Review Article ISSN 2639-9458

Microbiology & Infectious Diseases

Past Present and Future Status of HIV-AIDS Pandemic Problem in World

Narendra K Chopra*, Han Ni and Vichard Lim

Correspondence:
*

Narendra K Chopra, Faculty of Medicine SEGI University, Clinical

Faculty of Medicine SEGI University, Clinical Campus, Hospital Campus, Hospital Sibu, (Sarawak State), Malaysia.
Sibu, (Sarawak State), Malaysia.
Received: 15 December 2018; Accepted: 20 January 2019

Citation: Narendra K Chopra, Han Ni, Vichard Lim. Past Present and Future Status of HIV-AIDS Pandemic Problem in World.
Microbiol Infect Dis. 2019; 3(1): 1-6.

ABSTRACT
The origin of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has puzzled
scientists ever since the illness first came to light in early 1980s. The first recognized case of AIDS occurred in
USA in 1981. For over 25 years it has been the subject of fierce debate and cause of countless arguments. It is
now generally accepted that HIV is a descendent of simian immunodeficiency virus and there are many theories
about how these “Zoonosis” originated and how SIV became HIV in human. Advances in anti retroviral treatment
have steadily reduced the morbidity and mortality associated with HIV infection. However in the low-income,
high- prevalence countries, antiretroviral medication has taken a long time to reach the people who actually
need it. Access to medication must greatly improve if millions of deaths are to be avoided. HIV is preventable and
controllable disease with integrated primary health care approach and with chain of strong effective surveillance
system. Unless great progress is made in prevention, the number of people living with HIV will outstrip the resources
available for treatment. As per data from UNAIDS summary of global epidemic 2017, total 36.9 million people are
living with HIV, 1.8 millions are newly HIV infected adults & 1.8 million are infected children less than 15 years.
The impact of control of HIV depends on vital epidemiological parameters like Child prevalence & incidence and
annual new cases of HIV in adults & children, deaths due to AIDS in adults &children. The latest data of HIV/AIDS
in adults, children male female & deaths as per WHO/ UNAID will be presented & discuss.

The search for effective vaccines & microbicides must therefore be one of very highest priority. HIV is global threat
and action needs to be taken to prevent it killing many more millions than those who already have died. This action
needs not only to continue but to be speeded up considerably.

