30 Years of HIV/AIDS

1. 30 Years of HIV/AIDS Prepared by Krissie Guerard, MS Craig Steffens, MPH

2. Before 1981 • “The dominant feature of this first period was silence, for the human immunodeficiency virus (HIV) was unknown and transmission was not accompanied by signs or symptoms salient enough to be noticed. While rare, sporadic case reports of AIDS and sero-archaeological studies have documented human infections with HIV prior to 1970, available data suggest that the current pandemic started in the mid- to late 1970s. By 1980, HIV had spread to at least five continents (North America, South America, Europe, Africa and Australia). During this period of silence, spread was unchecked by awareness or any preventive action and approximately 100,000-300,000 persons may have been infected.”Jonathan Mann – 1989 • Recent studies estimate the origin of HIV to have taken place between 1884 and 1924. This was done by studying the virus’ evolution and sequencing.

3. Before 1981 • It is generally accepted that HIV originated in Africa before starting a pandemic. HIV is a descendant from Simian Immunodeficiency Virus (SIV) that became capable of infecting humans. HIV-1 from chimpanzees and HIV-2 from sooty mangabeys. • Earliest known instances include plasma sample from an adult male from the DRC in 1959, lymph tissue of female from DRC in 1960. HIV found in tissue samples of teenager from St. Louis in 1969.

4. 1981 • By March 1981, at least 8 cases of Karposi’s Sarcoma (KS) in New York City and cases of rare lung infection, Pneumocystiscarinii pneumonia (PCP) in New York and Los Angeles • In June, CDC published article in MMWR describing 5 cases of PCP in LA – “beginning of awareness of AIDS in US” En.wikipidia.org Aidsevidence.blogspot.com

5. 1981 • Mode of transmission unclear in early months: "Dr. Curran said there was no apparent danger to non homosexuals from contagion. 'The best evidence against contagion', he said, 'is that no cases have been reported to date outside the homosexual community or in women'"The New York Times • By December, PCP reported in persons who were injection drug users (IDU), and it was shown that the disease affected other populations besides homosexuals. • PBS 1-2

6. 1982 • By July, 452 cases reported to CDC from 23 states • Disease seen in hemophiliacs and persons with Haitian descent • Cases throughout European countries and Africa where it was known as “slim” or “slimming disease”

7. Webmd.com

8. 1983 • Reports of AIDS in women with no risk factors besides heterosexual sex. CDC warns it may spread in this way as well as mother-to-child. • French and American researchers report that they have isolated the causative agent • WHO discusses global AIDS • In U.S., 3,064 cases and 1,292 deaths

9. 1984 • Human Immuno-deficiency Virus (HIV) is identified by researchers, a retrovirus—requires reverse transcriptase to replicate • The virus high-jacks specific immune cells called CD4+ T-cells to produce more of itself, thus killing the host cell • The genetic material of the virus is integrated into the host cell DNA

10. 1984 • The world’s first need exchange is set up in Amsterdam • San Francisco’s bath houses are shut down. NY and LA do the same within a year. • The first 2 cases of AIDS appear in North Dakota.

11. 1985 • At least one case of HIV in every region of the world • The first HIV test approved by FDA • US blood banks are screened for HIV • Rock Hudson dies from AIDS • Ryan White banned from his Indiana school • Second strain of HIV detected (HIV-2) • PBS 1-5

12. 1986 • WHO launches a global health strategy • President Reagan asks Surgeon General to prepare a report on AIDS • More than 38,000 cases of AIDS reported from 85 countries • 15 more HIV cases in North Dakota

13. 1986 • AIDS Memory Quilt begins in San Francisco

14. 1987 • AZT is first drug approved by FDA • President Reagan does his first public speech declaring AIDS as “public enemy #1) • WHO estimates that there are 5-10 million people infected worldwide • US forbids immigration by people with HIVhttp://www.youtube.com/watch?v=U219eUIZ7Qohttp://www.youtube.com/watch?v=iRPJFuzdzkY&feature=related

15. 1988 • Universal precautions are required in hospitals and blood-related environments • C. Everett Koop send an 8 page, condensed version of his Report on AIDS to all 107 million households in U.S. • North Dakota had 13 more cases of HIV, 2 of them AIDS • December 1, 1988 marks the first World AIDS Day

16. 1990 • ~8 million people with HIV worldwide • Ryan White dies at age of 18 http://www.youtube.com/watch?v=Ly_PyT6HaLI&feature=related • Ryan White CARE Act is inaugurated • Americans with Disabilities Act includes people with HIV/AIDS • Former President Reagan apologizes for his neglect of HIV while in office

17. 1991 • Magic Johnson announces his infection and retires from the NBA • ~10 million people infected worldwide, 1 million in U.S. • Housing Opportunities for People with AIDS (HOPWA) established • Red Ribbon becomes the symbol of AIDS • Freddie Mercury dies of bronchopneumonia brought on by AIDS

18. 1992 • FDA approves another drug, dideoxcytidine, for treatment (first successful combination drug therapy) • Robert Reed, father from Brady Bunch dies • Certain UK newspapers printed articles questioning HIV as the cause of AIDS – example of the denialismveiwpoint among some researchers and world leaders

