Week One

The History of HIV/AIDS

Center for AIDS Research at Emory University

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
Center for AIDS Research at Emory University

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

Center for AIDS Research at Emory University

Questions that this lecture will address include:

! 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?

Center for AIDS Research at Emory University

The History of AIDS

James W. Curran, MD, MPH
Dean Rollins School of Public Health Professor Department of Epidemiology, RSPH Principal Investigator Center for AIDS Research at Emory University Former Director Office of HIV/AIDS Centers for Disease Control and Prevention

Center for AIDS Research at Emory University

Questions that Dr. Currans lecture will address include:

! 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?

Center for AIDS Research at Emory University

The Origin of HIV

Center for AIDS Research at Emory University

What is AIDS?

Acquired Immune Deficiency Syndrome

! A condition characterized by a set of symptoms and/or diseases that have a common root cause.

Center for AIDS Research at Emory University

What is the relationship between HIV and AIDS?

AIDS* = Infected with HIV

+
<200 CD4+ (T-helper) cells/l and/or CD4+ are <14% of total lymphocytes and/or have any of 24-25 AIDS-defining illnesses
*aka HIV Infection, Stage 3
Center for AIDS Research at Emory University

1.! Bacterial infections, multiple or recurrent* 2.! Candidiasis of bronchi, trachea, or lungs Combined 3.! Candidiasis of esophagus AIDS-defining Conditions 4.! Cervical cancer, invasive 2008 definition 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 Condition that might be diagnosed presumptively. Center for AIDS Research at Emory University Only among adults and adolescents aged >13 years Source: CDC MMWR

Acquired Immune Deficiency Syndrome HIV

Center for AIDS Research at Emory University

Acquired Immune Deficiency Syndrome Human Immunodeficiency Virus HIV = HIV-1 & HIV-2

HIV-1
! Pandemic ! 99% of all cases worldwide

HIV-2
! Much harder to catch ! 20+ years before symptoms appear
Center for AIDS Research at Emory University

Is HIV unique among human illnesses?

! Zoonosis: zoo=from animals

!! Influenza !! TB !! Plague !! Anthrax !! Cholera !! Ebola !! Rabies !! Strep !! Salmonella

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

Center for AIDS Research at Emory University

Is HIV unique among human illnesses?

! Zoonosis: zoo=from animals ! Retrovirus: retro=backwards

"! Lentivirus: lenti=slow
#! Goats (arthritis, encephalitis) #! Horses (anemia) #! Cattle (leukemia, cancer) #! Simians / Non-Human Primates (SIV)

Center for AIDS Research at Emory University

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

HIV-2!

Sykes monkey"

Sooty mangabey" SIVsmm"

SIVsyk"

SIVgsn" SIVcol" Colobus monkey" Greater spot-nosed" monkey"

SIV"
SIVver" SIVrcm"
SIVlho"

SIVcpz"

Chimpanzee" (Pan troglodytes! troglodytes)!

HIV-1!

SIVgor" Red-capped mangabey"

Vervet monkey"

HIV-1 Type O!

Slide courtesy of Beatrice Hahn UAB / Penn CFAR

L-Hoests monkey" Gorilla"

Center for AIDS Research at Emory University

More about HIV-1 & HIV-2!

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

Center for AIDS Research at Emory University

Group M, subgroups A-K

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

More about HIV-1 & HIV-2

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)

Center for AIDS Research at Emory University

How did the epidemic start? Bushmeat hunters ! Amplified by:

"!Population mobility
#!Trails #!Roads #!Migration #!Airplanes

"!Re-use of syringes

Center for AIDS Research at Emory University

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)

Center for AIDS Research at Emory University

How many people have HIV/ AIDS?

Center for AIDS Research at Emory University

Center for AIDS Research at Emory University

Center for AIDS Research at Emory University

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

Center for AIDS Research at Emory University

Center for AIDS Research at Emory University

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

Center for AIDS Research at Emory University

Center for AIDS Research at Emory University

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

Center for AIDS Research at Emory University

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

Center for AIDS Research at Emory University

Ball State University Libraries, Map Collection

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

PBS Frontline http://www.pbs.org/wgbh/pages/frontline/aids/atlas/world.html Center for AIDS Research at Emory University

PBS Frontline http://www.pbs.org/wgbh/pages/frontline/aids/atlas/world.html Center for AIDS Research at Emory University

PBS Frontline http://www.pbs.org/wgbh/pages/frontline/aids/atlas/world.html Center for AIDS Research at Emory University

What is the global spread of AIDS? ! AIDS Vu: US Map

#!http://www.aidsvu.org/ World Health Organization UNAIDS

! 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/
Center for AIDS Research at Emory University

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.
Center for AIDS Research at Emory University

Next Week The Science of HIV

Guest Lecturer: Eric Hunter, MD
Professor of Microbiology & Immunology Co-Director, Emory CFAR

Center for AIDS Research at Emory University