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Current Status of the HIV/AIDS Epidemic

Current Status of the HIV/AIDS Epidemic. Hail M. Al-Abdely, MD Consultant, Infectious Diseases. History of HIV/AIDS. History of HIV Infection. 1926 Some scientists believe HIV spread from monkeys to humans between 1926 - 1946.

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Current Status of the HIV/AIDS Epidemic

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  1. Current Status of the HIV/AIDS Epidemic Hail M. Al-Abdely, MD Consultant, Infectious Diseases

  2. History of HIV/AIDS

  3. History of HIV Infection • 1926 • Some scientists believe HIV spread from monkeys to humans between 1926 - 1946. • Recent research indicates HIV most probably first jumped from chimpanzees to humans as early as 1675 and didn't establish itself as an epidemic strain in Africa until 1930

  4. History of HIV Infection • 1959 • A man died in the Congo in what was the first proven AIDS death. Nature (02/05/98) Vol. 391, No. 6667, P. 594 • 1978 • Gay men in the US and Sweden -- and heterosexuals in Tanzania and Haiti -- begin showing signs of what will later be called AIDS.

  5. History of HIV Infection • 1981 • CDC (USA) notices an alarming rate of a rare cancer (Kaposi's Sarcoma) in otherwise healthy gay men. They first called the disease "gay cancer" but soon rename it GRID ("gay-related immune deficiency"). • 422 cases diagnosed in the U.S.; 159 are dead.

  6. History of HIV Infection • 1982 • CDC (USA) links the new disease to blood. • The term AIDS ("acquired immune deficiency syndrome") is used for the first time. • The Gay Men's Health Crisis is founded in New York City. • 1,614 cases of AIDS diagnosed in the U.S.; 619 are dead..

  7. History of HIV Infection • 1983 • CDC (USA) warns blood banks of a possible problem with the blood supply. • Institut Pasteur (France) finds the virus (HIV). • 4,749 cases of AIDS in the U.S.; 2,122 are dead.

  8. History of HIV Infection • 1984 • Dr. Robert Gallo (US) claims he discovered the virus that causes AIDS; however, this is about a year after the French discovery. • 11,055 cases of AIDS diagnosed in the U.S.; 5,620 are dead.

  9. History of HIV Infection • 1985 • The FDA (US) approves the first HIV antibody test. Blood products begin to be tested in the US and Japan. • The first International Conference on AIDS is held in Atlanta (US). • 22,996 cases of AIDS diagnosed in the U.S.; 12,592 are dead.

  10. History of HIV Infection • 1987 • AZT (zidovudine, Retrovir®) -- Glaxo Wellcome -- becomes the first anti-HIV drug approved by the FDA. • The recommended dose was one 100mg capsule every four hours around the clock. • 71,176 AIDS cases diagnosed in the U.S.; 41,027 people are dead.

  11. History of HIV Infection • 1991-1994 • ddI (didanosine, Videx®), ddC (zalcitabine, Hivid®), d4T (Zerit®) were approved by the FDA. • 478,756 AIDS cases diagnosed in the U.S.; 288,597 are dead

  12. History of HIV Infection • 1995-2000 • The era of Highly Active Anti-Retroviral Therapy (HAART). • Understanding of Viral dynamics • Effective prevention of perinatal transmission

  13. UN/AIDS data on the global epidemicJune 2000

  14. End-1999 global HIV/AIDS estimatesChildren and adults 34.3 million 5.4 million 2.8 million 18.8 million • People living with HIV/AIDS • New HIV infections in 1999 • Deaths due to HIV/AIDS in 1999 • Cumulative number of deaths due to HIV/AIDS

  15. About 15 000 new HIV infections a day in 1999 • More than 95% are in developing countries • 1 700 are in children under 15 years of age • About 13 000 are in persons aged 15 to 49 years, of whom: • almost 50% are women • about 50% are 15–24 year olds

  16. End-1999 global HIV/AIDS estimatesChildren (<15 years) • Children living with HIV/AIDS • New HIV infections in 1999 • Deaths due to HIV/AIDS in 1999 • Cumulative number of deaths due to HIV/AIDS 1.3 million 620 000 480 000 3.8 million

  17. Leading causes of death globally, 1999 Rank % of total 12.7 9.9 7.1 4.8 4.8 4.2 4.0 3.0 1.9 • 1 Ischaemic heart disease • 2 Cerebrovascular disease • 3 Acute lower respiratory infections • 4 HIV/AIDS • 5 Chronic obstructive pulmonary disease • 6 Perinatal conditions • 7 Diarrhoeal diseases • 8 Tuberculosis • 11 Malaria Source: The World Health Report 2000, WHO

