current status of the hiv/aids epidemic hail m. al-abdely, md consultant, infectious diseases

Current Status of the HIV/AIDS EpidemicCurrent Status of the HIV/AIDS Epidemic

Hail M. Al-Abdely, MDHail M. Al-Abdely, MD

Consultant, Infectious DiseasesConsultant, Infectious Diseases

History of HIV/AIDS

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

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.


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.


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..


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.


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.


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.


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.


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


1995-2000

– The era of Highly Active Anti-Retroviral Therapy (HAART).

– Understanding of Viral dynamics

– Effective prevention of perinatal transmission


UN/AIDS data on the global epidemicJune 2000

End-1999 global HIV/AIDS estimatesEnd-1999 global HIV/AIDS estimates Children and adultsChildren and adults

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

34.3 million

5.4 million

2.8 million

18.8 million

About 15 000 new HIV infections a day in 1999About 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

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

End-1999 global HIV/AIDS estimatesEnd-1999 global HIV/AIDS estimatesChildren Children (<15 years)(<15 years)

1.3 million

620 000

480 000

3.8 million

Leading causes of death globally, 1999Leading causes of death globally, 1999

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

12.7

9.9

7.1

4.8

4.8

4.2

4.0

3.0

1.9

Source: The World Health Report 2000, WHO

Rank % of total

Leading causes of death in Africa, 1999Leading causes of death in Africa, 1999

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

Rank % of total

Adults and children estimated to be living Adults and children estimated to be living with HIV/AIDS as of end 1999with HIV/AIDS as of end 1999

Western Europe

520 000520 000North Africa & Middle East

220 000220 000sub-Saharan

Africa

24.5 million24.5 million

Eastern Europe & Central Asia

420 000420 000

South & South-East Asia 5.6 million5.6 million

Australia & New Zealand

15 00015 000

North America

900 000900 000Caribbean

360 000360 000

Latin America


Total: 34.3 millionTotal: 34.3 million

East Asia & Pacific

530 000530 000

ChildrenChildren (<15 years)(<15 years) estimated to be living estimated to be living with HIV/AIDS as of end 1999with HIV/AIDS as of end 1999

Western Europe



Africa

1 million1 million

Eastern Europe &Central Asia

15 00015 000East Asia & Pacific

5 2005 200South & South-East Asia

200 000200 000


< 200< 200

North America

11 00011 000Caribbean

9 6009 600

Latin America

28 00028 000


Estimated adult and child deaths due to HIV/AIDSEstimated adult and child deaths due to HIV/AIDSfrom the beginning of the epidemic to end 1999from the beginning of the epidemic to end 1999

Western Europe



Africa







6 6006 600

North America

470 000470 000Caribbean

210 000210 000

Latin America

460 000460 000


Estimated deaths in children Estimated deaths in children (<15 years)(<15 years) due to due to HIV/AIDS from the beginning of the epidemic HIV/AIDS from the beginning of the epidemic

to end 1999to end 1999

Western Europe



Africa





440 000440 000


< 100< 100

North America

5 0005 000Caribbean

24 00024 000

Latin America

24 00024 000


Estimated adult and child deaths Estimated adult and child deaths from HIV/AIDS during 1999from HIV/AIDS during 1999

Western Europe



Africa





460 000460 000


< 200< 200

North America


30 00030 000

Latin America

48 00048 000


Estimated deaths in children Estimated deaths in children (<15 years)(<15 years) from HIV/AIDS during 1999from HIV/AIDS during 1999

Western Europe

< 100< 100North Africa & Middle East


Africa

430 000430 000


< 500< 500East Asia & Pacific

900900South & South-East Asia

44 00044 000


< 100< 100

North America

< 100< 100Caribbean

2 9002 900

Latin America

3 6003 600

Total: 480 000Total: 480 000

Estimated number of adults and childrenEstimated number of adults and childrennewly infected with HIV during 1999newly infected with HIV during 1999

Western Europe



Africa





800 000800 000


500500

North America


60 00060 000

Latin America

150 000150 000


Estimated number of children Estimated number of children (<15 years)(<15 years) newly infected with HIV during 1999newly infected with HIV during 1999

Western Europe

< 500< 500North Africa & Middle East


Africa

515 000515 000


500500East Asia & Pacific


86 00086 000


< 100< 100

North America

< 500< 500Caribbean

4 0004 000

Latin America

6 8006 800

Total: 620 000Total: 620 000

Cumulative number of children estimated to have Cumulative number of children estimated to have been orphaned by AIDS* at age 14 or youngerbeen orphaned by AIDS* at age 14 or younger

at the end of 1999at the end of 1999

Western Europe



Africa



500500 East Asia & Pacific


850 000850 000


< 500< 500

North America


85 00085 000

Latin America

110 000110 000

Total: 13.2 millionTotal: 13.2 million * Children who have lost their mother or both parents to AIDS before the age of 15 years

