AIDS: Thirty Years Later

On June 5, 1981 the first cases of Human Immunodeficiency Virus (HIV) were documented in a United States medical bulletin. 2011 marks the 30th anniversary of these 1st diagnosed cases of a virus that would become a global epidemic. Since its discovery in 1981, it is estimated that more than 20 million lives have been claimed by HIV (the virus that causes acquired immune deficiency syndrome (AIDS)), and according to the World Health Organization (WHO) another 5000 die each day while 7000 become newly infected.

Despite these grim figures, hope remains for the development of a vaccine. A recent HealthMap blog post gave an overview of new research findings out of the Oregon Health Sciences University, where researchers are working on development of a HIV/AIDS vaccine. The new vaccine was tested on rhesus macaque monkeys. The monkeys were infected with Simian Immunodeficiency Virus (SIV), the monkey form of HIV. This vaccine prevented infection in thirteen of the twenty-four monkeys who were originally infected with SIV for more than one year. These thirteen monkeys’ bodies controlled the replication of SIV to the point that highly sensitive tests could not find any traces of the virus. The next steps for the Oregon-based team will be to develop a vaccine for human testing.

33.3 million worldwide are currently living with HIV, and while a diagnosis of HIV used to be a death sentence, new antiretroviral therapy (ART) regimens are able to suppress the virus and slow the progression to AIDS. In addition, it was recently shown that ART is 96% effective in reducing HIV transmission where one partner has HIV. This is a crucial development, as sexual transmission accounts for 80% of new HIV infections.

According to the “AIDS at 30” report released June 3, 2011 by the Joint United Nations Program on HIV/AIDS (UNAIDS) a record number of people are now receiving ART in low- and middle-income countries thanks to many factors including the drop in price of ART over the past decade, newer drugs with fewer side effects (which improves patient adherence), and innovative programs that improve access to treatment. Despite the increase in ART utilization, another 9 million people were eligible for ART but were not receiving it. Even in wealthy, developed nations these highly effective medications are often difficult to obtain. This will certainly be one of many topics for discussion this week, as a United Nations General Assembly Special Session on HIV/AIDS is held June 8-10 in New York City.

It is hoped that international organizations and donor nations continue vigorous efforts to ensure that ART drugs are available and affordable to those in need. New science has shown that ART regimens can help us get ahead of the wave of new infections. The time to do this is now, as the global annual rate of new cases of HIV dropped over 25% over the last decade, and the exciting prospect remains that the epidemic could be stopped if all of the 34 million+ infected people could be treated. Ultimately, a vaccine or cure will be needed to halt this epidemic, and the “Berlin-patient,” (a man cured of HIV after receiving a stem cell transplant for a deadly form of leukemia) is living proof that this is possible.

Hope for HIV Vaccine; Ebola Strikes in Uganda

HIV/AIDS Vaccine Shows Promise
A new HIV/AIDS vaccine may be in the works as research at an Oregon University has shown to prevent virus replication in monkeys.

Louis Picker, a researcher at Oregon Health Sciences University (OHSU), specifically in the Vaccine and Gene Therapy Institute (VGTI) has been working on developing a HIV/AIDS vaccine from genetically modified cytomegalovirus (CMV).  CMV is a member of the Herpesviridae family and is most commonly associated with salivary glands in the body. CMV was used in this vaccine development because most people are already infected with CMV, although they show little to no symptoms. In addition, once an individual is infected with CMV they carry the virus for the rest of the life.

This new vaccine was tested on rhesus macaque monkeys at Oregon National Primate Research Center in Beaverton, Oregon. All of the moneys were infected with Simian Immunodeficiency Virus (SIV), the monkey form of Human Immunodeficiency Virus (HIV). This vaccine prevented infection in thirteen of the twenty-four monkeys who were originally infected with SIV for more than one year. These thirteen monkeys’ bodies controlled the replication of SIV to the point that highly sensitive tests could not find any traces of the virus.

These results are extremely promising and hopeful for developing a vaccine for humans. The next step for Dr. Picker and his team will be to develop the current vaccine for human testing.  If successful, this vaccine could prevent thousands of people in the United States from being infected each year.

Ebola Hits Uganda
Last week, a twelve-year old girl from Luwero died in the Bombo Military Hospital about 60 kilometers outside of Uganda’s capital, Kampala, from the deadly Ebola virus. Ebola was confirmed only after the girl’s blood sample tested positive for Ebola at the CDC in Atlanta.

Ebola virus is a viral genus in the Filoviridae family that causes Ebola hemorrhagic fever, which presents itself in patients by sudden symptoms of fever, malaise, muscle pain, headache, and pharynx inflammation. Rashes, red eyes, hiccups, and internal and external bleeding are also common in those suffering from Ebola.  There are four types that affect humans: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast and Ebola-Bundibugyo virus. Unfortunately, there is no known cure for Ebola and the fatality rate is about 85%.

