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【medical-news】The modern leper: the HIV-AIDS victim
Dr Charles Savona-Ventura, consultant obstetrician-gynaecologist and member of the Sexually Transmitted Infections Committee
With World AIDS Day being marked next Friday, Dr Charles Savona-Ventura looks at the spread of the disease in the world - and in Malta
Twenty-five have passed since the first cases of AIDS were recognised. The doctors from the Centres of Disease Control of the United States little suspected that they were heralding a new pandemic when on June 5, 1981 they reported five cases of the previously rare Pneumocystis carinii pneumonia in young homosexual men in Los Angelis.
On July 4 of that year, the CDC further reported that during the previous 30 months, 26 cases of the rare Kaposi Sarcoma had been reported among homosexual males, and that eight have died, all within 24-months of diagnosis.
By 1982, the CDC established the name Acquired Immune Deficiency Syndrome (AIDS) for this infection, identifying the populations at risk as being male homosexuals, intravenous drug abusers, haemophilic sufferers, and those of Haitian origin. That year the first case of AIDS was reported from Africa. In 1983, the CDC warned blood banks of a possible problem with the blood supply accounting for the cases found in haemophilic sufferers.
In 1983, Luc Montagnier of the Pasteur Institute isolated a retrovirus from patients from AIDS, which in 1984 was shown by Robert Gallo of the National Cancer Institute to be responsible for causing the disease. This retrovirus was later named the Human Immunodeficiency Virus (HIV). By 1983, the CDC added female sexual partners of men with AIDS as being at risk of developing the infection, while a heterosexual AIDS epidemic was revealed in Central Africa.
By 1985, at least one AIDS case had been reported from each region of the world. The first test to enable the detection of antibodies to HIV enabling early diagnosis was licensed by the US Food and Drug Administration (FDA) in 1985; while the first antiretroviral drug AZT was approved by the FDA in 1987. The first World Aids Day was held in 1988.
Despite the advances and increasing appreciation of the disease entity, the US government in 1990 was implementing an immigration policy whereby people with HIV infection were denied entry to the country. In 1993, President Bill Clinton signed an HIV immigration exclusion policy into law.
During the first two decades, the epidemiology and clinical presentation of the disease were established, and potent antiviral therapies were developed - for those who could afford them! The medical progress in the last five years has been less dramatic. However the number of victims continues to rise, while the infected population profile is gradually changing to a more universal one.
In the 25 years since the first report, more than 65 million persons have been infected with HIV, and more than 25 million have died from AIDS. Even more worrisome is the observation that more than 40 per cent of new infections among adults are in young people aged 15 to 24.
Ninety-five per cent of these infections and deaths have occurred in developing countries particularly in Sub-Saharan Africa where almost 64 per cent of the estimated 38.6 million persons living with HIV live. AIDS is now the leading global cause of premature death among people aged 15 to 59. In the hardest-hit countries, the infection erodes the foundations of society, governance, and national security. Safety nets and services are being stretched to breaking point causing social and economic repercussions that will span generations.
The Maltese story
The HIV-AIDS pandemic has not spared the Maltese population. The first case of AIDS in Malta was reported in 1984, with a second case being reported the subsequent year. Both cases died from the disease. By the end of 1986, five cases had been reported with four deaths; the estimated number of HIV positive individual amounted to 25 persons.
The appearance of the disease in the Maltese community stimulated an early response from the health authorities, and the Health Education Unit published its first educational leaflet entitled Fatti dwar l-AIDS in 1986. This publication aimed at informing the public about this new untreatable infection with the scope of promoting prevention and avoiding an excessive response from the public and health personnel.
As far as could be established, HIV was introduced to Malta in the early 1980s in Abbott Anti-Haemophilic Factor injections and by a few sero-positive homosexual men previously domiciled overseas. In March 1986, AIDS was made a compulsory notifiable disease and in December 1986, a National Committee for the Prevention and Control of AIDS was established. The WHO/CDC 1987 definition was formally adopted in Malta in January 1988, and a circular to this effect, including a copy of the definition was circulated to all doctors.
By the end of 1990, the total number of AIDS cases reported from Malta amounted to 15, with 13 of these individuals succumbing to their disease. The increasing number of cases being seen with the disease, compounded by the untreatability and infectivity of the disease, saw an escalating preoccupation among the public and among the health professions.
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作者:admin@医学,生命科学 2011-05-05 17:46
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