Keywords communities and whole continents. We have seen the epidemic

Acquired immunodeficiency syndrome (AIDS), Human immuno- set back the development of countries by many decades, widen the
deficiency virus (HIV). gulf between rich and poor nations, and push already stigmatized
groups closer to the margins of society.
Introduction
Scientists believe that HIV originally came from a virus particular The origin of HIV and AIDS has puzzled scientists ever since the
to chimpanzees in West Africa during 1930s, and originally illness first came to light in early 1980s. For over 35 years it has
transmitted to human through the transfer of blood through been subject of fierce debate and cause of countless arguments. In
hunting. Over the decades, the virus spread through Africa and the US, reporting high rates of the rare forms of pneumonia and
to the other parts of world. When acquired immune deficiency cancer in young gay man begins. The disease is initially called
syndrome (AIDS) first emerged, no one foresaw how the epidemic Gay- Related immune Deficiency (GRID) because it is thought
would spread across the world and how it would change many it only affects gay men. Cases are also reported in Injection Drug
millions of lives. There was no of real idea of what caused it Users by the end of the year.
and, consequently, no real idea of how to protect against it.
Human immunodeficiency virus (HIV) has devastated families, The first recognized case of AIDS occurred in the USA in 1981.
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A number of gay men in New York and San Francisco suddenly Kidney cells from local chimps were used to produce this live
began to develop rare opportunistic infections and cancers that polio vaccine. In his book, The River, Edward Hooper suggested
were resistant to any treatment. It is quickly become obvious that the origin of HIV could be traced to the testing of the CHAT
that all the men were suffering from a common syndrome. The oral polio vaccine, which was grown in kidney cells from local
discovery of HIV was made 2 years later. chimps infected with SIV. This, he claims, would have resulted
in the contamination of the vaccine which chimp SIV leading to
HIV is a lentivirus and, like all viruses of this type, it attacks the a large number of people subsequently becoming infected with
immune system. Lentiviruses are part of a larger group of viruses HIV-1. However, subsequent analysis of the vaccine in April 2001
known as retroviruses. They have been found in a number of showed no trace of either an HIV OR SIV [6].
different animals including cats, sheep, horses and cattle.
A second analysis confirmed that only macaque monkey kidney
However, as far as the origin of HIV is concerned, the most cells, which cannot be infected with SIV OR HIV, were used to
interesting lentivirus is the simian immunodeficiency (SIV) that make CHAT [7]. The fact that HIV probably existed in humans
affects monkeys. Although HIV came to light in the early 1980s, before the 1950s also suggests that the OPV theory is not tenable
there is evidence that HIV infection was prevalent much earlier. as the sole method of transmission.
The earliest known instances of HIV infection are as follows:
• A plasma sample taken in 1959 from an adult male living in The Colonialism Theory
Democratic Republic of Congo has been found positive for An American specialist in primate behavior, Jim Moore, first
HIV. proposed this theory in 2000 [8]. During the late 19th and early
• HIV has been found in tissue samples from an American 20th century, much of Africa, including French Equatorial Africa
teenager who died in St Louis in 1969. and Belgian Congo, were ruled by colonial forces. The labour
• HIV has been found in tissue samples from Norwegian sailor camps were overcrowded, sanitation was poor, and physical
who died around 1976. demands on the inmates were extreme, all of which would have
weakened the immune system of camp immates, paving the
A 1998 analysis of plasma sample from 1959 has suggested that way for SIV to become HIV. Practices such as use of unsterile
HIV-1 was introduced into humans sometime in 1940s or early needles to inoculate laborers against diseases such as small pox
1950s [1] much earlier than previously believed. Other scientists and employing prostitutes to keep the workers ‘happy’ would have
