The global response to AIDS has achieved significant results since the first case was reported 30 years ago, with a record number of people having access to treatment and rates of new HIV infections falling by nearly 25 per cent, the United Nations says in a new report. While the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7,000 per day. In addition, gender inequalities remain a major barrier to effective HIV responses. HIV is the leading cause of death among women of reproductive age, and more than a quarter of all new global HIV infections are among young women between the ages of 15 and 24. According to the report, investments in the HIV response in low- and middle-income countries rose nearly 10-fold between 2001 and 2009, from $1.6 billion to $15.9 billion. However, in 2010, international resources for HIV declined. “I am worried that international investments are falling at a time when the AIDS response is delivering results for people,” said Mr. Sidibé. “If we do not invest now, we will have to pay several times more in the future.”

1. AIDS Out | Life In
Sexlies
Reality
The HIV/AIDS Epidemic Saga

2. AIDS stands for “ Acquired Immunodeficiency Syndrome ”.
AIDS is caused by the Human Immunodeficiency Virus (HIV),
which weakens the body's immune system.
Credits: FlickR/Steev M

3. Once established an HIV infection, individuals are infected for
life and will probably succumb to serious opportunistic
infections caused by the weakening of their immune system.
Credits: FlickR/Steev M

4. What Where
Have Are
We We
Learnt Going

5. 85 million
infected worldwide
Credits: UN AIDS | 2011 epidemiology

6. 85 million
”.“ infected worldwide
Over 30 million deaths from HIV/AIDS so far, approximately
2 million deaths per year
Credits: UN AIDS | 2011 epidemiology

7. 85 million infected worldwide
”.“
Over 33 million are living with HIV infection in 2009, 2.6
million new HIV infections in 2009; approximately 7,000
new infections per day
Credits: UN AIDS | 2011 epidemiology

8. 85 million infected worldwide
”.“
# 1 cause of infectious mortality
worldwide
Credits: UN AIDS | 2011 epidemiology

9. 85 million
infected worldwide
”.“
# 4 cause of all mortality worldwide
Credits: UN AIDS | 2011 epidemiology

10. The Good News
The Good News
Credits: UN AIDS | 2011 epidemiology

11. The Good News
The global AIDS epidemic appears to have stabilized, and the annual
number of new HIV infections has been steadily declining since the late
1990s
The Good News
Credits: UN AIDS | 2011 epidemiology

12. The Good News
The global AIDS epidemic appears to have stabilized, and the annual
number of new HIV infections has been steadily declining since the late
1990s
The Good News
Although the number of new infections has been falling, new infections are
still high, and with reductions in mortality, the number of people living with
HIV worldwide has increased.
Credits: UN AIDS | 2011 epidemiology

13. AZT, a drug that had failed in early
cancer trials, shown to have anti-HIV
activity and to be tolerated by
patients over 6 weeks (1986).
The Controlled trial in 282 subjects with
advanced HIV infection (1986-87)
Zidovudine  19 deaths on placebo and 1 on
AZT
Promise  CD4 cell elevations in AZT group
 Substantial bone marrow toxicity
(AZT, ZDV) observed in the AZT group
Credits: Fischl MAetal; Richman DD et al, NEJM 1987

14. Individual drugs provided only temporary benefit,
and resistance could develop.
Sequential single drug therapies not much
better, as second responses were usually less
sustained
Would combination drug strategies, as had
proven useful in some infections (e.g.,
tuberculosis) and some cancers be more
effective?

15. Favorable
Pharmacokinetic
Interactions
Overcome Increased Efficacy
Drug Resistance Decreased Toxicity Multiply Targets
Additive
or Synergistic
Interactions

16. Dinner meeting in Montreal Development of a clinical
in 1989 during an AIDS protocol to compare therapy
conference (Merigan, Hirsch, with 1 drug to that with a
Lagakos) combination
Genesis and Conduct of ACTG 175
Long discussions (ACTG,
Enlistment of Scott Hammer
pharmaceutical companies,
and David Katzenstein to
FDA, and community
direct the study
representatives)

17. Credits: Corbis/ Robin Bain
Lessons Antiretroviral therapy improves survival for HIV-
infected persons.
fromTreatment with 2 active drugs (ddI + ZDV) slows HIV disease
progression when compared to treatment with one drug
(ZDV).
ACTG 175 The risk of progression, as well as drug
efficacy, correlate with reductions in
plasma HIV RNA levels.

18. Subsequent Developments

19. Development of Protease
Inhibitors (PIs) and
Non-Nucleoside Reverse
Transcriptase Inhibitors
(NNRTIs)

20. Clinical trials showing
that 3-drug regimens
(HAART) are better than
2-drug regimens (ACTG
320, Merck 035, Merck
039)

21. Low dose ritonavir
boosts the activity of
protease inhibitors
(Abbott 542)

24. 2004 - 2011
NOW
Concerted efforts to rollout ARV programs with appropriate monitoring in
developing countries (PEPFAR, WHO, UN-AIDS, etc.)

25. 2004 - 2011
NOW
Over 5 million now on ARVs (52% of those with <200, and 36% of those with
< 350 CD4 cells/uL)

26. 2004 - 2011
NOW
Reduced prevalence in several countries (e.g., Botswana, Tanzania, Rwanda,
Kenya) because of changes in sexual behaviors.

27. 2004 - 2011
NOW
And yet, for every new person treated worldwide with ARVs, more than one
becomes newly infected.

29. Major advances in antiretroviral pre- and post-exposure
prophylaxis

30. Increased test-
and-treat efforts

31. Further reductions in
worldwide incidence of
new infections

32. Further increases in persons living with HIV
Credits: FlickR/George Gates

33. Continued efforts to develop prophylactic and therapeutic
vaccines and immunotherapies
Credits: Google Image Search

34. Shout
for life. NOW
Sexlies
Reality
Spread the message
Credits: FlickR/Steev M