collected by Dr MZ

collected by Dr MZ

Current pandemic started in the mid-to late 1970s

approximately 100,000- 300,000 persons may have been infected

Mid-1970's-1980 history

1978 gay men in the US and Sweden and heterosexuals in Tanzania and Haiti begin showing signs of what will later be called AIDS.

collected by Dr MZ

1981 History

8 cases of KS among young gay men

June 5, 1981: 5 cases of PCP in gay men

from UCLA (MMWR)

collected by Dr MZ

1981: Initial Reports

• June 5, 1981: 5 cases of PCP in gay men from UCLA (MMWR)

• July 3, 1981: 26 additional cases

• Dec 10, 1981: 3 NEJM papers describe cases

Gottlieb MS NEJM 2001;344:1788-91

collected by Dr MZ

1982 History

GRID (gay-related immune deficiency)

Community-Acquired Immune Dysfunction• 1st cases in women reported• 1st transfusion & vertically transmitted cases reported

AIDS by August

collected by Dr MZ

1982 History

AIDS specific voluntary organizations

1. San Francisco AIDS foundation (SFAF)

2. AIDS project Los Angeles (APLA)

3. Gay Men’s Health Crisis (GMHC)

CDC reported first cases of possible MTCT

A child died of AIDS after multiple blood transfusion

collected by Dr MZ

1983 History

Dr Robert Gallo from National Cancer Institute isolated the virus – HTLV III

Dr Montagnier et al isolated the virus at Pasteur Institute France – called LAV

1984

History of the HIV epidemic, Marshall J. Glesby, Associate Professor of Medicine and Public Health, Weill Medical College of Cornell University

collected by Dr MZ

1985 History

FDA licensed the first blood test for AIDS for commercial production,

First international Conference on AIDS held in Atlanta

WHO consider the AIDS pandemic & initiateWorldwide action

collected by Dr MZ

1985 History

• The actor Rock Hudson died of AIDS on October 3rd

1985

• A new WHO definition for AIDS was adopted

collected by Dr MZ

1986 History

International Committee on the

Taxonomy of Viruses ruled HIV

A drug called azidothymidine (AZT)

slowed down the attack of the AIDS virus

collected by Dr MZ

collected by Dr MZ

1987 History

FDA approved AZT as the first antiretroviral drug for AIDS treatment.

AIDS became the first disease ever debated on the floor of the UN General Assembly.

WHO also reported that an estimated 5 to 10 million people were infected with HIV worldwide

collected by Dr MZ

1988 History

A world summit was held in London to discuss

a common AIDS strategy

Focused on AIDS prevention which emphasize

Education, free exchange of information &

Experience, need to protect human rights &

dignity

Announced by the Director-General of the

World Health Organization as world AIDS day

collected by Dr MZ

1989 History

A major drug trial known as ACTG01, AZT could slow progression to AIDS in HIV positive individuals with no symptoms at all

The second drug for the treatment of AIDS, dideoxyinosine (ddI) started to be made available to people with AIDS

collected by Dr MZ

1991 History

The third antiretroviral drug dideoxycytidine (ddC) was identified.

Earvin (Magic) Johnson announced that he had tested HIV positive and that he was retiring from professional basketball.

The red ribbon became an international symbol of AIDS awareness during 1991

collected by Dr MZ

collected by Dr MZ

1993 History

• The tennis player Arthur Ashe died

• Scientists had found that HIV 'hides out' in lymph

nodes and similar tissue early in the course of

infection.

• CDC had expanded the definition of AIDS to include

additional OIs, as well as HIV infected adults with a

CD4 count of less than 200.

collected by Dr MZ

1994 History

Dual nucleoside therapy better than monotherapy (Delta, ACTG 175, ZDV/3TC)

ACTG 076: AZT reduces

mother-to-child transmission of HIV

History of the HIV epidemic, Marshall J. Glesby, Associate Professor of Medicine and Public Health, Weill Medical College of Cornell University

collected by Dr MZ

1995 History

It was reported from Tanzania, that treating

people for STIs substantially reduced people's

risk of becoming infected with HIV.