have dated the sample to even earlier period- perhaps as far back created numerous opportunities for transmission. The fact that
as the end of 19th century. In January 2000, the results of study these labour camps were set up at around the same time that HIV
carried out by Dr Bette Korber of Los Alamos National Laboratory is first believed to have passed into humans- the early part of 20th
(which was presented at 7th Conference on Retroviruses and century- provides support for this theory.
Opportunistic Infections) suggested that that the first case of HIV-
1 infection occurred around 1930 in West Africa. The Conspiracy Theory
A significant number of African Americans believe HIV was created
It is now generally accepted that HIV is a descendant of an SIV as part of biological warfare programme that was designed to wipe
because certain strains of SIV bear a very close resemblance to designed to wipe out large numbers of black and homosexual
HIV-1 and HIV-2. HIV-1 corresponds to strain of SIV found in people [9]. Some believe that HIV virus was spread worldwide
chimpanzees [2,3] and HIV-2 corresponds to a strain found in the through the smallpox inoculation programme or alternatively to
sooty mangabey, which is indigenous to western Africa [4]. Viral gay men through hepatitis B vaccine trials.
transfer between animals and humans known as zoonosis is well
recognized. There are many theories as to how HIV could have The truth about the origin of HIV will continue to be debated for
crossed species. many more years. However, there is now clear evidence as how
HIV spread to USA. In March 2007, at the 14th Conference on
The ‘Hunter’ Theory Retroviruses and Opportunistic Infections in Los Angeles, data
According to the hunter theory, SIV was transferred to humans was presented showing that HIV had probably brought to Haiti
when hunters ate the flesh of infected Chimps or when the blood from Congo by a single infected person in around 1966 [10].
of chimpanzee contaminated cuts or wounds on the body of hunter.
The fact that there were several different early strains of HIV, each Genetic analysis showed that the virus had spread slowly from
with slightly different genetic makeup, would support this theory, person to person on the island before being transported to the
every time the virus was passed from a chimpanzee to a man; a US, probably by single individual, at some point between 1969
slightly different strain was produced. Wolf et al. were able to show and 1972. From this point on, the epidemic spread rapidly, with
how retro viral transfer from primates to hunters still occurs [5]. transmission occurring within and between the US and Haiti and
also internationally.
The oral polio vaccine (opv) theory
In the late 1950s, an oral polio vaccine called CHAT was tested The Contaminated Needle Theory
on about a million people in the Congo, Ruanda, and Urundi. In developing countries, the practice of reusing syringes without
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adequate sterilization to inject multiple patients could have led to a There are currently five main classes of drugs, operating at different
rapid transfer of viral particles between patients. This would have points in the HIV cycle:
created a huge potential for the virus to mutate and replicate in • Nucleoside reverse transcriptase inhibitors: Disrupt the
each new individual, thereby enhancing the spread of HIV. copying process by blocking the enzyme reverse transcriptase.
• Non- Nucleoside reverse transcriptase inhibitors: These
Thirty – Five Years of Hiv/Aids drugs attach themselves to the enzyme, reverse transcriptase,
1981: (March) At least eight cases of an aggressive form of Kaposi’s which controls the copying process.
sarcoma occurred amongst young gay men in New York [11]. At • Protease inhibitors: Acts by interrupting the assembly of the
about the same time, both in California and New York, a number new virus particle.
of cases of rare lung infection Pneumocystis carinii pneumonia • Entry inhibitors: Binds to the proteins on the outside of the
(PCP) was also diagnosed [12]. Early theories regarding the cause HIV virus, preventing it from attaching itself to and entering
of these outbreaks included infection with cytomegalovirus, the a CD4+ cell.
use of amyl nitrite or butyl nitrate ‘poppers’ an immune overload • Integrase inhibitor: Prevents integration of viral RNA to
[13,14]. cellular DNA.

