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HIV global pandemic

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Also listed as: WAS
Related terms
Background
Author information
Bibliography
Prevention
Africa
Asia
Americas

Related Terms
  • Antibodies, auto recessive, B-cells, bone marrow, bone marrow transplant, CBC, genetic disorder, immune system, immunodeficiency, inherited disorder, inherited immunodeficiency, leukocytes, leukemia, lymphoma, lymphocytes, malignancy, platelets, pneumonia, red blood cells, T-cells, thrombocytes, thrombocytopenia, tumor, WASP, white blood cells, Wiskott Aldrich syndrome, Wiskott-Aldrich syndrome protein, X-linked.

Background
  • Wiskott-Aldrich syndrome (WAS) is an inherited, immunodeficiency disorder that occurs almost exclusively in males. The recessive genetic disorder is caused by a mutation in the WAS (Wiskott-Aldrich syndrome) gene, which is an X-linked trait. The gene mutation leads to abnormalities in B- and T-lymphocytes (white blood cells), as well as blood platelet cells. In a healthy individual, the T-cells provide protection against viral and fungal infection, the B cells produce antibodies, and platelets are responsible for blood clotting to prevent blood loss after a blood vessel injury.
  • Individuals diagnosed with WAS suffer from recurrent infections, eczema and thrombocytopenia (low levels of platelets).
  • Before 1935, patients only lived an average of eight months. Today, patients usually live an average of eight years, according to a recent case study. The cause of death is usually attributed to extensive blood loss. However, cancer (especially leukemia) is common and often fatal among WAS patients.
  • The only possible cure for WAS is a bone marrow transplant. However, if a patient's family member is not a possible match for a bone marrow donation, patients may have to wait years for a potential donor. Other aggressive treatments may also increase a patient's life expectancy. For instance, one study found that patients who underwent splenectomy (removal of the spleen) lived to be more than 25 years old. The spleen may harbor too many platelets, and cause a decrease in the number of platelets in circulation. Antibiotics, antivirals, antifungals, chemotherapeutic agents, immunoglobulins and corticosteroids have also been used to relieve symptoms and treat infections and cancer associated with WAS.
  • Researchers estimate that about four people per one million live male births develop the disease in the United States.
  • The syndrome is named after Dr. Robert Anderson Aldrich, an American pediatrician who described the disease in a family of Dutch-Americans in 1954, and Dr Alfred Wiskott, a German pediatrician who discovered the syndrome in 1937. Wiskott described three brothers with a similar disease, whose sisters were unaffected.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Binder V, Albert MH, Kabus M, et al. The genotype of the original Wiskott phenotype. N Engl J Med. 2006 Oct 26;355(17):1790-3.
  2. Jin Y, Mazza C, Christie JR, et al. Mutations of the Wiskott-Aldrich Syndrome Protein (WASP): hotspots, effect on transcription, and translation and phenotype/genotype correlation. Blood. 2004 Dec 15;104(13):4010-9. Epub 2004 Jul 29.
  3. Natural Standard: The Authority on Integrative Medicine. .
  4. St. Jude Children's Research Hospital. Inherited Immunodeficiencies: Wiskott-Aldrich Syndrome (WAS). .
  5. U.S. Immune Deficiency Foundation. The Wiskott Aldrich Syndrome. .

Prevention
  • There is currently no known method to prevent WAS. However, individuals can be tested to determine whether they are carriers of the disease.

Africa
  • About 10% of the world population lives in Sub-Saharan Africa, but the region is home to about 64% of the global population living with HIV. In this region the disease is primarily transmitted through heterosexual contact, and more women are infected with HIV than men.
  • All countries in southern Africa, except Angola have an estimated adult (individuals ages 15-49) prevalence of HIV/AIDS greater than 10%. In fact, more than 20% of adults in Botswana, Lesotho, Zimbabwe and Swaziland have HIV/AIDS. Researchers estimate that 18.8% (5.5 million people) are living with HIV in South Africa.
  • In general, more women than men in Sub-Saharan Africa are infected with HIV. Researchers estimate that there are 13 women living with HIV for every 10 men who are HIV-positive in the region. In addition, women are typically infected at an earlier age than men. The difference between male and female infection rates is most apparent in people between the ages of 15-24 years old. In this age group, it is estimated that there are 36 females living with HIV for every 10 males. One of the most significant causes of the high HIV infection rate among females is their subordinate role in society. Married women must be subservient to their husbands, which makes it difficult for them to negotiate safe sex. In addition, women's economic dependence on men contributes to their vulnerability to HIV/AIDS infection.
  • Kenya, Uganda, Zimbabwe and urban areas of Burkina Faso have experienced declines in adult HIV prevalence in the last few years. Even though these countries have experienced a decline in risky sexual behaviors, and less people are diagnosed with HIV each year, the AIDS rates are still on the rise.
  • In general, the widespread prevalence of HIV and AIDS in Sub-Saharan Africa may be attributed to poor hygiene and economic conditions, as well as unprotected sex and blood transfusions. The WHO estimated that 25% of the blood transfused in Africa was not tested for HIV in 2000. Consequently, about 5-10% of HIV infections in Africa in 2000 were transmitted by blood transfusions. Poor economic conditions, which often lead to unsanitary conditions in healthcare clinics, contribute to the high infection rate. Unsanitary healthcare clinics may not be able to properly sanitize medical and surgical equipment, or may not have access to blood barriers like gloves. Prostitution also contributes to the spread of the disease. Many females are forced into prostitution because they lack economic power and job opportunities.
  • In 2000, South African President Thabo Mbeki publicly questioned the efficacy of HIV medications and doubted that HIV causes AIDS. While South Africa has created preventative programs to address the HIV epidemic, critics claim that the South African government has been slow to create antiretroviral programs. In Sub-Saharan Africa, about 17% of the estimated people in need of ART received the treatment in 2005.