Nelson Mandela called on all South Africans to

speak out against the stigma, blame, shame and

denial that has thus far been associated with this

epidemic.

collected by Dr MZ

1995-1996: The New Treatment Era

– HIV viral load testing became available • Clinicians could directly assess the effect of antiretrovirals on

viral replication (HIV RNA)

– First protease inhibitor (Saquinavir) approved by FDA

collected by Dr MZ

1996: The Era of HAART

• Paradigm: Aim to achieve durable suppression of HIV viremia

• Striking reductions in HIV-related morbidity and mortality

• Aggressive treatment guidelines: “Hit hard, Hit early!”

• Mathematical models suggested that 3 years of viral

suppression would result in eradication

History of the HIV epidemic, Marshall J. Glesby, Associate Professor of Medicine and Public Health, Weill Medical College of Cornell University

collected by Dr MZ

1996 History

UNAIDS became operational on January 1st 1996

the FDA approved the drug Viramune (nevirapine),

aggressive treatment with multiple drugs can convert deadly AIDS into a chronic, manageable disorder like diabetes

collected by Dr MZ

1996 History

At the end of the year UNAIDS estimated

3 million people, mostly under the age of 25,

newly infected with HIV,

23 million the total number of infected people.

6.4 million people; 5 million adults and 1.4 million

children, had already died.

collected by Dr MZ

collected by Dr MZ

1998 - 2000 Realism• HIV eradication is not possible with current therapy

– viral “reservoir” in resting T-memory lymphocytes– viral replication continues in lymph nodes even when

HIV RNA in plasma is <50 copies/mL

• Awareness that HIV is a chronic disease

• Recognition of long-term toxicities:

– fat redistribution (lipodystrophy)– metabolic abnormalities (insulin resistance, diabetes,

increased lipids)

• 2000: Durban AIDS conference – momentum builds to bring antiretrovirals to the developing world

History of the HIV epidemic, Marshall J. Glesby, Associate Professor of Medicine and Public Health, Weill Medical College of Cornell University

collected by Dr MZ

1998 History

• the company AIDSvax started the

first human trial of an AIDS vaccine

• San Francisco started a pioneering

Post Exposure Prophylaxis

The FDA approved Sustiva (EFV),

another drug in the NNRTI group

collected by Dr MZ

1998 History

A study found that

LSCS + AZT reduce risk of MTCT

less than 1%

NSVD + AZT reduce risk of MTCT

to 6.6%

Initial findings from a joint Uganda-US study identified a

single oral dose of NVP, as being both more affordable and

effective in reducing mother to baby transmission of HIV.

collected by Dr MZ

1998 History

In South Africa, Gugu Dlamini, an AIDS

activist, was beaten to death by her

neighbours after revealing her HIV

positive status on Zulu television.

In Botswana, Namibia, Swaziland and

Zimbabwe, the estimates showed that

between 20% and 26% of people were

living with HIV or AIDS

collected by Dr MZ

1999 History

• In February 1999, a group of researcher from

university of Alabama announced a type of SIVcpz

was almost identical to HIV 1.

collected by Dr MZ

1999 History

In the United States a doctor who

injected his former lover with HIV

infected blood, was sentenced to 50

years in prison

In the UK a judge ordered that a five-month-old baby girl

should be tested for HIV against her parents' wishes.

collected by Dr MZ

2000 History

In order to publicise the importance of

HIV testing to African-Americans,

reverend Jesse Jackson publicly took

an oral HIV test.

The research suggested that in about 7% of

cases, the virus was likely to have been

transmitted during oral sex

collected by Dr MZ

2000 History

Israel lost one of its most successful singers, Ofra

Haza, from what was believed to be an AIDS-related

complication.

Since her death the number of people coming forward

for anonymous HIV testing and contacting helplines

increased considerably.

collected by Dr MZ

2001 History

After years of denial, China finally

admitted that HIV/AIDS threatened its

public health and economic security.

Infections were predicted to grow from

about 600,000 to 6 million by 2005.

collected by Dr MZ

2001 History

Indian drug company Cipla offered to make AIDS drugs

available at reduced prices to the international aid

organization, MSF.

Cipla's offer to produce drugs at a price less than US$ 1 day

collected by Dr MZ

2001 History

"In this effort, there is no us and them, no

developed and developing countries, no rich and

poor- only a common enemy that knows no

frontiers and threatens all people."

Kofi Annan at the G8 summit in Genoa

A few weeks after, it was announced that the Global AIDS and Health

Fund was not only going to target AIDS as first suggested, but to also

include TB and malaria. he fund was officially named as The Global

Fund to fight AIDS, Tuberculosis and Malaria.

