1A-Hagen

Center for AIDS Research at Emory University

Week One

The History of HIV/AIDS


Why is AIDS still so stigmatizing?

Because it taps into our deepest prejudices, fears and concerns:

Innocent vs. Guilty victims Association with sex and drugs Invisible infection lasting years Death by disfiguring disease Apparent incurability Health disparities Mystery of origin


The Origin of HIV

Kimberley Sessions Hagen, EdD Asst. Professor (Behavioral Science and Health Education)

Rollins School of Public Health of Emory University

Asst. Director Center for AIDS Research at Emory University (CFAR)

Director/Goddess

Vaccine Dinner Club; CFAR Network Pizza Party


What is the relationship between HIV and AIDS?

Where and how did the epidemic originate? Where didnt the epidemic come from? How many people have HIV / AIDS?

Questions that this lecture will address include:


The History of AIDS

James W. Curran, MD, MPH Dean

Rollins School of Public Health

Professor Department of Epidemiology, RSPH

Principal Investigator


Former Director Office of HIV/AIDS

Centers for Disease Control and Prevention


How was AIDS discovered? How was the fact that AIDS is a sexually

transmitted disease confirmed? Who got AIDS in the early years of the epidemic? When did HIV/AIDS become a global problem? What lessons have we learned from AIDS? What are the key areas to be addressed in the

future?

Questions that Dr. Currans lecture will address include:


The Origin of HIV


Acquired

What is AIDS?

Immune

Deficiency

Syndrome A condition characterized by a set of

symptoms and/or diseases that have a common root cause.


AIDS* =

Infected with HIV

+


1. Bacterial infections, multiple or recurrent* 2. Candidiasis of bronchi, trachea, or lungs 3. Candidiasis of esophagus 4. Cervical cancer, invasive 5. Coccidioidomycosis, disseminated or extrapulmonary 6. Cryptococcosis, extrapulmonary 7. Cryptosporidiosis, chronic intestinal (>1 month's duration) 8. Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month 9. Cytomegalovirus retinitis (with loss of vision) 10. Encephalopathy, HIV related 11. Herpes simplex: chronic ulcers (>1 month's duration) or bronchitis, pneumonitis, or esophagitis

(onset at age >1 month) 12. Histoplasmosis, disseminated or extrapulmonary 13. Isosporiasis, chronic intestinal (>1 month's duration) 14. Kaposi sarcoma 15. Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex* 16. Lymphoma, Burkitt (or equivalent term) 17. Lymphoma, immunoblastic (or equivalent term) 18. Lymphoma, primary, of brain 19. Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary 20. Mycobacterium tuberculosis of any site, pulmonary, disseminated, or extrapulmonary 21. Mycobacterium, other species or unidentified species, disseminated or extrapulmonary 22. Pneumocystis jirovecii pneumonia 23. Pneumonia, recurrent 24. Progressive multifocal leukoencephalopathy 25. Salmonella septicemia, recurrent 26. Toxoplasmosis of brain, onset at age >1 month 27. Wasting syndrome attributed to HIV

* Only among children aged 13 years Source: CDC MMWR

Combined AIDS-defining Conditions

2008 definition


HIV

Acquired Immune Deficiency Syndrome


Human Immunodeficiency Virus

Acquired Immune Deficiency Syndrome

HIV = HIV-1 & HIV-2

HIV-2 Much harder to catch 20+ years before

symptoms appear

HIV-1 Pandemic 99% of all cases

worldwide


Zoonosis: zoo=from animals

Is HIV unique among human illnesses?

q Influenza qTB qPlague

qAnthrax qCholera qEbola

qRabies qStrep qSalmonella

q SARS Bats q H5N1 Flu Chickens, Turkeys q H1N1 Flu - Pigs


Zoonosis: zoo=from animals Retrovirus: retro=backwards Lentivirus: lenti=slow Goats (arthritis, encephalitis) Horses (anemia) Cattle (leukemia, cancer) Simians / Non-Human Primates (SIV)

Is HIV unique among human illnesses?


SIVcpz"

Chimpanzee"(Pan troglodytes!troglodytes)!

Sooty mangabey"

SIVsmm"

SIVcol"Colobus monkey"

L-Hoests monkey"

SIVlho"

Vervet monkey"

SIVver"

SIVsyk"

Sykes monkey"

SIV"SIVrcm"

Red-capped mangabey"

SIVgsn"Greater spot-nosed" monkey"

Slide courtesy of Beatrice Hahn UAB / Penn CFAR

Natural SIV hosts are the origin of HIV-1 and HIV-2

HIV-1!

HIV-2!

Gorilla"

SIVgor" HIV-1 Type O!


HIV-1: 4 groups (so far) Group M: (from SIVcpz) > 97% of AIDS cases worldwide

Group O: (from SIVgor) Outlier West Central Africa: 2% of cases

Group N: (from SIVcpz) Non M, Non O Cameroon: 10 cases

Group P: (from SIVgor) Cameroon: 1 case

More about HIV-1 & HIV-2

Center for AIDS Research at Emory University This slide is used with permission of the IAVI Report

Group M, subgroups A-K


HIV-2 8 Groups Only A & B are epidemic Group A: West Africa, Angola, Mozambique,

Brazil, India, Europe, US Group B: West Africa

Groups C-H only found in 1-2 people each Each case probably represents an

independent infection from a sooty mangabey monkey (SIVsmm)

More about HIV-1 & HIV-2


How did the epidemic start?

Bushmeat hunters Amplified by: Population mobility Trails Roads Migration Airplanes

Re-use of syringes


How DIDNT the epidemic start?

Oral Polio Vaccine (1950s) HIV-1 made the jump 1890s 1920s No p. t. troglodyte chimp cells used in

vaccine preparation Punishment for bad behavior Conspiracy Theories AIDS Denialists Peter Duesberg (USA) Pres. Mbeki (SA)


How many people have HIV/ AIDS?


[Estimated HIV in the United States and Puerto Rico 1983]


[Estimated HIV in the United States and Puerto Rico 1993]


UNFPAs AIDS Clock http://www.unfpa.org/aids_clock/

Center for AIDS Research at Emory University Ball State University Libraries, Map Collection http://cms.bsu.edu/Academics/Libraries/CollectionsAndDept/GISandMaps/MapCollection.aspx


PBS Frontline http://www.pbs.org/wgbh/pages/frontline/aids/atlas/world.html


AIDS Vu: US Map http://www.aidsvu.org/

CDC: AIDS Dot Maps http://www.cdc.gov/hiv/topics/surveillance/

resources/slides/dot/index.htm PBS Frontline: AIDS in the World http://www.pbs.org/wgbh/pages/frontline/aids/

atlas/world.html UNFPA: AIDS clock http://www.unfpa.org/aids_clock/

What is the global spread of AIDS? World Health Organization UNAIDS


Summary

HIV is a zoonosis. SIV is not a recent introduction into the

human population.

The establishment of HIV was globally amplified by human mobility and the re-use of injection equipment.

AIDS only appears to have come out of nowhere to take over the world because: 1. HIV is a lentivirus 2.that is spread by behaviors practiced by a

large proportion of the earths population.


Next Week

The Science of HIV

Guest Lecturer: Eric Hunter, MD

Professor of Microbiology & Immunology Co-Director, Emory CFAR

1A-Hagen

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