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Topic 1: INTRODUCTION TO
HIV/AIDS
COURSE CODE: ZOO 1100

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1. Overview

1. Introduction
In this topic, we will learn what is HIV/AIDS and its related theories. Also, we will cover the current global trends of HIV/AIDS

2. INTRODUCTION TO HIV/AIDS

1. What is HIV?
HIV stands for Human Immuno Defficeincy Virus which causes AIDS.

A blood test is carried out to find out whether a person is infected with HIV but tests positive for HIV it does not
necessary means that person has AIDS

AIDS diagnosis is made by a physician based on the definition case made CDC AIDS. A person who is infected with
HIV might receive an AIDS diagnosis after developing one of CDC defined AIDS indicator illness

HIV infected persons could receive an AIDS diagnosis on the basis of specific blood test (CD4 count) and might not
the basis of certain blood test (CD4) and might not have experienced any illness that is serious

Infection of HIV virus occurs when the virus attaches and penetrate the cells

The HIV virus targets specific cell types which are identified and is differentiated by the protein found on the surface
of the cell. The different cell indicates different proteins which are attractive to different viruses. For HIV virus-helper
cells and macrophages are the main cell types targeted by the virus. T-helper cells and macrophages are the main
players in the immune system of human.

2. What is AIDS?
AIDS means Acquired Immunodeficiency Syndrome. Over the time HIV infection have been seen to weaken the
immune system to the extend it have difficult in fighting off infections. These infections are normally regulated by
immune systems that are healthy but they cause problems or even become life threatening in an individual with AIDS.

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The immune system of an individual with HIV/AIDS has become weak the point that medical intervention might be
necessary to prevent serious illness.

§ AIDS is caused by HIV which is characterized by the weakening of the immune system which leaves
the body un prepared to fight the diseases. An individual might live with HIV for up to 10 years before
developing AIDS

§ Definition of AIDS is determined when CD4 cells are less than 200 cells per cubic millimeters

§ AIDS eventually results to death because of opportunistic infection (viral, fungal, and bacterial
infection) since the immune system is weak

§ Lack of treatment of AIDS could enhance rapid progression of diseases in one year of diagnosis

§ Update there is no cure or complete remedy for AIDS, although diseases could be managed by
antiretroviral treatment

3. History of HIV

The origin of the Human Immunodeficiency Virus (HIV) has been a subject of scientific research and debate since
the virus was identified in the 1980s. There is now a wealth of evidence on how, when and where HIV first began to
cause illness in humans.

HIV is a type of lentivirus, which means it attacks the immune system. In a similar way, the Simian Immunodeficiency
Virus (SIV) attacks the immune systems of monkeys and apes.1

Research found that HIV is related to SIV and there are many similarities between the two viruses. HIV-1 is closely
related to a strain of SIV found in chimpanzees, and HIV-2 is closely related to a strain of SIV found in sooty
mangabeys

In 1999, studies carried out found a strain of SIV (called SIVcpz) in a chimpanzee that was almost identical to HIV in
humans.

The scientist who discovered this connection concluded that it proved chimpanzees were the source of HIV-1, and
that the virus had at some point crossed species from chimps to humans

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HIV-2 comes from SIVs in sooty mangabey monkeys rather than chimpanzees. The crossover to humans is believed
to have happened in a similar way (through the butchering and consumption of monkey meat).

HIV-2 is far rarer, and less infectious than HIV-1. As a result, it infects far fewer people, and is mainly found in a few
countries in West Africa like Mali, Mauritania, Nigeria and Sierra Leone.

3. Theories of HIV/AIDS

1. Contaminated polio vaccine theory

The speculation continues that the AIDS virus, human immunodeficiency virus type 1 (HIV- 1), may have crossed into
humans as a result of contamination of the oral polio vaccine (OPV). This 'OPV/AIDS theory' claims that chimpanzees
from the vicinity of Stanleyville-- now Kisangani in the Democratic Republic of Congo--were the source of a simian
immunodeficiency virus (SIVcpz) that was transmitted to humans when chimpanzee tissues were allegedly used in
the preparation of OPV.

2. The cut hunter theory

The process of viral transfer from animals to humans is known as zoonosis. It is now generally accepted that HIV is
a descendant of the SIV because certain strains of SIVs have a homology to HIV-1 and -2. The virulent HIV-1 has its
closest counterpart in SIV of the chimpanzees (SIVcpz) and the more benign HIV-2 in the SIV of the sooty mangabeys
(SIV- sm). The basis of this theory is that SIV-cpz and SIV-sm were transferred to humans as a result of these
primates being killed and eaten, a practice know as "bushmeat hunting". While being butchered, their blood 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
transformed into HIV-1 or -2. Every time a SIV passed from a chimpanzee to man, it would develop in a slightly
different way and produce a slightly different strain. The fact that there are several different early strains of HIV, each
with a slightly different genetic makeup, would support this theory. Secondly, in Africa, retroviral zoonosis is still
occurring, as postulated in the article by Wolfe et al.[20] Discoveries such as this, have led to a call for an outright
ban on bushmeat hunting. The timing of the AIDS epidemic, according to this theory is attributed to urbanization and
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regional commerce, which facilitated conditions for sexually transmitted diseases. However, the emergence of the
AIDS epidemic in the mid-70s could not be explained by this theory alone as bushmeat hunting and hence SIV
zoonosis has been going on for centuries.

3. The contaminated needle theory

The lead role in this theory was played by Preston Marx, a virologist in primate research, who had worked extensively
on SIV. During a number of trips in the northern and eastern parts of Sierra Leone, Marx collected blood samples
from sooty mangabeys and also from the villagers who hunted the primates. In his laboratory in the United States, he
found that the mangabey blood samples tested positive for SIV and that the blood samples from a few of the villagers
contained both HIV and SIV genes. He was convinced that retroviral zoonosis must have been going on for centuries
but he was not sure of what "kick started" the epidemic of HIV and the timing of the epidemic in the mid-70s.

