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CCS 103 HIV/AIDS
Introduction to HIV/AIDS
Learning outcomes
By end of the lecture, you should be able to
• Explain the meaning of HIV/AIDS?
• Explain the various theories about the origin of HIV.
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What does HIV stand for?
Definition of terms
• HIV - The initials stands for Human Immunodeficiency Virus, which is
the virus that causes HIV infection.
• HIV virus is transmitted from person to another when infected blood,
semen, or vaginal secretions come in contact with an uninfected
person’s broken skin or mucous membranes.
A mucous membrane is wet, thin tissue found in certain openings to the
human body. These can include the gut (mouth, rectum etc.), eyes,
nose, reproductive organs (vagina and opening of the penis).
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• In addition, infected pregnant women can pass HIV to their baby
during pregnancy or delivery, as well as through breast-feeding.
• Some of the people with HIV infection develop AIDS which is the
most advanced stage of HIV infection.
Features of the virus
• There are 2 major variants (genotypes) of HIV.
• HIV-1 is the most common type of HIV which accounts for majority (98%)
of HIV infections worldwide. It is also more virulent/fetal than HIV-2.
• HIV-2 – relatively less prevalent/common compared to HIV-1. Its common
in West Africa.
• HIV-2 is less fatal/less pathogenic/benign and progresses more slowly
compared to HIV-1.
• There are also subtypes, strains and also recombinant forms within these
2 variants. This is because HIV is a highly mutating virus.
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• HIV is an Icosahedral (20 sided), enveloped RNA (ribonucleic acid) virus of
the family lentivirus, subfamily retroviruses.
• Retroviruses have an enzyme called reverse transcriptase that gives
them the unique property of making DNA (deoxyribonucleic acid) from
their RNA after entering a cell. The retroviral DNA can then integrate
into the chromosomal DNA of the host cell, to be expressed there.
• Note that Simian Immunodeficiency Virus (SIV) is a close retrovirus to HIV
and it infects monkeys and nonhuman primates such as Chimpanzee and
Gorillas.
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What does AIDS stand for?
• AIDS stands for Acquired Immunodeficiency Syndrome.
• Acquired – means that the disease is not hereditary but develops
after birth from contact with HIV.
• Immunodeficiency – means that the disease causes weakening of
the immune system that is characterized by the failure of the host
to control and eliminate HIV. Individuals with weakened immune
systems are more vulnerable to many disease-causing agents.
• Syndrome – refers to a group of symptoms that collectively
indicate or characterize a disease. For AIDS, this can include the
development of certain infections and/or cancers, decrease in the
number of immune cells called CD4+ cells (T helper lymphocytes).
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How does HIV cause AIDS?
• HIV attacks and destroys certain types of white blood cells called T helper
lymphocytes, also called CD4+ cells which are crucial to the normal function of
the human immune system. CD4+ cells are important infection-fighting cells of
the immune system.
• In fact, loss of these cells in people with HIV is an extremely powerful predictor
of the development of AIDS.
• Studies have also revealed that most people infected with HIV carry and under
no anti-retroviral treatment may carry the virus up to 10 years before enough
damage is done to the immune system for AIDS to develop.
• However, this time vary greatly from person to person and depended on many
factors, including a person's health status and their health-related behaviors.
NB: A person can be infected with HIV and not have AIDS.
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Historical overview of HIV/AIDS - in brief
The earliest known case of HIV-1 in a human was from a blood
sample collected in 1959 from a man in Democratic Republic of
Congo, but it is not known how he became infected.
Up until the 1980s, we don’t know how many people were
infected with HIV or developed AIDS. By this time, HIV may have
spread to several continents.
- However, it is known that the virus has existed in the United
States in 1970s.
- From 1979-1981 rare types of pneumonia e.g., Pneumocystis
carinii pneumonia (PCP), cancers e.g., Kaposi’s Sarcoma , and
other conditions (i.e., opportunistic infections) that do not
affect people with healthy immune systems were being
reported by doctors in USA among male patients who had sex
with other men.
- AIDS was therefore first described in 1981.
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• 1982 - the Centre for Disease control (CDC) began to use the term
“Acquired Immunodeficiency Syndrome (AIDS).
• Formal tracking (surveillance) of AIDS cases began that year in the United
States.
• 1983 - HIV virus was isolated and identified by researchers at the Pasteur
Institute in France.
