Department of Pathology, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PakistanPakistan
Department of General Medicine, Pakistan Institute of Medical Sciences, Islamabad, PakistanPakistan
Department of Biotechnology, International Islamic University, Islamabad, PakistanPakistan
Department of Biology, PMAS-Arid Agriculture University, Rawalpindi, Pakistan AIDS has emerged as a global epidemic in an unprecedented universal involvement compelling the transformation of the general outlook towards disease and the emergence of the concept of global health. First cases of AIDS were reported in 1981
Also available as PDF (figures and tables appear in the PDF).
AIDS has emerged as a global epidemic in an unprecedented universal involvement compelling the transformation of the general outlook towards disease and the emergence of the concept of global health. First cases of AIDS were reported in 19811 and the causative agent (HIV) was recognized in 1983 by Luc Montagnier.2 Different names were given to the disease initially such as lymphadenopathy, Kaposi’s sarcoma and opportunistic infections, Gay-related immune deficiency and the 4H disease, but ultimately the name AIDS was coined in July 1982.
Short HIV/AIDS Epidemic and Global Health Communication 1* 2 3 4 Usman Waheed ; Muneeba Azmat ; Muhammad Arshad ; Abida Arshad ; Hasan Abbas *Corresponding author 1 Usman Waheed Zaheer PhD Fellow Department of Pathology 1 Shaheed Zulfiqar Ali Bhutto Medical Department of Pathology, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan University 2 Department of General Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan Islamabad, Pakistan 3 Department of Biotechnology, International Islamic University, Islamabad, Pakistan Tel. +92333-5638702 E-mail: usman.waheed07@gmail.com 4Department of Biology, PMAS-Arid Agriculture University, Rawalpindi, Pakistan Volume 2 : Issue 4 Article Ref. #: 1000HARTOJ2118 AIDS has emerged as a global epidemic in an unprecedented universal involvement compelling the transformation of the general outlook towards disease and the emergence of the Article History: concept of global health. First cases of AIDS were reported in 19811 and the causative agent st Received: December 31st, 2015 (HIV) was recognized in 1983 by Luc Montagnier.2 Different names were given to the disease th initially such as lymphadenopathy, Kaposi’s sarcoma and opportunistic infections, Gay-related Accepted: February 16 , 2016 th immune deficiency and the 4H disease, but ultimately the name AIDS was coined in July 1982. Published: February 18 , 2016 The HIV attacks the body’s immune system decreasing the helper T-lymphocyte counts and leaving individuals susceptible to opportunistic infections and tumors. Citation Waheed U, Azmat M, Arshad M, Ar- More than 34 million people have died of AIDS since 1981 which includes 1.2 mil- shad A, Zaheer HA. HIV/AIDS Epi- demic and Global Health. HIV/AIDS lion only in 2014.3 An estimated 36.9 million people are living with HIV in 2015 (including Res Treat Open J. 2016; 2(4): 105- 2.6 million children), up from 29.8 million in 2001.4 Of 36.9 million infected individuals, 19 107. doi: 10.17140/HARTOJ-2-118 million are unaware of their HIV-positive status unfortunately. Around 5,600 people contract HIV every day, which makes 4 people being infected every minute and 230 people per hour.5 In the year 2013, 1.5 million people died due to AIDS out of which 220,000 were children under 15 years.6 (Table 1) Ninety percent of the HIV positive children are based in Sub Saharan Africa8 and glob- ally, most of children (90%) get the infection through vertical transmission from their mothers during pre and postpartum.9 Awareness to prevent the vertical transmission from mother to child is important for better quality of life in children of HIV mothers. Copyright ©2016 Waheed U. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), Chart showing number of people living with HIV in different regions of the world.6 Figure 1: which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2005 2006 2007 2008 2009 2010 2011 2012 2014 People living with 32.2 million 32.8 million 33.2 million 33.5 million 34.0 million 34.4 million 34.9 million 35.3 million 36.9 million HIV New HIV infections 2.9 million 2.8 million 2.7 million 2.6 million 2.6 million 2.5 million 2.5 million 2.3 million 2.0 million (Total) New HIV infections 2.3 million 2.3 million 2.2 million 2.2 million 2.2 million 2.2 million 2.2 million 2.0 million 1.8 million ( Adults) New HIV infections 540,000 520,000 480,000 450,000 400,000 360,000 310,000 260,000 150,000 ( Children) AIDS-related deaths 2.3 million 2.3 million 2.2 million 2.1 million 2.0 million 1.9 million 1.8 million 1.6 million 1.2 million : HIV/AIDS statistics 2005-2014.6,7 Table 1 Reasons for inadequate action against AIDS include in- classes of drugs which target diverse stages in the life cycle of sufficient funding along with mixed and unregulated infrastruc- HIV virus thus keeping the viral replication in check and pre- ture in developing countries. People living with HIV are also venting disease progression. Without the ARV treatment, the subjected to stigma and are sidelined from becoming productive transmission rate of HIV from mothers to their babies during individuals of a society. Thus the people living with HIV are pregnancy and delivery is around15-30%.11 A further 5-20% reluctant to renounce the safety of the status “Healthy” which become infected through breastfeeding.12 The PMTCT services not only leads to delay in getting treatment but also reduces the have scaled up and the proportion of women visiting PMTCT long term adherence to the HIV treatment. Along with these dif- has increased from 33% to 68%.13 Women who are HIV posi- ficulties, mobilizing resources and emphasizing sustainability by tive should be encouraged to give birth at a clinic. The services political commitment and smart investments have established a should further be scaled up so that all pregnant women across favorable course over the past decade with decrease in new HIV the developing world must be tested for HIV. Under the WHO infections.3 Recent statistics show a reduction in new HIV infec- guidelines on PMTCT, all HIV positive mothers identified dur- tions by 35% in general population along with a decline in infec- ing pregnancy, should receive a course of antiretroviral drugs tions among children by 58% since 2000 whereas AIDS-related to prevent mother to child transmission.14 The successful imple- deaths have also been reduced by 42% since the peak in 2004.6 mentation of PMTCT programme relies on public support and mobilization that can be achieved by investing energies for The HIV management needs a holistic approach of pre- awareness and petitioning with potential benefactors, services vention, treatment and follow-up of the HIV-infected individu- providers, policy makers and general public.