A global view of HIV infectionA global view of HIV infection 33 million adults living with HIV/AIDS as of end 199933 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

Spread of HIV over time in Asia, 1984 to 1999Spread 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

New

in

fect

ion

s

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Highly industrialized countries

North Africa & Middle EastEastern Europe & Central asiaSub-Saharan AfricaLatin America & the Caribbean

Southern & Eastern Asia

Estimated annual number of new HIV Estimated annual number of new HIV infections by region, 1980 to 1999infections by region, 1980 to 1999

Peo

ple

liv

ing

wit

h H

IV/A

IDS

Highly industrialized countries

North Africa & Middle East

Eastern Europe & Central Asia

Sub-Saharan AfricaLatin America & the Caribbean

Southern & Eastern Asia

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

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 Estimated number of people living with HIV/AIDS by region, 1980 to 1999HIV/AIDS by region, 1980 to 1999

Estimated adult HIV prevalence in Kenya, Estimated adult HIV prevalence in Kenya, 1990-19991990-1999

Source: National AIDS and STD Control Programme, 1999 and UNAIDS

0

2

4

6

8

10

12

14

16

90 91 92 93 94 95 96 97 98 99

HIV

pre

vale

nc

e (%

)

HIV prevalence among pregnant womenHIV prevalence among pregnant womenin South Africa, 1990 to 1999in South Africa, 1990 to 1999

Source: Department of Health, South Africa

0.71.7 2.1

4

7.6

10.4

14.2

17

22.8 22.4

0

5

10

15

20

25

90 91 92 93 94 95 96 97 98 99

HIV

pre

vale

nc

e (%

)

Impact of HIV/AIDS on urban households, Côte d’Ivoire

Impact of HIV/AIDS on urban households, Côte d’Ivoire

General populationGeneral population Families living with AIDSFamilies living with AIDS

Source: Simulation-based on data from Bechu, Delcroix and Guillaume, 1997

Monthly income per capitaMonthly income per capita

Monthly consumptionper capitaMonthly consumptionper capita

00

5 0005 000

10 00010 000

15 00015 000

20 00020 000

25 00025 000

– 5 000– 5 000

30 000 Francs CFA30 000 Francs CFA

Savings/DisavingsSavings/Disavings

Reduction in production in a household with an AIDS death, Zimbabwe

Crops

Maize

Cotton

Vegetables

Groundnuts

Cattle owned

Reduction in output

61%

47%

49%

37%

29%

Source: Stover & Bollinger, 1999

Projected population structure with and Projected population structure with and without the AIDS epidemic, Botswana, 2020without the AIDS epidemic, Botswana, 2020

80757065605550454035302520151050

020406080100120140 0 20 40 60 80 100 120 140

Males Females Deficits due to AIDS

Projected population structure in 2020

Population (thousands)

Ag

e in

yea

rs

Source: US Census Bureau, World Population Profile 2000

Prevention Campaigns can be effective

HIV prevalence rate among HIV prevalence rate among 13 to 19-year-olds, Uganda, 1989 to 199713 to 19-year-olds, Uganda, 1989 to 1997

0

1

2

3

4

5

1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97

girls

boys

Source: Kamali et al. AIDS 2000, 14: 427-434

HIV

pre

vale

nc

e (%

)

HIV prevalence rate among pregnant 15-24 year-olds HIV prevalence rate among pregnant 15-24 year-olds by educational status, Ugandaby educational status, Uganda

0

5

10

15

20

25

30

1991-1994 1995-1997

HIV

pre

vale

nc

e (%

)

illiterate

primary education

secondary education

Source: Kilian A et al. AIDS 1999, 13: 391-398.

Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000

South-Africa

35

40

45

50

55

60

65

1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00

Lif

e e

xp

ecta

ncy

at

bir

th,

in y

ears

Botswana

Uganda

Zambia

Zimbabwe

Source: United Nations Population Division, 1998

HIV prevalence in military personnel in AfricaHIV 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

Trend in HIV prevalence in 21 year old military Trend in HIV prevalence in 21 year old military conscripts in Thailandconscripts in Thailand

Source: Armed Forces Research Institute of Medical Sciences, Thailand

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

HIV

pre

vale

nc

e (%

)H

IV p

reva

len

ce

(%)

00

55

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

Proportion of all new HIV infections that are inProportion of all new HIV infections that are ininjecting drug users, selected countries, 1998-1999injecting drug users, selected countries, 1998-1999