• The virus was at first named lymphadenopathy- associated virus (LAV) by
an International Scientific Committee.
• The CDC identified all major routes of transmission and ruled out
transmission by casual contact, food, water, air or surfaces.
• The CDC also published their first set of recommended precautions for
healthcare workers and allied health professionals to prevent HIV
transmission.
• The World Health Organization (WHO) held its first meeting to assess the
global AIDS situation and began international surveillance.
- 1984 - the virus was isolated by the National Cancer Institute in the United States
and named Human T-cell lymphotropic virus-type III (HTLV-III).
- First case was also described in Kenya.
- 1985 - The U.S Food and Drug Administration (FDA) licensed the first commercial
antibody test - an Enzyme-Linked Immunosorbent Assay (ELISA) used to detect
antibodies to the virus and to screen blood donors.
1986
- The International Committee on the Taxonomy of Viruses said that the virus that
causes AIDS will officially be called HIV (Human Immunodeficiency Virus (HIV-1)
instead of HTLV-III or LAV.
- HIV-2 was also identified.
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1987
• The WHO launched the Global Program on AIDS to raise awareness;
provide technical and financial support to countries; conduct research;
promote participation by NGOs; and promote the rights of people living
with HIV.
• The U.S Food and Drug Administration (FDA) approved the first
antiretroviral drug, zidovudine (AZT), as treatment for HIV.
• The WHO confirmed that HIV could be passed from mother to child
during breastfeeding.
• The WHO estimated that 5-10 million people were living with HIV
worldwide.
• 1988 - WHO declared 1s t December as the first World AIDS Day.
• 1992 - AIDS becomes the leading cause of death among adults ages 25-
44 in the U.S.
• 1995 - FDA approved a new HIV drug which led a new era of highly
active anti-Retroviral treatment (HAART).
• HAART involves taking three or more drugs that fight HIV at the same
time (a combination therapy).
• HAART brought an immediate decline of between 60% and 80% in rates
of AIDS-related deaths and hospitalisation in those countries which
could afford.
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• 1996 - FDA approved another drug for HIV management (nevirapine).
• 1999 - WHO announced that AIDS was the fourth biggest cause of death worldwide
and number one killer in Africa.
• About 33 million people were living with HIV and 14 million people had died from
AIDS since the start of the pandemic.
• 2006 - male circumcision was found to reduce the risk of female-to-male HIV
transmission by 60%.
• 2012 - The FDA approved pre-exposure prophylaxis (PrEP) for HIV-negative people
to prevent the sexual transmission of HIV.
• 2017 - For the first time ever, more than half of the global population living with HIV
are receiving antiretroviral treatment (ARVs), a record of 19.5 million people.
Common theories of origin of HIV/AIDS
• When and where the HIV virus first emerged has remained unknown for
many years.
• However, several theories have been put forward, but none is
conclusively agreed on the origin of HIV/AIDS.
• Some of the mostly acknowledged theories about the origin of HIV
include the following:
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1. Religious theories (God’s wrath and witchcraft)
• Many religious groups believe that HIV came from an angry God who
was unhappy with homosexuality and promiscuity since the scriptures
condemn these practices.
• Many Africans also believe that AIDS is caused by another supernatural
power – witchcraft, and they use anti-witchcraft rituals and objects to
counteract the infection.
For further reading: Adam Ashforth (2002). An Epidemic of Witchcraft? The Implications of AIDS for
the Post-Apartheid State, African Studies. https://doi.org/10.1080/00020180220140109
2. The contaminated needle theory (the theory of serial passage)
• It was in the 1950s when the use of disposable plastic syringes became
common around the world as a cheap, sterile way to administer medicines.
• However, due to the huge quantities of syringes needed in Africa which would
have been very costly.
• It is therefore likely that the African healthcare professionals working on
inoculation and other medical programmes, could have used one single
syringe to inject multiple patients without any sterilisation in between.
• This would rapidly have transferred any HIV from one person to another.
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3. The cut hunter theory
• Infectious diseases that are transmitted from animals to humans are called zoonosis.
• It is now generally accepted that HIV is a descendant of the simian immunodeficiency virus (SIV)
because certain strains of SIVs are closely related to HIV-1 and -2.
• The basis of this theory is that SIV was transferred to humans as a result of primates such
chimpanzee being killed and eaten - a practice know as ‘‘bushmeat hunting’’.
