MIC 201 test 1 lecture 5 Flashcards

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• started much earlier than this, but cases were sporadic and unknown to be HIV/AIDS yet
• CDC reported rare case ammonia which usually in immunocompromised ppl in gay men
• end of 1981, 200 cases of some sarcoma reported
• generally rare / uncommon illnessed attacking gay young men

1920s

• researchers found that a form of simian immunodeficiency virus (SIV) jumped to humans in central africa
• believe HIV originated in kinshasa chimps -> humans
  • bc of slaughtering chimps/animals -> covered in blood = got it (exposed)
  • also rapid urbanization in africa at the time (ppl crowding = more spread)

• 1st known case HIV in human in person who died in the congo, later confirmed to have HIV from preserved blood sample
• june 28, NYC, a 49 y/o jamaican-american died of the rare pneumonia

• 1964, jerome horwitz of barbara ann cancer institute synthesize AZT under a grant from NIH
  • AZT originally intended as a cancer drug
• 60s recap
  • made AZT
  • 1966 HIV first arrived in americas (1st person infected in haiti)
  • 1968 virus went to US
  • 1969 st louis teenager dies of unusualy illness (later HIV+)

• 80s - early years - stigma, disease, high mortality, identified HIV as the cause
• 90s - emphasis on drug treatment, combination therapies, longer survival
  • no treatment until late 80s, AZT, and mid 90s started combination therapy
• 2000s-present - HIV is a chronic disease, significant increase in life span, prevention transmission thru drug therapy, long acting drugs, search for cure/vaccine, etc.

• 1981: 2 children in same hospital, both <3 months, sick
  • oral trhush, dev delay, diarrhea, fever, anemia, elevated gamma globulin levels
  • both died before 6 mo
  • what disease? immune deficiency?
  • where from?
  • mother in good health
  • same type of infants kept being brought in
  • did not know what was going on
• 1982: report of infants getting aids from transfusions
  • 22 cases by end of year of opportunistic infections
• 1984: several cases published of children

• 1981 - initial cases seen at JMH
• 1983-4 - case reports of children with AIDS published
• 1983-4 - case definition developed for pediatric AIDS
• 1983 - first abandoned orphan in Miami
• 1983 - isolation of the virus (HIV)

• parents died of HIV and children left
• often, children also had HIV
• made very difficult to find homes for them
• there was no treatment, only supportive care
• stigma made it hard for ppl to find support, many left homes and lived in cars, etc. bc of stigma

...

could now test for HIV in children + research pediatric HIV

• particular one
• died 1986
• was put up for adoption - orphaned
• contracted HIV before birth
• difficult to find homes for orphans bc ppl afraid they would get HIV
• mother died of AIDS, couldnt care for her

• high rate of parinatal transmission (20-30% in USA, 39% in Africa)
• rapid disease progression in 20% infants
• death common in 1st 2 years og life
• multiple HIV associated complications (cardiomyopathy, encephalopathy, LIP, etc.)
• delay in diagnosis of infection - bc usually didnt have symptoms in first few months
• only supportive care available - no treatment
  • until early 90s
• lack of community support - rejection by families
• considered to be a progressive + fatal disease
• causative agent unknown at first
• early mortality

• once isolated virus
• household transmission of HIV
• perinatal transmission
• clinical trials drugs children/pregnant women
• study of long term survivors without progression of disease
  • some children survived for long time, studied them
• studied mother/fathers
  • often times did not seem sick, but babies were
  • mothers were infected - did not show symptoms but they were
• living in same house did not spread disease - casual contact

• median age present symptoms 8 months
• survival about 38 months
• 25% children died by age 2
• PCP occurred at median age of 5 months, median survival for that was 1 month
• very sad overall

...

• ryan white - hemophilia/HIV, denied school entry in indiana
  • allowed in, but family moved after bullet fired into his home
• 3 ray brothers w/ hemophilia/HIV
  • not allowed to attend school
  • family sued + won
  • home burned down 1 week later

• distributed info to every household to make ppl less afraid of ppl w/ HIV

• AZT used for HIV and was a miracle drug
• organized a pediatric subunit for clinical trials in 1986-87
• clinical trial funded in 1989 bc had no treatments
• suddenly children who would have died were allowed to live much better
• AIDS activists felt AZT was toxic, were against its use
• no other drug available, it was approved to be used

well tolerated in children

• pregnant women took AZT
• not easy bc of worries + risks of AZT
• did small study w/ pregnant women
• developed into regimen for pregnant women
  • antepardum
  • antipardum
  • baby given after birth for 6 weeks, bc maternal blood can circulate in baby for that long

• transmission reduced from 25.5% placebo to 8.5% in AZT group mother to child
• affected for perinatal transmission
• rate of it began decreasing
• now 1-2% rate

• counsel + test pregnant women
• treatment for mother
• antiretroviral therapy for reduction of perinatal transmission of HIV given to mother/infant
• diagnostic testing for HIV and follow-up of infant

• no prenatal care/late to care
• not offered HIV testing/counseling
• offered ARV but not take medication
• unexplained failures

• licensure of AZT + DDI
• trials of combination therapy
• could now manage + treat children with HIV
• pcp prophylaxis
• use of ZDV during pregnancy
• early diagnosis of HIV in infants - follow up until 4-6 months

• companies combined multiple drugs so only take 1-2 pills a day
• revolutionized treatment, used to take handfulls of pills

long half life given every month or 2 being studied

so far see every 2 months has same efficacy as the 1 month one

very little chance to transmit to baby

bc of combination therapy

• 2019 - have tools to end HIV epidemic in the US
• initiative will leverage critical scientific advances in HIV prevention, diagnosis, treatment, and care through the programs, resources, and infrastructure of the CDC, NIH, HRSA, and HIS
• addresses 4 key pillars in implementation scientific research
  • testing for HIV
  • link to care and early treatment, improve retention and adherence
  • PrEP and PEP
  • rapidly detect and respond to emerging cluters of HIV infections

• hopes for cure
• early aggressive treatment protocols
  • active drugs
  • can prevent virus from hiding + assimilating
  • do this if baby born with HIV

• if person dont have HIV but are at risk, can take pill to prevent risk fo becoming infected
• take daily, reduce risk of HIV by >90%