  18. Leading causes of death in Africa, 1999 Rank % of total • 1 HIV/AIDS • 2 Acute lower respiratory infections • 3 Malaria • 4 Diarrhoeal diseases • 5 Perinatal conditions • 6 Measles • 7 Tuberculosis • 8 Cerebrovascular disease • 9 Ischaemic heart disease • 10 Maternal conditions 20.6 10.3 9.1 7.3 5.9 4.9 3.4 3.2 3.0 2.4 Source: The World Health Report 2000, WHO

  19. Adults and children estimated to be living with HIV/AIDS as of end 1999 Eastern Europe & Central Asia 420 000 Western Europe 520 000 North America 900 000 East Asia & Pacific 530 000 North Africa & Middle East 220 000 South & South-East Asia5.6 million Caribbean 360 000 sub-Saharan Africa 24.5 million Latin America 1.3 million Australia & New Zealand 15 000 Total: 34.3 million

  20. Children(<15 years)estimated to be living with HIV/AIDS as of end 1999 Eastern Europe & Central Asia 15 000 Western Europe 4 100 North America 11 000 East Asia & Pacific 5 200 North Africa & Middle East 8 000 South & South-East Asia 200 000 Caribbean 9 600 sub-Saharan Africa 1 million Latin America 28 000 Australia & New Zealand < 200 Total: 1.3 million

  21. Estimated adult and child deaths due to HIV/AIDSfrom the beginning of the epidemic to end 1999 Eastern Europe & Central Asia 21 000 Western Europe 210 000 North America 470 000 East Asia & Pacific 52 000 North Africa & Middle East 70 000 South & South-East Asia 2.6 million Caribbean 210 000 sub-Saharan Africa 14.8 million Latin America 460 000 Australia & New Zealand 6 600 Total: 18.8 million

  22. Estimated deaths in children (<15 years) due to HIV/AIDS from the beginning of the epidemic to end 1999 Eastern Europe & Central Asia 5 000 Western Europe 3 000 North America 5 000 East Asia & Pacific 2 900 North Africa & Middle East 6 000 South & South-East Asia 440 000 Caribbean 24 000 sub-Saharan Africa 3.3 million Latin America 24 000 Australia & New Zealand < 100 Total: 3.8 million

  23. Estimated adult and child deaths from HIV/AIDS during 1999 Eastern Europe & Central Asia 8 500 Western Europe 6 800 North America 20 000 East Asia & Pacific 18 000 North Africa & Middle East 13 000 South & South-East Asia 460 000 Caribbean 30 000 sub-Saharan Africa 2.2 million Latin America 48 000 Australia & New Zealand < 200 Total: 2.8 million

  24. Estimated deaths in children (<15 years)from HIV/AIDS during 1999 Eastern Europe & Central Asia < 500 Western Europe < 100 North America < 100 East Asia & Pacific 900 North Africa & Middle East 1 000 South & South-East Asia 44 000 Caribbean 2 900 sub-Saharan Africa 430 000 Latin America 3 600 Australia & New Zealand < 100 Total: 480 000

  25. Estimated number of adults and childrennewly infected with HIV during 1999 Eastern Europe & Central Asia 130 000 Western Europe 30 000 North America 45 000 East Asia & Pacific 120 000 North Africa & Middle East 20 000 South & South-East Asia 800 000 Caribbean 60 000 sub-Saharan Africa 4.0 million Latin America 150 000 Australia & New Zealand 500 Total: 5.4 million

  26. Estimated number of children (<15 years)newly infected with HIV during 1999 Eastern Europe & Central Asia 500 Western Europe < 500 North America < 500 East Asia & Pacific 2 400 North Africa & Middle East 2 000 South & South-East Asia 86 000 Caribbean 4 000 sub-Saharan Africa 515 000 Latin America 6 800 Australia & New Zealand < 100 Total: 620 000

  27. Cumulative number of children estimated to have been orphaned by AIDS* at age 14 or youngerat the end of 1999 Eastern Europe & Central Asia 500 Western Europe 9 000 North America 70 000 East Asia & Pacific 5 600 North Africa & Middle East 15 000 South & South-East Asia 850 000 Caribbean 85 000 sub-Saharan Africa 12.1 million Latin America 110 000 Australia & New Zealand < 500 Total: 13.2 million * Children who have lost their mother or both parents to AIDS before the age of 15 years

  28. A global view of HIV infection33 million adults living with HIV/AIDS as of end 1999 Adult prevalence rate 15.0% – 36.0% 5.0% – 15.0% 1.0% – 5.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% not available

  29. Spread of HIV over time in Asia, 1984 to 1999 2.0% – 5.0% 1.0% – 2.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% trend data unavailable outside region

  30. 4,000,000 3,500,000 3,000,000 Highly industrialized countries 2,500,000 North Africa & Middle East Eastern Europe & Central asia 2,000,000 Sub-Saharan Africa Latin America & the Caribbean 1,500,000 Southern & Eastern Asia 1,000,000 500,000 - 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 Estimated annual number of new HIV infections by region, 1980 to 1999 New infections