• While being butchered, the blood of these primates got into the cuts and wounds of the hunter.
These SIVs then adapted to the hunter’s body and then over a period of time they transformed
into HIV-1 or -2.
• Every time a SIV passed from a chimpanzee to man, it would produce a slightly different strain.
The fact that there are several different strains of HIV would support this theory.
• Secondly, in Africa, retroviral zoonosis is still occurring, recent one being the Ebola.
4. The contaminated Oral Polio Vaccine (OPV) theory
• The most controversial and thought provoking theory.
• There are many actors in this theory but the lead player is a former BBC
journalist - Edward Hooper who lived in Africa between 1981 and 1986.
• In 1986, while in Kampala, Uganda, he reported that hundreds of people on
the shores of Lake Victoria were dying of a mysterious illness believed to be
AIDS.
• The mysterious illness involved cough, fever, ulcers in the mouth, sores and
constant diarrhoea. All patients were also thin and shrunken and therefore, it
was called SLIMS.
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• Hooper suggested that HIV could be traced to the testing of an oral
polio vaccine called CHAT that had been administered to about a
million people in Central Africa (Congo, Rwanda and Burundi) in
the late 1950s.
• He believed that the CHAT oral polio vaccine was Chat was
contaminated with SIV from chimpanzees as the live polio virus
was grown using grown kidney cells obtained from local chimps.
• He claimed that vaccinated people with this SIV contaminated
CHAT polio vaccine later become infected with HIV.
5. The colonialism theory
• This theory is based on cut hunter and contaminated
needle theory premise.
• It was first proposed in 2000 by Jim Moore - an American
specialist in primate behaviour, who published his findings
in the journal AIDS Research and Human Retroviruses.
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- During the late 19th and early 20th century, much of Africa was
ruled by colonial forces.
- In areas such as French Equatorial Africa and the Belgian Congo,
colonial rule were harsh and many Africans were forced into labour
camps where sanitation was poor, food was scare and physical
demands were extreme.
- These conditions created poor health in anyone, so SIV could
easily have infiltrated the labour force and taken advantage of their
weakened immune systems to become HIV.
• A stray and perhaps sick chimpanzee with SIV may also have been taken by workers
as an extra source of food with this virus (SIV) later transforming into HIV.
• Jim Moore also believes that many of the labourers were vaccinated with unsterile
needles against diseases such as smallpox to keep them alive and working.
• Also, many of the labour camps officially encouraged and actively employed sex
workers to keep the workers happy.
• All these factors created numerous possibilities for HIV transmission.
• Moore’s support to his theory is the fact that the labour camps were set up around
the time that HIV was first believed to have passed into humans - the early part of
the 20th century.
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6. Conspiracy theories/beliefs
• A conspiracy theory attempt to explain harmful or tragic events as
the result of the actions of a small powerful group.
• Conspiracy beliefs about the origin of HIV and the role of the
government in the AIDS epidemic are common, particularly in the
African Americans, Latino populations and less common among the
whites and Asians.
• A recent study done in California found that 27% of African Americans believed that
“HIV/AIDS is a man-made virus that the federal government made to kill and wipe out
black people”
• Another study also found that 20% of black American men strongly agreed that AIDS was
produced in a government laboratory to control black population.
• Further, over 50% of the African Americans also believed that the government secretly
had an HIV/AIDS vaccine that was being withheld from the poor.
• These beliefs have potentially dangerous consequences for HIV prevention and AIDS
treatment: Conspiracy beliefs are significantly associated with negative attitudes toward
condom use and inconsistent condom use among black man.
• Source: Ross et al., (2006). Conspiracy Beliefs about the Origin of HIV/AIDS in Four
Racial/Ethnic Groups. https://dx.doi.org/10.1097%2F01.qai.0000209897.59384.52
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7. Monkey origin theory
• A recent study done in 2010 by Paul Sharp (Nottingham
University) and Beatrice H. Hahn (University of Alabama)
reported that HIV-1 may have originated from chimpanzees
and that the virus had at some point crossed species from
chimps to humans.
Source: Paul Sharp & Beatrice H. Hahn, (2010). The evolution of HIV-1
and the origin of AIDS. https://doi.org/10.1098/rstb.2010.0031
8. Mysterious origin theory
- This theory suggests that viral material was carried by a comet
passing close to the earth and that this material was
deposited, subsequently infecting nearby people.
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