Module 2 Libre : VIH - Histoire et chiffres
Module 2:
Contents
Learning objectives
At the end of Module 2, the participant will be able to:HIV – AIDS BACKGROUND HISTORY
Although there is now evidence that the first HIV-related deaths occurred in the mid-20th century, the background history presented focuses on the emergence of the epidemic in the early 1980s.
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Five gay men in Los Angeles suffer from an extremely rare case of pneumonia.
In June 1981, the US Centre for Disease Control (CDC) reported that five young homosexual patients in Los Angeles were suffering from a rare and unusual form of pneumonia, caused by “pneumocystis” a parasite normally harmless to humans.
At the same time, in New York, doctors noticed an increase in the number of cases of a very rare skin cancer that manifests itself as brownish-purple patches called Kaposi's sarcoma.
On account of these first cases in homosexual men, the first name given to this new disease was "gay cancer".
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The first studies in 1982 showed that this disease, which destroys the immune system, is transmitted through sex and blood.
The US Centre for Disease Control (CDC) named the disease "AIDS" for Acquired Immuno-Deficiency Syndrome.
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The first case of AIDS in Luxembourg was diagnosed in 1983.
That same year, the virus responsible for the immune system deficiency was isolated at the laboratory of the Pasteur Institute in Paris, which publishes its results in the American journal "Science". The first name given to the virus at the time was LAV which stands for lymphadenopathy associated virus.
You can see a photo of Professors Luc Montagnier, Jean-Claude Chermann and Françoise Barré-Sinoussi from the Pasteur Institute posing with a jar containing the virus.
Twenty-five years later this French discovery was awarded the Nobel Prize for Medicine.
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The screening test was commercialized in 1985. In Luxembourg all blood products collected had to be tested for antibodies in case of AIDS.
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In 1986, the virus responsible for AIDS was named HIV which stands for Human Immunodeficiency Virus.
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The first antiretroviral drug, azidothymidine (AZT), was approved in the USA.
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World AIDS Day.
And the Aidsberodung of the Red Cross was founded in Luxembourg.
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The 1990s were very dark with many victims claimed.
The "contaminated blood scandal" hit several countries, including France and Switzerland, in the early 1990s. Several media outlets revealed that in the early 1980s, when the AIDS virus was becoming a worldwide epidemic, many haemophiliacs and hospital patients were infected with HIV through blood transfusions. The extent of the tragedy was not known in France until August 1991, when a report was published by the National Blood Transfusion Centre citing that one haemophiliac in two had been infected, i.e. nearly 2,000 people, including children
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The atmosphere became breathable at long last when triple therapy arrived in 1996.
After 13 long years of research, this new treatment finally slowed down the progression of HIV and reduced mortality among HIV patients, despite serious side effects at times (diarrhoea, vomiting, swollen stomach, sunken cheeks, etc.).
Thanks to treatment, the risk of transmission of the virus from mother to child during pregnancy was significantly reduced (1%). Breastfeeding was still not recommended.
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PEP (Post Exposure Prophylaxis) was used for the first time in 1998 in San Francisco.
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2008 to 2016
Progress in treatment and prevention tools has been constantly made since 2008! (More details in Module 3 "Prevention Tools").
According to the results of numerous studies, grouped together under the name of the "Swiss Statement", an HIV-positive person who has an undetectable viral load for at least 6 months and who is undergoing treatment correctly, no longer transmits HIV during unprotected sexual relations: this was a revolution in the scientific world and among HIV professionals!
In 2013, the Aidsberodung was rechristened to HIV Berodung to comprise Hepatitis, STIs and HIV in its name.
In 2014, PrEP (pre-exposure prophylaxis) was introduced and UNAIDS launched the 90-90-90 target (more details at the end of Module 1).
Although condoms are still an effective weapon against HIV, there was increasing talk of TASP (treatment as prevention = Swiss Statement). (More details in Module 3 "Prevention Tools")
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In 2019, HIV self-tests were launched in Luxembourg, marketed first in pharmacies and then also in some supermarkets.
HIV EPIDEMIOLOGY 2020
Number of patients included in the HIV cohort per year.
The following graph shows the development of the HIV epidemic in Luxembourg. The figures represent the people living with HIV who were included in the Luxembourg cohort. They correspond to the number of people newly infected during the year plus the number of HIV positive people who have started a follow-up in Luxembourg during said year.
We observed a notable decrease in the number of HIV-infected patients included in the National Infectious Diseases Service for 2020: 81 newly included persons compared with 100 persons in 2019. This decrease is mainly due to a drop in the number of newly diagnosed patients (33 in 2020 compared with 48 in 2019). It is difficult to interpret this decrease because of the COVID-19 crisis and the health restrictions that led to a sharp decrease in the number of screening tests carried out in 2020 in Luxembourg, as in the rest of the world. Despite this overall decrease, there was an increase of 4 new infections diagnosed among drug users, which may be linked to limited access to prevention methods during the period of lockdowns or health restrictions. On the other hand, there were 12 deaths in the HIV cohort this year, including one death due to COVID-19, but linked to the presence of co-morbidities.