19. 1993 • PCP is AIDS-defining diagnosis for 32% of AIDS cases and the CDC revises its definitions of AIDS to include opportunistic infections • Philadelphia opens • Female condom is approved • AZT resistance found in persons never treated with anti-HIV drugs (transmission) – researchers push for new drugs to be developed

20. 1994 • AZT becomes standard of care to avoid perinatal transmission (study ACTG 076) • Author Randy Shilts dies

21. 1995 • Olympic diver Greg Louganis reveals he has AIDS • AIDS is leading cause of death among 25-44 year old Americans • First protease inhibitor drug (Saquinavir) is approved • U.S. admits French doctor discovered AIDS virus • Joint United Nations program on AIDS (UNAIDS) is established

22. 1995

23. 1996 • FDA approves oral collection (OraSure) for HIV antibody tests • Magic Johnson returns to basketball • Rent opens on Broadway Foundationsports.com

24. 1996 • First at-home HIV-antibody test approved • Highly Active Antiretroviral Therapy (HAART) begins, using a combination of at least 3 drugs • Dr. David Ho is Time Magazine Man of the Year

25. 1996 • 5 types of ARVs: 1. Nucleoside/nucleotide Reverse Transcriptase Inhibitors 2. Non-nucleoside Reverse Transcriptase Inhibitors 3. Protease Inhibitors 4. Fusion or Entry Inhibitors 5. Integrase Inhibitors

26. 1997 • Research discovers that HIV invades the memory cells of the immune, creating hidden reservoirs • AIDS related deaths drop 40% from past years largely due to HAART

27. 1998 • First human trial for a vaccine begins in U.S. • President Clinton announces a special package of initiatives aimed at reducing the impact of HIV/AIDS on racial and ethnic minorities – Minority AIDS Initiative • Doctor injected a former lover with HIV+ blood, then sentenced to 50 years prison

28. 1998 Washingtonexaminer.com

29. 1999 • States are told that they must track HIV infection by either name or code • U of Alabama researchers trace source of HIV to chimpanzee in West Central Africa • For first time, there are more women living with HIV disease in Africa than men Unmultimedia.org

30. 2000 • 57% of new infections in U.S. are among African Americans who make up only 13% of the population • In Botswana, ¼ of all adults and 4/10 of all pregnant women are infected • U.S. and UN security councils declare HIV a security threat

31. 2000 North Dakota HIV Incidence by Race/ethnicity, 1984-present

32. 2001 • On September 21, 2001, FDA licensed the First Nucleic Acid Test (NAT) systems to Screen Plasma for Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV). Nucleic acid test (NAT) systems intended for screening of plasma donors. These test systems are expected to further ensure the safety of plasma-derived products by permitting earlier detection of HIV and HCV infections in donors

33. 2002 • Global Fund is established to boost response to AIDS, TB and malaria • Swiss researchers reported first fully documented case to be infected with a second strain of HIV through unprotected sex • In U.S., FDA approves rapid HIV test • HIV/AIDS is the leading cause of death world-wide among those 15-59

34. 2002 • A study showed that ½ of Americans still believed you could contract HIV via everyday contact

35. 2003 • First HIV vaccine to undergo a major trial is ineffective • Vatican cardinal Lopez Trujillo said condoms were not safe and could not stop HIV transmission; WHO responded, denouncing his statements

36. 2004 • President’s Emergency Plan for AIDS Relief (PEPFAR) is initiated – care to 15 countries • FDA approved the first rapid oral fluid test Avert.com

37. 2005 • 1.1 million people in U.S. estimated with HIV, ¼ of those are unaware • Patent on AZT runs out, allowing pharmaceutical companies to produce the drug legally and cheaper than previously

38. 2006 • Circumcision shown to reduce infection among heterosexual men • Atripla (once-a-day) available for treatment • June 5th marks a quarter century since the first AIDS case

39. 2007 • ~33 million people living with HIV worldwide • Another major HIV vaccine trial is halted after preliminary results show no benefit

40. 2008 • Man in Germany ‘cured’ after bone marrow transplant from donor with genetic resistance to HIV News.bbc.co.uk About 1 in 1,000 Europeans and Americans have resistance to HIV

41. 2008 • CDC releases new HIV incidence numbers showing the epidemic in the U.S. is worse than initially thought • U.S. congress reauthorizes PEPFAR for another 5 years and up to $48 Billion

42. 2009 • President Obama removes ban preventing HIV+ persons from entering U.S. • Washington DC has a prevalence of 3%, a severe and generalized epidemic • UNAIDS published report showing the number of new infections worldwide had decreased by 17% since 2001 • President Obama calls for the first ever National HIV/AIDS strategy

43. 2009

44. 2010 • CAPRSISA 004 microbicide trial in South Africa showed a 40% reduction in transmission through use of a topical gel containing tonfovir. Results of this study have been inconsistent. • iPrEx trial showed reduction in transmission among MSM taking pre-exposure prophylaxis (PrEP)

45. 2011 and the future • June 5, 2011 marked 30 years since the fist case of AIDS, with an estimated 30 million death worldwide • More studies for vaccines and “cures” though we are unlikely to discover a breakthrough cure

46. North Dakota Cases 1984-2011

47. Acknowlegement • PBS Frontline • http://www.avert.org/ • Webmd.com

48. Questions? kguerard@nd.gov csteffens@nd.gov 701.328.2378 1.800.70.NDHIV www.ndhealth.gov/hiv