GFATM

collected by Dr MZ

2001 History

"At the time, I read the report with great

interest, but I never imagined I was looking at

the first sign of an epidemic, that in just 20

years would have infected 60 million people,

killed 22 million and achieved the status of the

most devastating epidemic in human history."

Peter Piot recalling the first mention of the

virus

collected by Dr MZ

2001 History

Kofi Annan appointed

Stephen Lewis as his

'special envoy for AIDS

in Africa'.

collected by Dr MZ

2001 History

It was reported that some Asian countries had reduced the transmission of HIV through widespread condom use. In Thailand, new infections had plummeted from 143,000 in 1991 to 20,000 in 2000.

Without 100% condom programme

100% condom programme

HIV infection

collected by Dr MZ

2002 History

The US Secretary of State Colin Powell strongly advocated condom use to prevent the spread of AIDS and other sexually transmitted diseases

The UN Secretary General,

Kofi Annan said the fear of stigma

leads to silence and when it comes

to fighting AIDS, silence is death'

collected by Dr MZ

collected by Dr MZ

2003 History

Swaziland was believed to have the

world's highest rate of HIV with almost

four out of 10 adults infected with HIV

In February, a rare case of female-to-female sexual transmission of HIV was reported.

collected by Dr MZ

2003 History

In November, the AIDS vaccine also failed in clinical trial in Thailand.

• The UNAIDS warned that the efforts to stem the world's AIDS epidemic were 'entirely inadequate'.

• It was estimated that every day in 2003, an estimated 14,000 people got infected with HIV.

• It was estimated that 40 million around the world including 2.5 million children were living with HIV/AIDS.

collected by Dr MZ

2003 History

CDC announced a new four -part initiative to reduce the

number of new HIV infections in the US

• introducing HIV testing as a routine part of med care

• use of rapid test

• offer HIV-positive women routine HIV testing as part

of their antenatal care

• increased focus on people who are already infected

with HIV and their partner tracing

collected by Dr MZ

2003 History

On World AIDS Day the WHO

announced a new plan called '3 by 5'

to provide HIV/AIDS treatment for

many resource-poor countries. The

WHO was hoping to have 3 million

people in resource poor countries on

AIDS drugs by the end of 2005.

collected by Dr MZ

2004 History

In May, five Bulgarian nurses and a Palestinian

doctor accused of deliberately infecting children

with HIV were sentenced to death by a Libyan

court.

Mohammed Dica, was the first person in 137

years to be convicted in England and Wales

for sexually transmitting a disease

collected by Dr MZ

2004 History

President Bush's $15 billion initiative to

combat the global AIDS pandemic, by

now known as PEPFAR (President's

Emergency Plan For AIDS Relief)

collected by Dr MZ

2005 History

Only around 1.3 million people

in low- and middle-income

countries had been receiving

antiretroviral treatment – less

than half of the 3 million target.

collected by Dr MZ

2006 History

US National Institutes of Health revealed the

results of two African trials of male

circumcision as an HIV prevention method

with clear evidence that the intervention

reduced HIV transmission by around 50%.

The WHO and other organizations

suggested they would soon begin promoting

male circumcision in areas with severe HIV

epidemics.

collected by Dr MZ

2001- 2006

• Interest in PI-sparing regimens

– Emergence of NNRTI-based regimens

• Deferred initiation of antiretroviral therapy

• Interest in treatment interruption strategies

– Ultimately not supported by clinical trials

• Simpler, once daily regimens with fewer pills

• Optimism about new classes of drugs

History of the HIV epidemic, Marshall J. Glesby, Associate Professor of Medicine and Public Health, Weill Medical College of Cornell University

collected by Dr MZ

25 years of AIDS

6 Highly Active Antiretroviral Treatment launched

7 Scientists develop the first treatment regimen to reduce mother-to-child transmission of HIV

8 UNAIDS is created

9 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched

10 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by 2005

40

30

20

10

0

50

35

25

15

5

45

Mill

ion

1980 1985 1990 1995 2000 2005

1 2 34

5

7

8

9

10

6

1 First cases of unusual immune deficiency are identified among gay men in USA

2 Acquired Immune Deficiency Syndrome (AIDS) is defined for the first time

3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS

4 The first HIV antibody test becomes available

5 The first therapy for AIDS – zidovudine, or AZT -- is approved for use in the USA

People living with HIV

Children orphaned by AIDS in sub-Saharan Africa

1.1