Number of newly diagnosed patients per year.
The second graph shows only the number of new infections per year. A new infection is defined as an infection that has been detected within 6 months of the person becoming infected with HIV.
This graph shows the modes of contamination of new infections in 2020. The majority of new infections in Luxembourg occur through heterosexual and homosexual/bisexual intercourse.
Modes of contamination of newly diagnosed cases in 2020 by age.
With regard to the age groups of newly infected people, this graph shows that the majority of infections occur between the ages of 26 to 54 among people having unprotected sex.
The graph "Development of cases included in the list of the Service National Maladies Infectieuses (SNMI) --- You can't use shortcodes inside element --- according to sex by year" clearly shows that the number of HIV-positive women including the Luxembourg cohort is much lower than the number of men joining the same cohort. The various graphs of 2020 presented correspond to the general trend reported in previous years.
SOME KEY HIV FIGURES:
million people
were living with HIV in 2020 worldwide.million people
were infected with HIV in 2020.million HIV-positive people
were on antiretroviral treatment at the end of 2020 compared with 25 million at the end of 2019.people are estimated to be living with HIV
in Luxembourg, but about 15% of these people are not aware that they are infected.UNITED NATIONS GOALS
The Millennium Summit, held in September 2000 at UN Headquarters in New York, was the largest gathering of heads of state and government ever. It concluded with the adoption of the Millennium Declaration, which set out the eight Millennium Development Goals (MDGs). One of these, MDG 6, aims to combat HIV/AIDS, malaria and other diseases.
In 2001, at the General Assembly Special Session on HIV/AIDS, Member States adopted the Declaration of Commitment on HIV/AIDS, which sets out a broad agenda and priorities for prevention, care, support and treatment.
In 2015, the world halted and reversed the spread of HIV. According to UNAIDS, globally, the epidemic has been forced to decline.
New HIV infections and AIDS-related deaths have declined significantly since the peak of the epidemic. The goal now is put an end to the AIDS epidemic by 2030.
https://www.unaids.org/fr/resources/fact-sheet
Adopted by world leaders at a landmark United Nations Summit, 17 Sustainable Development Goals (SDGs) entered into force on 1 January 2016. They pursue ambitious targets seeking to "Transform our world" by 2030. Health and well-being constitute the guiding principle of SDG 3, which aims, under point 3.3, to end the AIDS epidemic and combat hepatitis.
The "90-90-90" target launched globally in 2014 by UNAIDS, and its impact on the epidemic in many countries, is in line with this vision and constitutes an intermediate step.
UNAIDS 95-95-95 TARGET
In 2020, the 90-90-90 Target, launched globally by UNAIDS in 2014, became the 95-95-95 Target.
This target aims to end the AIDS epidemic by ensuring access to treatment for HIV-positive people. Only through treatment can the epidemic be stopped.
IN CONCRETE TERMS, THE 95-95-95 TARGET MEANS THAT:
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To achieve this target, screening on a large scale is essential in order to "find" HIV-positive people, and to ensure rapid access to treatment so that their viral load becomes undetectable and they can no longer transmit the virus (see U=U)
95-95-95 Target
UNAIDS Key populations
DIFFICULTIES AND OBSTACLES ENCOUNTERED:
These are ambitious targets! But as they are on a global scale, many factors need to be taken into consideration:
- There are still many misconceptions about HIV, modes of transmission, methods of prevention, the course of the infection, and people living with HIV. Many people therefore do not take the right preventive measures and stigmatization is still very present in the world, but also here in Luxembourg.
- Prevention campaigns and calls for screening require a good knowledge of customs and habits in order to target the populations most at risk effectively.
- Access to screening (test) and then to treatment is not always guaranteed. On the other hand, being HIV-positive is still often very stigmatizing and hinders the screening process. Furthermore, the symptoms of HIV can take time to appear, HIV-positive people do not feel sick, so screening and even treatment can be delayed.
- The cost of antiretroviral treatment in Western countries is approximately €1,000 to €1,500 per person per month, not including regular medical monitoring. In Luxembourg the costs are covered by social security. In other parts of the world, however, the cost issue means that many patients are not on treatment.
- Lifelong treatment is not always easy to understand and causes problems of adherence. If antiretroviral treatment is undergone correctly, the viral load decreases until it becomes undetectable (explained in Module 3). The person therefore maintains good immunity and feels well. Some patients however stop taking their medication once they start feeling better.
The 2017 UNAIDS report on the state of the response to HIV is posted on the UNAIDS website.
Seven (developed and developing) countries have already achieved the 90-90-90 targets: Botswana, Cambodia, Denmark, Iceland, Singapore, Sweden and the United Kingdom - and many more are close to achieving them.
GLOBAL PROGRESS ON THE 95-95-95 TARGETS
of all people living with HIV know their HIV status
of all people tested are on antiretroviral treatment
of all people on treatment have an undetectable viral load
Luxembourg is getting closer to the target, since the study of the care cascade carried out by the Luxembourg Institute of Health at the end of 2020 shows that: