGLY DAMAGING THE IMMUNE SYSTEM, THE PATIENT SUFFERS FROM A VARIETY OF INFECTIONS SUCH AS TB AND INFECTIONS NOT CAUSING DISEASE IN NORMAL PTS. (OPPORTUNISTIC INFECTIONS)

5 OPPORTUNISTIC INFECTION AN INFECTION CAUSED BY A MICROBE NOT NORMALLY ABLE TO CAUSE DISEASE IN PERSONS WITH NORMAL IMMUNITY. GERMS CAUSING THESE INFECTIONS ARE FREQUENTLY FUNGI.

6 HIV/AIDS THERE ARE TWO TYPES OF THE VIRUS, HIV-1 AND HIV-2. HIV-1 IS THE MORE VIRULENT AND IS ASSOCIATED WITH THE VAST MAJORITY OF CASES. HIV-2 IS RESTRICTED TO WEST AFRICA

7 HIV/AIDS THE VIRUS ATTACKS AND KILLS A SUBSET OF LYMPHOCYTES (CD4, OR HELPER T CELLS), RESPONSIBLE FOR MAINTAINING IMMUNITY AGAINST FOREIGN ANTIGENS. INITIALLY, ANOTHER SET OF T LYMPHOCYTES, CD8 CELLS, ATTACKS THE INFECTED CD4 CELLS, KILLING MANY OF THE VIRUSES, BUT EVENTUALLY THE VIRUS WINS OUT, AND CD4 CELLS DROP IN NUMBER. THE LEVEL OF CD4 CELLS MIRRORS THE SEVERITY OF THE DISEASE.

8 ORIGINS OF HIV/AIDS BOTH VIRUSES PROBABLY RESULTED FROM MUTATIONS IN SIMIAN IMMUNODEFICIENCY VIRUSES (SIV), OCCURRING IN CAMEROON. SIV IS KNOWN TO OCCUR IN HUMANS EATING OR DEALING IN BUSHMEAT, AND IT IS ASSUMED THAT THE TRANSMISSION OF HIV OCCURRED IN THE EARLY 20 TH CENTURY. IN RETROSPECT, IT IS THOUGHT THAT THE DISEASE WAS PRESENT AT THAT TIME, BUT NOT RECOGNISED AS SUCH.

9 HIV/AIDS TRANSMISSION SEXUAL CONTACT MOST COMMON-EITHER HOMO-OR HETEROSEXUAL TRANSFUSION OF BLOOD OR BLOOD PRODUCTS NEEDLE INJECTIONS MOTHER TO CHILD ( INTRAUTERINE OR THROUGH BREAT MILK)

10 HIV/AIDS HISTORY AIDS WAS FIRST RECOGNISED AS SUCH IN THE U.S. IN 1981, IN A CLUSTER OF IV DRUG USERS AND GAY MEN. THEY PRESENTED WITH A RARE PROTOZOAL OPPORTUNISTIC INFECTION (PNEUMOCYSTIS PNEUMONIA) AND A RARE CANCER INVOLVING THE SKIN PREVIOUSLY SEEN PRIMARILY IN ITALIAN MEN (KAPOSI S SASRCOMA). IT WAS FIRST UNOFICIALLY CALLED 4H DISEASE, THEN GRID,( GAY-RELATED IMMUNODEFICIENCY DISEASE). ONCE IT WAS RECOGNISED THAT IT WAS NOT RESTRICTED TO GAY MEN, THE TERM AIDS WAS COINED.

11 THE FOUR Hs HOMOSEXUALS HAITIANS HEROIN ADDICTS HEMOPHILIACS

12 HIV/AIDS HISTORY FIRST CLINICALLY OBSERVED IN THE U.S. IN 1981 IN GAY MEN AND I.V. DRUG USERS IN 1983, RESEARCH GROUPS IN THE U.S., HEADED BY ROBERT GALLO, AND IN FRANCE, HEADED BY LUC MONTAGNIER, INDEPENDENTLY ISOLATED A VIRUS FROM INFECTED PATIENTS. GALLO S GROUP CALLED IT HTLV-III (HUMAN T LYMPHOTROPHIC VIRUS III) AND MONTAGNIER S GROUP CALLED IT LAV (LYMPHADENOPATHY-ASSOCIATED VIRUS) SINCE IT WAS SUBSEQUENTLY FOUND THAT BOTH VIRUSES WERE THE SAME, THE VIRUS WAS RENAMED HIV (HUMAN IMMUNODEFICIENCY VIRUS