Now serendipity plays a hand. On a flight from New York to New Orleans, he noticed a passenger reading an article
by one of his colleagues in Manhattan. Marx was captivated by this theory and felt that retroviral zoonosis and the re-
use of unsterile needles, as practiced in Africa in the mid-50s could have spread HIV from person to person and
ignited the epidemic. Hence, he proposed the theory of serial passage.

4. The theory of serial passage

The process of serial passage commences when a person exposed to SIV, through retroviral zoonosis, receives an
injection. When the same needle is used to inject another individual, the SIV gets transferred and infects the second
person. This person then receives another injection with a new needle which is re-used on a third patient. This
procedure gets repeated and with each passage the SIV adapts and grows stronger to the human immune system.
The virus is thus serially passaged through several persons by contaminated needles and this process eventually
transforms the benign SIV into the virulent HIV. This transformed HIV is virulent enough to be transmitted through
sexual contact and thus started an epidemic.

The history of the hypodermic syringe and needle in Africa bears testimony to this theory. Post World War II, penicillin
was introduced as an antibiotic. In 1943, 21 million units, were produced which increased to 120 million units in 1949.
In the 1950s, WHO and other agencies launched massive health programs in Africa. Poverty and limited resources
compelled the reuse of syringe and needles. Marx demonstrated experimentally that the SIV became 1000 times

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more pathogenic when serially passaged through just three monkeys. This theory is less flawed than the
contaminated OPV and the cut hunter theories. The only explanation it lacked was the latent interval between the
use of unsterile needles.

5. The colonialism theory

The colonialism theory is based on the cut hunter theory premise but is more thorough and specific. Joseph Conrads'
novel regarding the colonial rule in Belgian Congo, "Heart of Darkness", was as much fact as fiction and described
the horror of the official policies in the Congo. The Belgian colonial rule under King Leopold was very harsh and cruel.
It is estimated that more Africans died as a result of colonial practice in French Equatorial Africa and Belgian Congo
between 1880 and onset of World War II, then had been taken from Africa as slaves in the preceding 400 years. The
first census in 1920s estimated that the population in the two colonies, at that stage was 15 million. Census recorders
reported that about another 15 million had died in the preceding two decades. A fatality of 50% far exceeds even the
35% fatality rate of the plague in Europe. The state of the colonies was such that they had a poor diet, poor sanitation
and exhausting labor demands. The well-meaning but ill equipped doctors, trying to protect workers from various
rampant diseases, faced an uphill task. Re-use of syringes and unsterile needles was rampant and to appease the
laborers, sex workers were officially encouraged. The transfer of pathogens under such circumstances was inevitable
emergence of the HIV epidemic.

4. Global trends of HIV/AIDS

In 2022, around 130,000 [90,000-210,000] children aged 0-9 were newly infected with HIV, bringing the total number
of children aged 0-9 living with HIV to 930,000 [730,000-1.28 million]. Nearly 85 per cent of these children live in sub-
Saharan Africa. One bright spot on the global horizon is the rapid decline of approximately 58 per cent in new HIV
infections among children aged 0-9 since 2010 due to stepped-up efforts to prevent mother-to-child transmission of
HIV. However, the number of new HIV infections among adolescents (aged 10-19) has declined at a slower rate of
about 47 per cent.
The number of new HIV infections has plateaued in recent years

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Number of annual new HIV infections among children aged 0–9 years and adolescents aged 10–19 years, 2000–
2022

An estimated 100,000 [67,000-146,000] children and adolescents died from AIDS-related causes in 2022. About 73
per cent of these preventable deaths occurred among children under 10 years old. The number of annual AIDS-
related deaths among children has declined by about 80 per cent since its peak in 2002, while the number of annual
AIDS-related deaths among those aged 10-19 has only decreased by 27 per cent since 2002.

While tremendous strides have been made in early childhood survival for
children living with HIV, adolescents are being left behind
Number of AIDS-related deaths among children aged 0–9 years and adolescents aged 10–19 years, 2000–2022

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5. Geographic disparity of HIV/AIDS Distribution

Sub-Saharan Africa, particularly Southern Africa, remains the region most heavily affected by the epidemic. In 2022,
sub-Saharan Africa accounted for approximately 66 per cent of people of all ages living with HIV and 85 per cent of
children and adolescents living with HIV worldwide. The spread of HIV in sub-Saharan Africa is mostly through
heterosexual relationships, both in the context of transactional and commercial sex and in longer-term relationships,
including marriage. Current evidence in Southern Africa has identified sexual relationships between adolescent girls
or young women and older men as a common HIV transmission route. In addition, infants born to mothers living with
HIV are at risk of becoming infected if their mothers are not on effective treatment or retained in care.

People in sub-Saharan Africa are disproportionately affected by the HIV

epidemic, especially children
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Number of children aged 0–19 years living with HIV, 2022

In most other regions of the world, HIV disproportionately affects persons who inject drugs, men who have sex with
men and sex workers. The epidemic is evolving, however, and transmission patterns are changing throughout the
world. In Eastern Europe and Central Asia, HIV epidemics that were once distinguished largely by transmission
among persons who inject drugs are now increasingly characterized by significant sexual transmission. In parts of
Asia, HIV is transmitted more and more among heterosexual couples. In Asia as a whole, HIV epidemics have long
been concentrated in persons who inject drugs, sex workers and their clients, and men who have sex with men. Now,
HIV infections are steadily spreading into lower-risk populations through transmission to the sexual partners of those
most at risk.

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