1982: The term acquired immune deficiency syndrome (AIDS) is The goal of HIV therapy is to reduce the viral load to undetectable
first used. levels (i.e below 50 copies/ml). This would help to restore immune
1983: (May) Doctors at the Institute Pasteur in France reported that function, reducing HIV- related morbidity and mortality and thus
they had a isolated a new virus; they named it lymhadenopathy- aid in achieving the ultimate goal of improving quality of life.
associated virus or LAV [15]. Currently over 29 antiretroviral (ARV) agents are available and
1984: (April 23rd) Dr Robert Gallo of the National Cancer many more are in development stage.. Until recent times the side
Institute, USA isolated the virus and named it HTLV-III. effects, both short and long term, have been a concern but the
1985: An HIV antibody test became available. newer agents are addressing these issues. In the Highly active anti
1986: (May) The International Committee on the Taxonomy retroviral therapy (HAART) era, as the life expectancy of HIV-
of Viruses recommended that the terms LAV and HTLV-III be infected individuals continues to increase, cardiovascular disease,
dropped and and a new name,Human immunodeficiency virus hepatic disease and malignancy have become important issues
(HIV), be used [16]. among this population.
1987: Zidovuidine (AZT), the first antiretroviral drug, got FDA
approval [17]. In order to combat this, newer agents are being developed, with
1993: The Anglo- French clinical trial Concorde concluded that higher genetic barrier and better efficacy against resistant strains.
AZT was not effective in treating in asymptomatic HIV-positive
patients [18]. The key development in HIV care in high-income countries has
1994: ACTG 076 showed AZT reduced mother-to child HIV been the elimination of mother-to- child transmission (MTCT) of
transmission by two-thirds [18]. HIV. This has been achieved by introducing effective voluntary
1995: The Delta trial and the ACTG175trial showed that testing and counseling, enabling access to ARV therapy, instituting
combination of AZT with didanosine (ddI) were more effective safe delivery practices and by making available safe breast-milk
than AZT alone in delaying disease progression and prolonging substitutes. Even in resource- limited countries, a reduction in
life. The first protease inhibitor, saquinavir, became available. MTCT is seen with limited interventions.
1996: Introduction of viral load test.
1997: For the first time, the number of deaths from AIDS dropped It is very unlikely that HIV and AIDS will ever be eradicated
substantially across the developed countries. without new scientific developments. For every person who starts
2003: Fuzeon gained FDA approval. This was the first of new type treatment with ARV, another six become infected. Unless great
of anti-HIV drug that was designed to prevent the entry of HIV progress is made in prevention, the number of people living with
into human cells. HIV will outstrip the resources available for treatment.
2006: Two African trials of male circumcision as an HIV
prevention method were halted early for ethical reasons because Current methods for preventing HIV infection are far from perfect.
preliminary analysis showed that they reduced HIV transmission Education has been proved to be effective and necessary, both
by around 50%. for people who are not infected with HIV and for those who are
infected. Behavior therapy, condom use, voluntary HIV testing and
Since the start of the HIV epidemic, a series of antiretroviral drugs treatment of sexually transmitted infections are proven methods of
have been developed which have significantly prolonged the lives HIV prevention
of HIV –positive people. But there have been associated challenges
such as the increase in pill burden, problem with adherence to In theory, if everyone abstained from sex or remained faithful to
treatment, drugs side effects, development of resistance, treatment one partner and always used condoms and condoms alone nobody
failure and increase in cost of care. injected drugs, then HIV and AIDS might be controlled and
eradicated. However, in real world behavior changes and condoms
Microbiol Infect Dis, 2019 Volume 3 | Issue 1 | 3 of 6
alone will not eliminate the virus; they will only help to control are one and half times more likely to become infected with
its spread. A number of HIV prevention approaches are currently HIV.
available or are in late stage of clinical trials.
Key Populations
Global Hiv Status as Per Unaids Report 2017 Key populations and their sexual partners account for:
People Leaving with HIV • 47% of new HIV infect globally.
• In 2017, there were 369 million people leaving with HIV. - • 95% of new HIV infection in Eastern Europe and central Asia
35.1 million adults. - 1.8 million children under 15 years. and Middle East and north Africa.
• 75% of all people living with HIV knew their HIV status. • 16% of new HIV infection in Eastern and Southern Africa.
• About 9.4 million people did not know that they were living
with HIV. The risk of acquiring HIV infection is
• 27 times higher among men who have sex with men.
People Living with HIV Accessing A.R.V Treatment • 23 times higher among people who inject drugs.
• In 2017, 21.7 million people living with HIV were assessing • 13 times higher for female sex workers.
antiretroviral therapy, up from 8 million in 2010. • 13 times higher for transgender woman.
• 59% of all people living with HIV of children were accessing
treatment. HIV/ Tuberculosis (T.B)
- 59% of adults aged 15 years and above had access to treatment as • TB remain the leading cause of death among people living
did 52% of children aged 0 to 14 years. with HIV accounting for around one in three AIDS – related
- 65% of female adults aged 15 and above had access to treatment. deaths.
- 53% male adults aged 15 years and above had access to treatment. • In 2016, 10.4 million people developed TB disease; 1.2
• 80% of pregnant women living with HIV had access to million were living with HIV.
antiretroviral medicines to prevent transmission of HIV to • It is estimated that 49% of people living with HIV and
treat their babies in 2017. tuberculosis are unaware of their co-together and are therefore
not receiving care.
New HIV Infections • Therefore every tuberculosis patient must be screened for
• New HIV infections have been reduced by 47% since the peak HIV test and every HIV patient must be screened for Mantoux
in 1996 test & sputum for AFB.
- In 2017, around 1.8 million were newly infected with HIV
compared to 3.4 million in 1996. Male Circumcision
- Since 2010, new HIV infections among adults have declined by Since 1980s, scientists have suspected that male circumcision
estimated 16% from 1.9 millions to 1.6 million in 2017. might reduce the chances of HIV transmission during sex.
- Since 2010, new HIV infections among children have declined Circumcised men are less likely to have HIV than uncircumcised
by 35% from 270,000 in 2010 to 180,000 in 2017. men, and countries with higher rate of male circumcision have
lower rates of HIV infection. Removal of HIV target cells from
AIDS Related Deaths foreskin, keratinization of skin surface, and reduction of Sexually
• AIDS-related deaths have been reduced by more than 51% Transmitted infections (STIs) are key factors through which
since the peak in 2014. circumcision exerts its protective effect [20,21]. We now have
• In 2017, around 940,000 people died from AIDS-related conclusive evidence from studies in Africa that male circumcision,
illness. if performed safely in medical environment, brings about a 65%
Worldwide, compared to 1.9 million in 2004 and 1.4 million in reduction in the risk of man becoming infected with HIV through
2010 heterosexual sex.