Asia
  • The prevalence of adult HIV is lower in Asian countries than in Sub-Saharan African countries. According to the CDC, the epidemic in most Asian countries is attributed to high-risk behaviors, such as unprotected sex and injection-drug use. An estimated 16% of people who required ART in Asia received treatment in 2005.
  • India: In 2006, India surpassed South Africa as having the world's largest HIV population. Out of the estimated 8.3 million people living with HIV in Asia, about 5.7 million live in India. About 80% of HIV infections are acquired heterosexually. However, recent data show a decline in HIV prevalence in four Indian states among pregnant women ages 15-24. In 2000 an estimated 1.7% of pregnant women were infected, and in 2004 an estimated 1.1% of pregnant women were infected.
  • China: In China, an estimated 650,000 people are living with HIV. According to the CDC, about 50% of infected people acquired the disease from injection-drug use. However, the exact number is difficult to estimate because the Chinese government is reluctant to report the information. In addition, it is common for individuals to hide their HIV status because they are afraid of being discriminated against, according to the Chinese Department of Disease Control. There have been reports of some patients in China who were refused admission to hospitals because of their HIV-positive status.
  • Thailandand Cambodia: The HIV/AIDS epidemic in Thailand and Cambodia is attributed to commercial sex, which is legal in both of these countries.
  • In 2003 there was a decline in HIV prevalence among pregnant women. In 1995 2.4% of pregnant women were infected, and in 2003, 1.2% of pregnant women were infected. However, HIV incidence among men who have sex with men increased in Bangkok from 17% in 2003 to 25% in 2005.

Americas
  • According to the CDC, most HIV infections in the Americas are among men who have sex with men, injection-drug users and prostitutes. In general, about 68% of people in South and Central America and the Caribbean who needed ART received it in 2005. In the United States, about 55% of people who needed ART received it in 2005. High medical costs and lack of healthcare insurance significantly affect the availability of treatment.
  • United States: In 2006, more than one million people were living with HIV/AIDS in the United States. An estimated 252,000-312,000 HIV-infected people in the United States are unaware that they are HIV-positive, making them at high risk for transmitting HIV to others, according to the CDC.
  • Widespread availability of diagnostic tests for HIV infection has helped prevent HIV infections. About 50% of people ages 15-44 have reportedly taken an HIV test in the last year. Since the mid-1980s, blood donor screening methods and testing technology have continually improved. Today nucleic acid tests are used to screen blood products for infectious diseases like hepatitis and HIV. Therefore, the risk of HIV transmission is estimated to be as low as one per two million blood donations.
  • Prevention interventions, such as drug treatment programs, risk reduction education and peer outreach, have contributed to a steady decline in new HIV/AIDS diagnoses among injection-drug users. In 2001, an estimated 8,048 injection-drug users were diagnosed with HIV, compared to 5,962 in 2004.
  • Certain subpopulations are more likely to develop HIV. For instance, men who have sex with men (MSM) account for about 45% of newly reported HIV/AIDS diagnoses and nearly 54% of cumulative AIDS diagnoses. MSM made up about two-thirds of all men living with HIV in 2004, even though only about 5% to 7% of men in the United States reported having sex with other men. According to one national study, about 25% of male homosexuals surveyed in large U.S. cities are infected with HIV, and nearly 50% of those infected are unaware of their HIV status.
  • Racial and ethnic minority communities also are disproportionately affected by HIV/AIDS in the United States. Recent data show that during 2001-2004, African Americans and Hispanics together accounted for 69% of all reported HIV/AIDS cases in the United States. African Americans, who only make up about 13% of the U.S. population, accounted for 51% of all new HIV/AIDS diagnoses in the United States.
  • Currently, women account for about one quarter of all new HIV/AIDS diagnoses, and in 2002 HIV infection was the leading cause of death for black women who were 25-34 years old.
  • Brazil: Brazil has an adult HIV prevalence of about 0.5%. Brazil accounts for more than one-third of all HIV infections in Latin America. The virus is primarily transmitted during commercial sex, sex between men and injection-drug use.
  • Many Brazilians, ages 15-24, engage in high-risk behavior that could lead to the development of HIV. For instance, one of out three Brazilians, ages 15-24, reported that they engaged in sexual activity before the age of 15, and one in five reported that they had more than 10 sexual partners, according to the CDC.
  • Brazil provides free ART to everyone who needs treatment. An estimated 83% of HIV-infected people receive the treatment.
  • Caribbean: At the end of 2005, an estimated 330,000 people were living with HIV and AIDS in the Caribbean. About 37,000 people were newly infected during 2005, and about 27,000 died from AIDS. Researchers estimate that the adult prevalence rate is between 1.1% and 2.7%, making it the second-most affected region in the world.
  • HIV transmission is primarily heterosexual. However, sex between men is also a significant route of transmission.
  • HIV prevalence has declined in the urban areas of Haiti, but has remained relatively constant throughout other areas of the Caribbean.

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