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 l 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. l 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 l 1978 –Gay men in the US and Sweden -- and heterosexuals in Tanzania and Haiti -- begin showing signs of what will later be called AIDS. History of HIV Infection

5. l 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. History of HIV Infection

6. l 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.. History of HIV Infection

7. l 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. History of HIV Infection

8. l 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. History of HIV Infection

9. l 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. History of HIV Infection

10. l 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. History of HIV Infection

11. l 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 History of HIV Infection

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

13. UN/AIDS data on the global epidemic June 2000

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

15. About 15 000 new HIV infections a day in 1999 l More than 95% are in developing countries l 1 700 are in children under 15 years of age l 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. l Children living with HIV/AIDS l New HIV infections in 1999 l Deaths due to HIV/AIDS in 1999 l Cumulative number of deaths due to HIV/AIDS End-1999 global HIV/AIDS estimates Children (<15 years) 1.3 million 620 000 480 000 3.8 million

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

18. Leading causes of death in Africa, 1999 l 1 HIV/AIDS l 2 Acute lower respiratory infections l 3 Malaria l 4 Diarrhoeal diseases l 5 Perinatal conditions l 6 Measles l 7 Tuberculosis l 8 Cerebrovascular disease l 9 Ischaemic heart disease l 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

19. Adults and children estimated to be living with HIV/AIDS as of end 1999 Western Europe 520 000 North Africa & Middle East 220 000 sub-Saharan Africa 24.5 million Eastern Europe & Central Asia 420 000 South 5.6 million & South-East Asia 5.6 million Australia & New Zealand 15 000 North America 900 000 Caribbean 360 000 Latin America 1.3 million Total: 34.3 million East Asia & Pacific 530 000

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

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

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

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

24. Estimated deaths in children (<15 years) from HIV/AIDS during 1999 Western Europe < 100 North Africa & Middle East 1 000 sub-Saharan Africa 430 000 Eastern Europe & Central Asia < 500 East Asia & Pacific900 South & South-East Asia 44 000 Australia & New Zealand < 100 North America < 100 Caribbean 2 900 Latin America 3 600 Total: 480 000

25. Estimated number of adults and children newly infected with HIV during 1999 Western Europe 30 000 North Africa & Middle East 20 000 sub-Saharan Africa 4.0 million Eastern Europe & Central Asia 130 000 East Asia & Pacific 120 000 South & South-East Asia 800 000 Australia & New Zealand500 North America 45 000 Caribbean 60 000 Latin America 150 000 Total: 5.4 million

26. Estimated number of children (<15 years) newly infected with HIV during 1999 Western Europe < 500 North Africa & Middle East 2 000 sub-Saharan Africa 515 000 Eastern Europe & Central Asia500 East Asia & Pacific 2 400 South & South-East Asia 86 000 Australia & New Zealand < 100 North America < 500 Caribbean 4 000 Latin America 6 800 Total: 620 000

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

28. A global view of HIV infection 33 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. New infections - 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 4,000,000 8081828384858687888990919293949596979899 Highly industrialized countries North Africa & Middle East Eastern Europe & Central asia Sub-Saharan Africa Latin America & the Caribbean Southern & Eastern Asia Estimated annual number of new HIV infections by region, 1980 to 1999

31. People living with HIV/AIDS Highly industrialized countries North Africa & Middle East Eastern Europe & Central Asia Sub-Saharan Africa Latin America & the Caribbean Southern & Eastern Asia 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 8081828384858687888990919293949596979899 Estimated number of people living with HIV/AIDS by region, 1980 to 1999

32. Estimated adult HIV prevalence in Kenya, 1990-1999 Source: National AIDS and STD Control Programme, 1999 and UNAIDS 0 2 4 6 8 10 12 14 16 90919293949596979899 HIV prevalence (%)

33. HIV prevalence among pregnant women in South Africa, 1990 to 1999 Source: Department of Health, South Africa 0.7 1.7 2.1 4 7.6 10.4 14.2 17 22.8 22.4 0 5 10 15 20 25 90919293949596979899 HIV prevalence (%)

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

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

36. Projected population structure with and without the AIDS epidemic, Botswana, 2020 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 020406080100120140020406080100120140 Males Females Deficits due to AIDS Projected population structure in 2020 Population (thousands) Age in years 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 0 1 2 3 4 5 1989/901990/911991/921992/931993/941994/951995/961996/97 girls boys Source: Kamali et al. AIDS 2000, 14: 427-434 HIV prevalence (%)

39. HIV prevalence rate among pregnant 15-24 year-olds by educational status, Uganda 0 5 10 15 20 25 30 1991-19941995-1997 HIV prevalence (%) illiterate primary education secondary education 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 South-Africa 35 40 45 50 55 60 65 1950-551955-601960-651965-701970-751975-801980-851985-901990-951995-00 Life expectancy at birth, in years Botswana Uganda Zambia Zimbabwe Source: United Nations Population Division, 1998

41. HIV prevalence in military personnel in Africa l Nigeria: 11% among peacekeepers returning from Sierra Leone and Liberia vs 5% in adult population l 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. Trend in HIV prevalence in 21 year old military conscripts in Thailand Source: Armed Forces Research Institute of Medical Sciences, Thailand 1989199019911992199319941995199619971998 1999 HIV prevalence (%) 05

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 0 10 20 30 40 50 60 70 80 90 100 CanadaChinaLatviaMalaysiaMoldovaRussian Federation UkraineViet Nam Source: National AIDS Programmes Percentage

45. Annual number of newly registered HIV infections, Russia, 1993 to 1999 108158 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 93949596979899 Year of registration Number of HIV infections Source: Russian Federal AIDS Centre, Moscow

46. Heterosexual transmission is taking over even in the West

47. Annual number of reported HIV infections in the UK, by mode of transmission, 1983 to 1999 0 500 1000 1500 2000 2500 8384858687888990919293949596979899 Number of diagnoses HeterosexualMSM + MSM/IDU Source: PHLS Communicable Disease Surveillance Centre UK, July 2000

48. Effective therapy: epidemiological effects

49. 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. **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.

51. Annual number of deaths due to AIDS, Canada, 1990 to 1999 0 200 400 600 800 1000 1200 1400 1600 90919293949596979899 Number of AIDS deaths Source: Health Canada, HIV and AIDS in Canada. Surveillance Report to December 31, 1999

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

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

54. Reported AIDS Cases in Saudi Arabia – WHO data Total = 414

55. KFSH Experience

56. Number of New Patients Reported from KFSH

57. Sex Distribution Total of 168 patients

58. Age Distribution - 1998

59. AIDS Epidemiology KFSH Experience

60. Mode of Transmission 1993-1998 1985-1998 **Others : homosexual, bisexual, drugs, OTx, Unknown

61. Source of Infection

62. Conclusion l HIV epidemic continues to expand. l Poorer countries are more affected with enormous detrimental consequences medically, socially and economically. l HAART may lead to prolonged survival and larger pool of HIV infected patients. l Our country is not immune against HIV, hence preventive measures need to be adopted with great emphasis on education. l HIV is not going away any soon. Be prepared to manage HIV patients.