0

10

20

30

40

50

60

70

80

90

100

Canada China Latvia Malaysia Moldova RussianFederation

Ukraine Viet Nam

Source: National AIDS Programmes

Per

cen

tag

e

Annual number of newly registered HIV infections, Annual number of newly registered HIV infections, Russia, 1993 to 1999Russia, 1993 to 1999

108 158 196

1,546

4,399 3,947

15,462

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

93 94 95 96 97 98 99

Year of registration

Nu

mb

er o

f H

IV i

nfe

ctio

ns

Source: Russian Federal AIDS Centre, Moscow

Heterosexual transmission is taking over even in the West

Annual number of reported HIV infections in the Annual number of reported HIV infections in the UK, by mode of transmission, 1983 to 1999UK, by mode of transmission, 1983 to 1999

0

500

1000

1500

2000

2500

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Nu

mb

er o

f d

iag

no

ses

Heterosexual MSM + MSM/IDU

Source: PHLS Communicable Disease Surveillance Centre UK, July 2000

Effective therapy: epidemiological effects

AIDS patients, AIDS deaths and patients AIDS patients, AIDS deaths and patients on HAART among homosexual men, San Francisco, on HAART among homosexual men, San Francisco,

USA, 1980 to 1998USA, 1980 to 1998

0

1000

2000

3000

4000

5000

6000

7000

8000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

taking antiretroviral drugstaking antiretroviral drugs

AIDS deathsAIDS deaths

AIDS casesAIDS cases

Source: San Francisco Department of Public Health (California), USA, 1999

0

2

4

6

8

10

12

14

16

18

82 84 86 88 90 92 94 96 98**

Year

Dea

ths

per

100

,000

Po

pu

lati

on

**Preliminary 1998 data

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.

Annual number of deaths due to AIDS, Annual number of deaths due to AIDS, Canada, 1990 to 1999Canada, 1990 to 1999

0

200

400

600

800

1000

1200

1400

1600

90 91 92 93 94 95 96 97 98 99

Nu

mb

er o

f A

IDS

de

ath

s

Source: Health Canada, HIV and AIDS in Canada. Surveillance Report to December 31, 1999

The Middle-East – “Good luck with an accurate data!”

Estimates of HIV/AIDS Cases in the Middle-East- end of 1999

Country Adults (15-49) Adult rate (%)North Africa & Middle East 210,000 0.12Algeria 11,000* 0.07*Bahrain 500* 0.15*Cyprus 400 0.10Egypt 8100* 0.02*Iraq 300* <0.01*Israel 2,400 0.08Jordan 660* 0.02*Kuwait 1,300* 0.12*Lebanon 1,500* 0.09*Libyan Arab Jamahiriya 1,400* 0.05*Morocco 5,000* 0.03*Oman 1,200* 0.11*Qatar 300* 0.09*Saudi Arabia 1,100* 0.01*Sudan 140,000* 0.99*Syrian Arab Republic 800* 0.01*Tunisia 2,200* 0.04*Turkey 2,500 0.01United Arab Emirates 2,300* 0.18*Yemen 900* 0.01*

Reported AIDS Cases in Saudi Arabia – WHO data

0

20

40

60

80

100

120

Ca

se

s

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Total = 414

KFSH Experience

Number of New Patients Reported from KFSHNumber of New Patients Reported from KFSH

1420

41

2315

28 27

80

0

10

20

30

40

50

60

70

80

85-86 87-88 89-90 91-92 93-94 95-96 97-98 99-2000

Sex Distribution

69%

31%

Male Female

Total of 168 patients

Age Distribution - 1998Age Distribution - 1998

7%14%

32%17%

30%

>50 35-49 25-34 16-24 <15

AIDS EpidemiologyKFSH Experience

0

5

10

15

20

25

30

35

85-86 87-88 89-90 91-92 93-94 95-96 97-98

Male Female <15-yr

Mode of Transmission

34%

16%

8%

2%

1993-1998

46%

30%

8.90%

14%

Blood Hetero Perinatal Others

1985-1998

**Others : homosexual, bisexual, drugs, OTx, Unknown

Source of InfectionSource of Infection

0

2

4

6

8

10

12

14

16

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

Haem Btx Hetero Per Otx Multiple

Conclusion

HIV epidemic continues to expand.

Poorer countries are more affected with enormous detrimental

consequences medically, socially and economically.

HAART may lead to prolonged survival and larger pool of HIV

infected patients.

Our country is not immune against HIV, hence preventive

measures need to be adopted with great emphasis on education.

HIV is not going away any soon. Be prepared to manage HIV

patients.

current status of the hiv/aids epidemic hail m. al-abdely, md consultant, infectious diseases

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