  31. 25,000,000 20,000,000 Highly industrialized countries North Africa & Middle East 15,000,000 Eastern Europe & Central Asia Sub-Saharan Africa Latin America & the Caribbean 10,000,000 Southern & Eastern Asia 5,000,000 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 Estimated number of people living with HIV/AIDS by region, 1980 to 1999 People living with HIV/AIDS

  32. Estimated adult HIV prevalence in Kenya, 1990-1999 16 14 12 10 HIV prevalence (%) 8 6 4 2 0 90 91 92 93 94 95 96 97 98 99 Source: National AIDS and STD Control Programme, 1999 and UNAIDS

  33. HIV prevalence among pregnant womenin South Africa, 1990 to 1999 25 22.8 22.4 20 17 14.2 15 HIV prevalence (%) 10.4 10 7.6 5 4 2.1 1.7 0.7 0 90 91 92 93 94 95 96 97 98 99 Source: Department of Health, South Africa

  34. Impact of HIV/AIDS on urban households, Côte d’Ivoire General population Families living with AIDS 30 000 Francs CFA 25 000 Monthly income per capita 20 000 15 000 Monthly consumption per capita 10 000 5 000 Savings/Disavings 0 – 5 000 Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997

  35. Reduction in production in a household with an AIDS death, Zimbabwe Reduction in output 61% 47% 49% 37% 29% Crops • Maize • Cotton • Vegetables • Groundnuts • Cattle owned Source: Stover & Bollinger, 1999

  36. Projected population structure with and without the AIDS epidemic, Botswana, 2020 80 Projected population structure in 2020 75 70 Males Females Deficits due to AIDS 65 60 55 50 Age in years 45 40 35 30 25 20 15 10 5 0 140 120 100 80 60 40 20 0 0 20 40 60 80 100 120 140 Population (thousands) Source: US Census Bureau, World Population Profile 2000

  37. Prevention Campaigns can be effective

  38. HIV prevalence rate among 13 to 19-year-olds, Uganda, 1989 to 1997 5 girls 4 boys 3 HIV prevalence (%) 2 1 0 1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 Source: Kamali et al. AIDS 2000, 14: 427-434

  39. 30 illiterate primary education 25 secondary education 20 HIV prevalence (%) 15 10 5 0 1991-1994 1995-1997 HIV prevalence rate among pregnant 15-24 year-olds by educational status, Uganda Source: Kilian A et al. AIDS 1999, 13: 391-398.

  40. Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000 65 60 Botswana Uganda 55 South-Africa Life expectancy at birth, in years Zambia 50 Zimbabwe 45 40 35 1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00 Source: United Nations Population Division, 1998

  41. HIV prevalence in military personnel in Africa • Nigeria: 11% among peacekeepers returning from Sierra Leone and Liberia vs 5% in adult population • South Africa: 60-70% in military vs 20% in adult population Source: Nigeria AIDS bulletin No 15, May 20, 2000; The Mail & Guardian, Pretoria, March 31, 2000; UNAIDS/WHO 1999 estimate

  42. 5 HIV prevalence (%) 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Trend in HIV prevalence in 21 year old military conscripts in Thailand Source: Armed Forces Research Institute of Medical Sciences, Thailand

  43. I.V drug injection – a growing problem in eastern Europe

  44. Proportion of all new HIV infections that are in injecting drug users, selected countries, 1998-1999 100 90 80 70 60 Percentage 50 40 30 20 10 0 Canada China Latvia Malaysia Moldova Russian Ukraine Viet Nam Federation Source: National AIDS Programmes

  45. Annual number of newly registered HIV infections, Russia, 1993 to 1999 18,000 15,462 16,000 14,000 12,000 10,000 8,000 Number of HIV infections 6,000 4,399 3,947 4,000 1,546 2,000 196 108 158 0 93 94 95 96 97 98 99 Year of registration Source: Russian Federal AIDS Centre, Moscow

  46. Heterosexual transmission is taking over even in the West

  47. Heterosexual MSM + MSM/IDU 2500 2000 1500 Number of diagnoses 1000 500 0 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 Annual number of reported HIV infections in the UK, by mode of transmission, 1983 to 1999 Source: PHLS Communicable Disease Surveillance Centre UK, July 2000

  48. Effective therapy: epidemiological effects

  49. taking antiretroviral drugs 8000 AIDS deaths 7000 6000 AIDS cases 5000 4000 3000 2000 1000 0 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 AIDS patients, AIDS deaths and patients on HAART among homosexual men, San Francisco, USA, 1980 to 1998 Source: San Francisco Department of Public Health (California), USA, 1999

  50. Trends in Age-Adjusted* Rates of Death due to HIV Infection, USA, 1982-1998 *Using the age distribution of the projected year 2000 US population as the standard. **Preliminary 1998 data

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