Pandemic

8 August 2016

TuberculosisWe are entering the third decade of what may be the most devastating epidemic in human history: HIV/AIDS. The HIV/AIDS Pandemic is a large-scale epidemic affecting more than one country. AIDS was first clinically diagnosed in the early 1980s but retrospective diagnosis suggests it existed well before this date. AIDS is a syndrome, which develops from an impaired ability to fight diseases. It undermines the body’s defenses against viruses, infections and malignancies.

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Here, we describe the origins and evolution of these viruses, and the circumstances that led to the AIDS pandemic. Pandemic Assignment Since scientists identified the HIV as the cause of AIDS in 1983, it has spread insistently, causing one of the most harmful pandemics ever recorded in human history. However, concerted global efforts to fight the pandemic are making a significant difference. More than nine million people living with HIV in low and middle-income countries now have access to life-saving antiretroviral treatments.

HIV/AIDS Overview Human immunodeficiency virus (HIV) invades the body through the exchange of certain body fluids. The virus invades cells such as T helper cells and begins to replicate itself in the human body. Acquired immunodeficiency syndrome (AIDS) of humans is caused by two lentiviruses, “HIV-1 and HIV-2; HIV-1 accounts for the majority of infections in the world, and has at least 10 genetic subtypes” (Lamptey, Wigley, Carr, Collymore, 2002).

Both HIVs are the result of multiple cross-species transmissions of simian immunodeficiency viruses (SIVs) naturally infecting African primates. However, as according to Sharp & Hahn (2011), one transmission event, involving SIVcpz from chimpanzees in southeastern Cameroon, gave rise to HIV-1 group M—the principal cause of the AIDS pandemic” and noted that by “tracing the genetic changes that occurred as SIVs crossed from monkeys to apes and from apes to humans”. AIDS Pandemic and the Efforts to Stop HIV/AIDS

According to Merson “on June 5, 1981, few suspected a pandemic of AIDS when the Centers for Disease Control reported five cases of Pneumocystis carinii pneumonia (PCP) in young homosexual men in Los Angeles” (2006). Morbidity and Mortality Weekly Report (MMWR) reported that all the men had other unusual infections as well, indicating that their immune systems were not working; two had already died by the time the report was published. In a timeline created by AIDS. com, “this edition of the MMWR marks the first official reporting of what will become known as the AIDS epidemic” (2014).

Although “after pandemic HIV-1 first emerged in colonial west central Africa, it spread for some 50 to 70 years before it was recognized” (Sharp & Hahn, 2011) because phylogenetic and statistical analyses have dated the last common ancestor of HIV-1 to around 1910 to 1930. For a while the American government completely ignored the emerging AIDS pandemic. The first attempt to treat HIV was in “September 1986, when early results from clinical trials involving AZT (zidovudine) – a drug that was first investigated as a cancer treatment – showed that it might slow the attack of HIV” (AVERT, 2013).

Although AZT could slow progression to AIDS in HIV positive individuals with no symptoms, a year’s supply for each person would cost around seven-thousand dollars and many did not have adequate health insurance to cover the cost. In 1995, “FDA announced that the drug 3TC (lamivudine) had been approved for use in combination with AZT in treating AIDS and HIV” (AVERT, 2013) after a number of studies had shown that HIV could quickly become resistant to AZT and that the drug had no benefit for those in the early stages of the disease.

On April 5th 1990 Ryan White, schoolboy who had become infected with HIV via a blood transfusion for his haemophilia, died. He was known for his fight to return to public school after he was banned due to fears of spreading of AIDS to other children. “Following Ryan’s death, the American government implemented a new programme named after him – the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act” (AVERT, 2013). Its aim was to improve the quality and availability of care for low-income, uninsured and underinsured individuals and families affected by HIV.

In 2000, the government funded programs such as needle exchange services and abstinence-only education and in 2001 the Centers of Disease Control (CDC) set a goal to halve the number of people infected with HIV each year in the USA to 20,000 by the end of 2005 but by 2003 it was already clear that the CDC’s goal would be missed, the number of new infections had shown no sign of declining. In 2006, President Bush signed the reauthorisation of the Ryan White HIV/AIDS Program, “since its creation in 1990 the program had provided federal funding for thousands of

Americans living with HIV/AIDS unable to pay for their treatment themselves” (AVERT, 2013). In 2007, raltegravir – was approved by the FDA which according to AVERT “Raltegravir was the first of a new class called integrase inhibitors” and “the significant progress in treatment proved to be particularly important to thousands of HIV positive Americans whose treatment had been failing due to drug resistance (2013). It was believed to provide extended years of meaningful survival to patients.

In July 2010, “the USA’s first HIV/AIDS Strategy was released” (The White House Office of National AIDS Policy, 2010) and reducing new HIV infections was included as one of the Strategy’s three core aims. According to AVERT (2013), “in order to reduce new infections without an increase in funding, the Strategy recommended that HIV prevention efforts be intensified in the communities where HIV is the most heavily concentrated”.

MedlinePlus concluded that “there is no cure or vaccine to prevent HIV/AIDS, but early detection through HIV testing and treatment can frequently turn this fatal disease into a manageable chronic disease” (2009). The HIV-1 pandemic is a complex mix of diverse epidemics within and between countries and regions of the world. “AIDS remains the fourth leading cause of death in low-income countries” (International AIDS Vaccine Initiative, 2014). While there will never be a solution to HIV and AIDS, a preventive vaccine would do a great deal to curb the pandemic.

But unfortunately, the problem with developing a vaccine is that the HIV genome mutates very quickly. Stowell (2006) explains that all organisms vary a little throughout the centuries. The HIV genome mutates around 1000 times more quickly than the human genome – around 1000 times more mutations accumulate in a single year, relative to the length of the genome. Antiretroviral treatment has transformed AIDS from an inevitably fatal condition to a chronic, manageable disease in some settings.

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