als. The prevention includes male circumcision, post and pre exposure of prophylaxis, injection safety, safe blood transfusion It is very important that HIV infected individuals are and safe sexual practices. The treatment modality is Antiretro- tested at the earliest to initiate the treatment regime. The test- viral Therapy (ARV) or combination of drugs Highly Active ing for HIV antibodies has been performed since 1985 and is Antiretroviral Therapy (HAART). These therapies result in the useful in rapid field testing, the reason being their feasibility in reduction of the HIV viral load in the blood and other bodily terms of ease to perform and economically affordable infrastruc- fluids to an undetectable level, thus minimizing the risk of HIV ture that obviates the need to process and store specimens and transmission from one individual to the other. There are more transport them from the field. Unprecedented numbers of kits are than 25 HIV medicines which are approved to treat HIV infec- available for testing HIV antibodies. The antibody test has sig- tions alone or in combination. These drugs are further grouped nificantly lesser yield in children who are then tested with PCR into six categories according to their mode of action such as since the antibody tests yield insignificant results in the first 18 Non-nucleoside reverse transcriptase inhibitors (NNRTIs) and months of life.
Nucleoside reverse transcriptase inhibitors (NRTIs) that inhibit the conversion of HIV RNA into DNA thus blocking the replica- Initial rampage by HIV was cut short by the collective tion cycle of HIV. Vitamins especially Vitamin A and mineral front against the AIDS by establishing fight against the disease. supplementation such as Selenium have also been used as an In 1993, the World Development Report devised a 3 pronged adjuvant to the standard treatment with variable results in qual- approach to develop government policies and endorsed the in- ity of life and virtually no effect on the prognosis. The greatest crease in prevention activities for HIV/AIDS activities by a fac- challenge in fighting the AIDS epidemic is loss to follow up due –15 15 tor of 10 . By the late 1900’s, access to antiretroviral therapy to non-compliance to therapy.
in the high income countries turned the tables on AIDS mortality, this was closely followed by introduction of ART in developing Apart from treating adults and children, the vertical and low income countries. Around 41% of the total individuals transmission of disease from mother to child is also kept in affected by HIV are now covered under ART that includes an es- check through the Prevention of mother-to-child transmission timated 200,000 children. Approximately, 12.9 million patients (PMTCT) services. Mothers are given ARV’s during pregnancy had access to antiretroviral therapy in 2013.
to eliminate the risk of transmission. The ARV’s have various The progress made in the Fight against AIDS is enor- (GHO) data: Number of deaths due to HIV/AIDS. http://www.
mous; however, for achieving the goal of eradication of HIV as who.int/gho/hiv/epidemic_status/deaths/en/. Accessed Decem- an epidemic by the year 2030, the efforts will have to be scaled ber 3, 2015.
up. The prevention of HIV infection in communities is possible through greater access to the drugs that can treat the individuals 7. The Joint United Nations Programme on HIV/AIDS (UN- and prevent mother to child transmission with appropriate test- AIDS). 2013 Global Fact Sheet. http://www.unaids.org/en/re- ing and support for the families. Drug availability along with de- sources/campaigns/globalreport2013/factsheet/. Accessed Feb- velopment of the current infrastructure with extensive capacity ruary 15, 2016.
building and improved management is required to eliminate the epidemic of AIDS.
8. WHO. PMTCT Strategic Vision 2010-2015: Preventing mother-to-child transmission of HIV to reach the UNGASS and UN members in 2015 have endorsed a bold agenda in Millenium Development Goals. http://apps.who.int/iris/bitstre development debate constructed around 17 Sustainable Devel- am/10665/44268/1/9789241599030_eng.pdf. Accessed Febru- opment Goals (SDGs) with a dynamic shift to public oriented ary 15, 2016.
approaches.16 Moreover, the next five years have been marked as crucial in scaling up the AIDS response. This up scaling will not 9. IATT on Prevention of HIV Transmission in Pregnant Wom- only pave ways to eradicate a public health problem by the year en, Mothers and their Children. Guidance on global scale-up of 2030, but would also generate benefits of US$1157 billion.16 the prevention of mother to child transmission of HIV: towards universal access for women, infants and young children and The scaling up of AIDS response includes stress on eliminating HIV and AIDS among children. http://www.unicef.
HIV prevention, and expanding access to treatment, increasing org/aids/files/PMTCT_enWEBNov26.pdf. Accessed February transparency and policy development based on better data with 15, 2016.
robust accountability, upholding human rights especially wom- en, and finding new ways to address the criminalization, stigma, 10. Overview of HIV treatments. 2015. https://www.aids.gov/ and discrimination against AIDS effected individuals. Increased hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-options/ efforts for research and development in fighting AIDS, global overview-of-hiv-treatments/. Accessed February 15, 2016.
access to HIV treatment and safeguarding the right to health are key elements in the prevention of HIV epidemic.
11. Singhal P, Naswa S, Marfatia YS. Pregnancy and sexu- ally transmitted viral infections. Indian J Sex Transm Dis. 2009; CONFLICTS OF INTEREST: None.
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