90 – 90- 90 Target Microbicides

• In 2017, three out of four people living with HIV (75%) knew A microbicide is a chemical product applied in the vagina to
their status. inactivate HIV. Anal application is also been studied. They act
• Among people who knew their status, 4 out of five (80%) as a physical barrier, maintain vaginal flora, and prevent STIs. A
were accessing treatment. number of second- generation microbicide candidate, including
• Among people accessing treatment, 4 out of five (80%) was tenofovir- containing microbicides, are in the early stages of
virtually suppressed. research. Nine HIV microbicide trials were in progress at the start
• 47% of all people living with HIV are virtually suppressed. of February [22].

Women Three microbicide candidates are undergoing phase III trial to test
• Every week around 7000 young women aged 15 to 24 years their effectiveness; these are:
become infected with HIV. • Buffer Gel, which maintains acidity in the vagina.
• More than one third (35%) of women who experience violence • Carr guard, an entry inhibitor based on carrageenan, which is
Microbiol Infect Dis, 2019 Volume 3 | Issue 1 | 4 of 6
 derived from seaweed. care and other health care setting will result in a situation where
• PRO 2000, another entry inhibitor. very few patients infected with HIV will be unaware of their
diagnosis. This would help in controlling HIV transmission as well
In August 2006, Family Health International decided to halt a as identifying HIV infection before advanced immunosupression
phase III trial of Surfactant called SAVVY after preliminary results has set in.
showed no evidence of protective effect [23]. Two phase III trial of
an entry inhibitor called cellulose sulphate were halted in January Increased awareness of HIV status; increase in condom use;
2007 after some sites recorded a higher HIV infection rate among increase in condom use; increase in use of female –initiated HIV
women who used the gel compared to those in the placebo group. prevention methods, such as use of microbicides of potency and
It is not yet known why cellulose sulphate was associated with cervical diaphragm and increase in male circumcision in high
an increased risk of infection; this result was entirely unexpected prevalence countries will all help to reduce sexual transmission
[24]. of HIV.

Cervical Barrier Health manpower shortage and inadequate infrastructure will

Cervical barriers such as diaphragm may help protect women result in limited HIV treatment programmers in resource- limited
from HIV and other STIs. An efficacy trial of diaphragm for HIV countries. In spite of this, most of those found to be infected will
prevention had recently completed in South Africa and Zimbabwe. have access to care. Antiretroviral drugs will be more widely
available and treatment will be extremely convenient. Evidence
Herpes Suppression shows that treatment should be initiated at higher CD4 lymphocyte
Genital herpes simplex infection significantly increases the risk count than is currently practiced.
of HIV acquisition as well as the risk of transmission to others
[25,26]. Trials are being conducted in Africa and the US to test the The availability of cheaper ARV drugs, increase in choice of drugs,
effectiveness of suppression of herpes with acyclovir in lowering less toxicity, higher genetic barrier, and convenience of treatment
HIV risk. would result in all cases being treated. Antiretroviral drugs will
also be widely used to prevent HIV transmission. MTCT will
Preexposure Prophylaxis with Anteretrovirals be gradually eliminated in high-income countries. Antiretroviral
Efficacy trial of truvada (Tenofovir and Emitricitabine) in therapy will be continued after delivery, both to treat the mother’s
preexposure prophylaxis is being conducted in Botswana, Thailand disease and to allow safe breast feeding.
and Peru [27]. Proof of this concept derives from the use of ARV to
prevent MTCT of HIV. A significant disadvantage of this approach The HIV pandemic remains the most serious infectious diseases
could be the development of drug resistance. challenge in public health. AIDS is a preventable disease. Every
day over 7000 persons become infected with HIV and over
HIV Vaccine 6000 dying from AIDS. Most deaths are the result of inadequate
The aim of vaccination is to induce either neutralizing antibody access to HIV prevention and treatment services [28]. People
or a T-cell response or both. Although the search for an effective need empowerment to negotiate safe and responsible sexual
vaccine has been continuing for more than 25 years, it has been relationships; gender inequalities must be confronted, and those
continuing for more than 25 years, it has remained elusive. The who choose to have sex need access to condoms. Needle exchange
genetic diversity of HIV; its ability to infect the cell of the immune programs should be encouraged, as they have proven to be highly
system, to spread from cell to cell, and to integrate its genome effective in preventing HIV transmission among injecting drug
into the host cell; and viral resistance are the main challenges users. The search of effective vaccines and microbicides must be
in producing an effective vaccine, currently 30 HIV vaccine one of very highest priorities in scientific research.
candidates are in clinical trials.
Acknowledgements
There is no ‘magic bullet’ for HIV prevention. None of the new I am highly thankful to Dr. Samiah Yasmin Professor, Dean
methods being tested currently is likely to be 100% effective faculty of Medicine, Segi University, Professor Dr Jamaludin
in prevention and all will need to be used in combination with Zainol Deputy Dean, Professor Dr. Mohd Raili Suhaili, Associate
existing approaches. However, even a partially effective vaccine Dean, faculty of Medicine clinical campus hospital Sibu 96000
or microbicide could save many millions of lives. Experts have (Sarawak), Dr. Mahadevan Supramanium, Director, Research &
calculated that a vaccine that is effective 50%, given to just 40% Innovation Management Center & Institute of Graduate studies Segi
of the population could reduce the number of HIV infections in University and Margareth Wong, clinical community/ Research
developing world by more than half over 10 to 12 years. Greater Manager faculty of medicine, clinical campus, hospital Sibu
access to existing HIV prevention tools could avert half of new in (Sarawak) for their valuable guidance constant encouragement
infections projected to occur over next decade. and inspiration.

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