front 1 gwendolyn scott recording - 39 years of progress in the
diagnosis, treatment, and prevention of HIV infection in children | |
front 2 1981 first case reported of AIDS | back 2 - 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
|
| back 3 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)
|
| back 4 - 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
|
| back 5 - 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+)
|
front 6 35 years of AIDS progress | back 6 - 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.
|
front 7 infection in children: 1981 JMH | back 7 - 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
|
front 8 HIV infection: chronology
The early years | back 8 -
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)
|
front 9 miami had orphans bc of parental loss | back 9 - 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
|
front 10 1984 antibody test to try to test pts for HIV | |
front 11 pediatric HIV research: the beginning | back 11 could now test for HIV in children + research pediatric HIV |
| back 12 - 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
|
| back 13 - 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
-
lack of community support - rejection by
families
-
considered to be a progressive + fatal disease
-
causative agent unknown at first
-
early mortality
|
front 14 research areas
- as virus was identified | back 14 - 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
|
front 15 survival children HIV 1981-1987 | back 15 - 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
|
front 16 high mortality / morbidity in children w/ perinatal acquired
infection w/ HIV | |
| back 17 - 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
|
| back 18 - distributed info to every household to make ppl less afraid of
ppl w/ HIV
|
| back 19 -
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
|
front 20 phase I clinical trials of AZT in children | back 20 well tolerated in children |
front 21 perinatal transmission using AZT | back 21 - 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
|
| back 22 - 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
|
front 23 prevention of perinatal transmission | back 23 - 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
|
front 24 women at risk for perinatal transmission | back 24 - no prenatal care/late to care
- not offered HIV
testing/counseling
- offered ARV but not take medication
- unexplained failures
|
front 25 1990-1994 pediatric HIV infection | back 25 - 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
|
| back 26 - companies combined multiple drugs so only take 1-2 pills a
day
- revolutionized treatment, used to take handfulls of
pills
|
front 27 long acting injectable drugs | back 27 long half life given every month or 2 being studied
so far see every 2 months has same efficacy as the 1 month one |
front 28 now mother viral load undetectable | back 28 very little chance to transmit to baby |
front 29 pediatric deaths after 1996 dropped dramatically | back 29 bc of combination therapy |
front 30 ending HIV epidemic: plan for america | back 30 - 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
|
| back 31 - hopes for cure
- early aggressive treatment protocols
- active drugs
- can prevent virus from hiding +
assimilating
- do this if baby born with HIV
|
| back 32 - 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%
|