Human Immunodeficiency Virus

1. Human Immunodeficiency Virus Kyle Kuhn, Gerard Jenkins and Agnes Kazior March 11, 2003

2. What is HIV? • Any of several retroviruses that infect and destroy helper T cells of the immune system

3. HIV is a lentivirus • genus of the retroviridae family • produce multi-organ diseases • characterized by long incubation periods and persistent infection • infect a wide range of prime hosts, as well as some non-primate mammals Courgnaud et al. J. Virol. 75:857, 2001

4. Two Types of HIV

5. HIV-1 More virulent Responsible for worldwide epidemic Severity of infection varies from person to person HIV-2 Primarily found in western Africa Not transmitted as efficiently Genome more closely related to SIVmm than HIV-1 HIV-1 vs. HIV-2

6. HIV-1 likely descended from SIVcpz HIV-2 likely descended from SIVsm Origins of HIV Pan troglodytes troglodytes Sooty Mangabey

7. Origins of HIV • Researchers claim that these chimps are the source of HIV-1 • Chimps are only rarely infected with SIVcpz • Actual Reservoir maybe a third unidentified primate species • Definite source remains elusive

8. Zoonosis: How did it happen? • Human killing and eating of chimpanzees • contact with infected blood • ingestion of uncooked or undercooked meat • Chat - polio vaccine • Hypothesis: HIV is a recombinant construct that occurred when SIV from a contaminated vaccine was administered to humans and arose when human antigens were incorporated into the SIV • Two reports in 2001 discount this theory (Blanco P. et al. and Berry N. et al.)

9. Zoonosis: When did it happen? • Three earliest know HIV infections • 1959 - serum sample from an adult male living in what is now the Democratic Republic of Congo • 1969 - tissue samples from a teenager who died in St. Louis • 1976 - tissue samples from a Norwegian sailor • January 2000 - study by Dr. Bette Korber estimates first case of HIV infection to be 1930 • Study based on complicated computer model of HIV’s evolution and has a 20yr error margin

10. Zoonosis: Where did it happen? • The two primates that carry the SIVs most closely related to HIV are indigenous to western Africa

11. HIV A Brief History of the modern epidemic

12. In The Beginning... • 1675 - Speculation that HIV was first transmitted from chimpanzees to humans • 1926-1946 - Scientists believe HIV first spread from monkeys to humans • 1959 - First proven AIDS death • 1978 - Gay men in US and Sweden begin showing signs of what is now known as AIDS ?

13. 1981 - CDC notices increase in cases of Kaposi’s sarcoma and Pneumocystis carinii pneumonia The First Indications

14. Defining The Problem • 1982 - The term AIDS (acquired immune deficiency syndrome) is used for the 1st time • 1983 - Institut Pasteur isolates HIV-1 CDC issues warning to blood banks about potential problem • 1984 - Dr. Robert Gallo claims discovery of HIV

15. The Start of the War • 1985 - FDA approves first HIV antibody diagnostic test - First International Conference on AIDS • 1986 - HIV-2 isolated • 1987 - AZT approved by FDA (1st anti- HIV drug)

16. Reality Sets In • 1987 - President Reagan says “AIDS” in public - AIDS memorial quilt started

17. The War Against HIV/AIDS • 1988 - FDA begins granting pre- approval distribution status to HIV/AIDS related drugs • 1989 - First licensed HIV-1 diagnostic kit to directly detect virus (rather than antibodies)

18. Fighting a Losing Battle? • 1991 - 10 million people worldwide are HIV-positive - Magic Johnson publicly announces he is HIV positive

19. Increasing The Arsenal • 1992 - FDA starts “accelerated approval” process for HIV/AIDS related drugs • 1995 - Saquinavir (Invirase) is first protease inhibitor approved in US - US admits that Institut Pasteur, not Dr. Gallo, discovered HIV • 1996 - Nevirapine (Viramune) first non- nucleoside reverse transcriptase inhibitor approved in US

20. Current Status • 1997 - 6,400,000 Approximate worldwide death total - 22,000,000 HIV-positive people in the world • 1998-2001 - development and approval of new drugs • 2003 - AIDSVAX developed by VaxGen fails in large clinical trial • Trial did show statistically significant prevention in African-Americans and other non-Hispanic minorities

21. AIDS in the US

23. Unprotected sex Vagina, Penis, Anal, Oral Shared needles Drugs, Steroids, Tattoo, Piercing Mother to child Birth, Breast Feeding Blood transfusions Abstinence Protection during sex Condom, Latex barrier Avoiding risky behavior Not sharing needles, no promiscuous activity Transmission & Prevention

24. HIV vs. AIDS • HIV causes AIDS by attacking the immune system’s CD4 T cells. • Normal CD4 count is between 500 – 1500 CD4 T cells per ul of blood, while AIDS CD4 count is less than 200 CD4 T cells per ul of blood. • AIDS viral load is about 55,000 HIV RNA copies per ml of blood. • On average, it takes approximately 10 years to develop AIDS from initial infection. • As a person’s CD4 count decreases, he/she is more prone to opportunistic infections.

25. HIV in U.S. • As of January 2001, there were about 850,000 people living with HIV in the U.S. • Approximately 40,000 new HIV infections occur in the U.S. every year.

26. AIDS in U.S. • As of January 2002, there were 816,149 reported cases of AIDS in the United States. • As of January 2002, there were 467,910 reported deaths due to AIDS in the United States.

27. HIV/AIDS in Africa

28. HIV/AIDS in Africa • During 2001, there were 3.4 million new HIV infections, 2.3 million AIDS deaths in Africa. • As of January 2002, approximately 28 million people are living with AIDS in Africa. • The life expectancy is 47 years with AIDS and 62 years without AIDS.

29. HIV/AIDS World Wide • Approximately 42 million people are living with HIV or AIDS. • About 5 million people were infected with HIV during 2002. • About 3.1 million people died of AIDS during 2002. • Approximately 21.8 million people have died of AIDS since the epidemic began.