Uganda’s last outbreak of Ebola occurred in 2007, but wasn’t officially declared until February 20, 2008. There were 148 people ill and 37 of them died. In hopes of preventing a similar situation, nearly 40 people who may have been exposed to the young girl who died have been quarantined and monitored for any early Ebola symptoms. Government officials have said visitors to Uganda do not need to worry about possible contact with the virus since these people were quarantined early.

Rio de Janeiro: Carnival 2011

The much-anticipated Carnival in Brazil comes to an end today, March 8th, better known in the United States as “Fat Tuesday”.  After four days of wild celebration, partygoers prepare themselves for 40 days of Lent until Easter. Carnival is an opportunity to not only let loose before Lent, but also for Brazilians to celebrate their culture with music, dancing and fun.  Carnival in Brazil is all about excess, lack of inhibition, and celebrations.

This giant celebration takes months and months of planning.  For the Samba schools that perform in the Samba stadium “Sambodromo”, dance moves must be choreographed, music written and rehearsed and elaborate costumes designed. These parades attract millions of spectators, both from Brazil and the rest of the world, as the biggest and best Samba schools show off their costumes and dance moves that have taken nearly all year to put together. Rio de Janeiro residents flood the streets to have their own neighborhood celebrations for Carnival, creating an euphoric atmosphere throughout the tropical city.

Behind the Carnival scenes, there is a lot of planning and preparation that takes places in the Brazilian Health Ministry. Brazil, well known for being a pioneer in HIV/AIDS awareness, increases its enthusiastic and aggressive HIV/AIDS preventions campaign during this 2011 Carnival season. During Carnival this year, the Brazilian Health Ministry distributed 89 million free condoms, which is 26 million more than last year. In addition, HIV/AIDS prevention announcements will be displayed extensively on television, radio and Internet advertisements throughout Carnival in an attempt to target and educate as many people as possible.

Australia Disbanding Outbreak Team and the Changing Face of HIV in China

http://healthmap.org/en/?ps=148  (Australia's alerts this year)

Australia to discontinue infectious disease investigation team:
Australia is one of very few industrialized nations without a national disease control center.  For the past 20 years, outbreak investigations have been preformed through the Master of Applied Epidemiology program at Australian National University (ANU).  Funding has run out, raising concerns among public health experts.  Professor Robert Douglas of ANU explained that the group played a role in “stemming the spread of about 200 epidemics, including severe acute respiratory syndrome (SARS), Hendra virus, the swine flu and food-borne infections.”  To see a map of outbreaks in Australia this year, please click here.

Cholera on Daru Island
A cholera outbreak in Papua New Guinea’s (PNG) Daru Island has Austalian official worried.  This outbreak is an extension of last year’s cholera outbreak in mainland PNG.   At least 16 people have died.   While 274 of the Torres Strait Islands are owned by Australia, Daru Island belongs to PNG.  Australia has enacted travel restrictions between the Torres Strait Islands and PNG to reduce the likelihood of cholera’s spread.  They have also sent emergency support to help combat the outbreak.

HIV in China
Recently, China released figures that as of September this year, there are 360,000 HIV positive cases in the country, among whom 130,000 have progressed to AIDS and 60,000 have died. Furthermore, HIV was the number one killer among all infectious disease-related deaths. In recent years, China has seen a shift in HIV demographic from high risk populations such as IV drug users and plasma sellers to the general population who contract the disease via heterosexual transmission. Multiple provinces and autonomous regions also reported this similar trend and an increase in HIV cases and deaths each year. While the country has made enormous strides over the years in reducing the stigma around the disease and promoting a message of tolerance and awareness through public education and propaganda, those infected with HIV still experience heavy discrimination and poor access to medical and social support. Just yesterday, in China’s first ever lawsuit over employment-discrimination against people who are HIV-positive, the court ruled against the defendant, citing that the city education bureau had correctly followed public service standards in assessing its teaching candidates.

Dengue in Brazil and Miami:
Since January 2010, Brazil has seen a 90% increase in deaths from Dengue as compared to the same period last year.  Many of the deaths have been from type 1 Dengue, which had been largely absent in Brazil since the 1990s. Health officials are particularly concerned about the dramatic increase in cases, as Brazil now enters its six-month rainy season. During this time frequent downpours cause standing water to become mosquito breeding ponds. The health ministry is launching a campaign to educate the public through TV and radio ads as well as through the distribution of flyers.

In other Dengue news, Miami has reported its 1st case of dengue fever in 50 years. This news comes 4 months after health authorities announced 1000 probable cases in Key West, FL. This news marks the likely resurgence of dengue in the state of Florida.

H1N1 Resurfaces:
In Harare, Zimbabwe 1 case of H1N1 has been confirmed  and 5 others are suspected. The public was notified of the cases via the state-owned Zimbabwe Broadcasting Corporation, which stated via the Deputy Minister of Child Health and Welfare Dr. Mombeshora that Zimbabwe possesses enough medicine to protect the public in the event of an H1N1 outbreak. For the combined areas of Harare, Masvingo, and Matabeleland North and South,  a total of 15,453 cases of H1N1 were suspected as of last Friday, November 5th.