13 HIV/AIDS THE DIAGNOSIS IS MADE BY EITHER NOTING CINICALLY THE CHARACTERISTIC COMPLICATIONS IN THE ACTIVE STAGE OF THE DISEASE, OR BY TESTING FOR ANTIBODIES TO THE HIV. THE DISEASE IS MONITORED BY TESTING THE ABSOLUTE NUMBER OF CD4 T LYMPHOCYTES IN THE BLOOD.OF PATIENTS INFECTED

14 HIV/AIDS IN AFRICA MOST HEAVILY AFFECTED REGION (ASIA SECOND) ABOUT 2/3 OF ALL CASES (22.9 MILION) 5% OF ALL POPULATION AFFECTED RESPONSIBLE FOR 10% OF ALL DEATHS IN CHILDREN OVERALL LIFE EXPECTANCY IN SEVERAL COUNTRIES AFFECTED

15 HIV/AIDS IN THE U.S. AS OF 2016, ABOUT 675,000 HAVE DIED OF THE DISEASE SINCE THE BEGINNING OF THE EPIDEMIC OVER 1.2 MILLION PEOPLE NOW INFECTED, 20% OF WHOM ARE UNAWARE OF THEIR DISEASE

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17 HIV/AIDS A PANDEMIC AS OF 2016, THERE WERE ABOUT 36.7 MILLION PEOPLE AFFECTED, WITH ABOUT 1.8 NEW CASES ANNUALLY, DOWN FROM 3.1 MILLION IN SLIGHTY OVER ½ OF THE CASES WERE IN WOMEN AND 2.1 MILLION IN CHILDREN. DEATHS IN 2016 WERE 1 MILLION, DOWN FROM 1.8 MILLION IN 2005

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22 FAMOUS PEOPLE DYING OF AIDS ROCK HUDSON ANTHONY PERKINS LIBERACE ALVIN AILEY ROY COHN GIA CARANGI (FASHION MODEL) PERRY ELLIS (FASHION DESIGNER) ARTHUR ASHE ISAAC ASIMOV RYAN WHITE

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28 HIV/AIDS EFFORTS IN PREVENTION USE OF CONDOMS VAGINAL GELS MALE CIRCUMCISION DISTRIBUTION OF STERILE NEEDLES TO ADDICTS SCREENING OF BLOOD AND BLOOD PRODUCTS ABSTINENCE THERE IS NO EFFECTIVE VACCINE

29 HIVAIDS TREATMENT IN RECENT YEARS, A NUMBER OF ANTI-VIRAL MEDICATIONS HAVE BEEN FOUND TO TREAT AIDS. NONE OF THEM AFFECT A CURE, BUT THEY ARE EFFECTIVE IN IMPROVING SYMPTOMS AND PROLONGING LIFE. A MAJOR PROBLEM HAS BEEN PROVIDING INEXPENSIVE DRUGS TO THE POOR, PARTICULARLY OVERSEAS. PROGRESS IN MAKING A VACCINE HAS BEEN SLOW AND DISAPPOINTING.

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31 THE FUTURE IN THE BATTLE BETWEEN MAN AND MICROBE

32 ON MANKIND S SIDE MEDICAL ADVANCES GENETIC MANIPULATION OF GERMS AND VECTORS DEVELOPMENT OF NEW ANTIMICROBIALS AND VACCINES MASS VACCINATION PESTICIDES PRIVATYE FUNDING FOR MEDICAL RESEARCH

33 ON MICROBES SIDE GLOBAL CLIMATE CHANGE HUMAN ENCROACHMENT ON ANIMAL HABITAT WAR THREAT OF GERM WARFARE HUMAN MASS MIGRATION ANTI-VACCINATION MOVEMENT MASS HIGH SPEED INTERCONTINENTAL MOVEMENT, BOTH TOURISTIC AND COMMERCIAL

34 ON MICROBES SIDE POVERTY POLITICAL HOSTILITY BETREEN COUNTRIES EMERGENCE OF RESISTANT STRAINS OF ORGANISMS LACK OF ORGANISED MOTIVATION AND FUNDING FOR MEDICAL RESEARCH INADEQUATE/ INEFFECTIVE TREATMENTS INADEQUATE MEDICAL INFRASTRUCTURE CUTURAL HABITS AND TABOOS LACK OF EDUCATION

35 WHO WILL WIN????