Brian Thomas Foley

It is probable that humans were first infected with HIV in the Kinshasa region of the Democratic Republic of the Congo in the 1950s and yet many decades later we are still studying and discovering how best to control what has become a global epidemic. One of the epicenters of the disease was in Miami when people with symptoms that were inexplicable in their particular populations became of interest to clinicians and scientists. This was occurring in other major cities, which also became the epicenters for this strange and destructive disease. This chapter highlights the history of one local region of the United States, Miami-Dade County, Florida and exemplifies the global problem. This chapter will indicate how local teams of scientists were called into action to address the impending epidemic. This is an example of how modern science can mobilize scientific teams that discover the origins and consequences of a highly complex disease. Eventually from that, scientific and medical foundations began to develop interventions for the control of HIV/AIDS and its related consequences. Recounting the beginnings of the research locally demonstrates significantly the importance of multidisciplinary and interdisciplinary approaches. The organizations responsible globally, nationally, and locally investigated many aspects of the populations that were afflicted with this communicable disease. Laboratory analysis proceeded in concert with the multiple strategies from clinics to neighborhood street outreach workers and then back into the laboratories. What happened in the city of Miami, and specifically at the University of Miami, is a story of how remarkable scientific endeavors can be and account for the effectiveness of science in the modern world. It also demonstrates how the scientific approach moves from the local to the national and then global level as its findings are disseminated to ensure verifiable evidence that is generalizable to global populations.

The first documented cases of HIV/AIDS in the United States bewildered physicians as they presented an unusual disease spectrum. Two young men were diagnosed with Kaposi sarcoma and Pneumocystis carinii pneumonia, which was inexplicable at that time, as these health outcomes were rare among their age, race/ethnicity, and individuals not living in nursing homes. Subsequently, it was found that after infection with HIV, individuals were asymptomatic up to 4 weeks and if symptoms developed, they appeared as a simple type of flu. The progression and global proliferation of the HIV pandemic is mirrored by the spread of Zika virus (ZikaV). Humans were probably first infected with HIV in the Kinshasa region in the 1940s and ZikaV was first detected in humans in the Zika forest in the 1950s. Aedes aegypti and Aedes albopictus mosquitoes transmit ZikaV, an arbovirus, as well as other related arboviruses. In addition to mosquito transmission, ZikaV transmission occurs through sexual risk and blood transfusions. The latter two risk factors were prominent modes of transmission during the early stages of HIV/AIDS epidemic and sexual transmission risk remains prominent. In addition, injection drug use is a risk factor to become HIV infected. For HIV, blood transfusion risk was reduced after appropriate testing of blood supplies. Unlike HIV, ZikaV does not produce significant symptoms that require medical attention among four-fifths of infected individuals. Indeed, initially considered a relatively benign virus, the unexpected emergence of ZikaV in the Americas since 2015, and continuing as a virulent and pathological virus for children and adults, created a sense of fear and distress. These emotional responses parallel the HIV/AIDS epidemic. Clinicians, epidemiologists, and other scientists are currently increasingly laboring to discern the full spectrum of risk, relative to vector and population behaviors, and as with HIV, to develop vaccines and chemotherapy against ZikaV. NIH and Walter Reed ZikaV vaccines are on the way.

Injection drug use is a major risk behavior associated with transmission of HIV-1B. Yet, despite its importance there have not been many detailed studies characterizing the transmission of HIV-1B in well-defined injection drug use networks. This preliminary study characterized people who were closely associated and injected drugs together under private circumstances compared to those who injected drugs in a context of public risk locales with many injectors in attendance. In this study, we examined networks of HIV-1B seropositive injection drug users (IDUs). We wished to ascertain whether socioepidemiological connections and relationships (including IDU and sexual) among individuals who inject drugs would be reflected in the molecular relatedness and clustering of their HIV-1B nucleotide and protein sequences – specifically hypervariable domains (V1–V5) of the HIV-1B envelope (env) gene. We wished to learn if there was a link between subject socioepidemiology and viral sequence diversity, phylogenetic relationships, signatures, thermodynamics, and glycosylation patterns. This chapter addresses whether in risk locales where many people inject together, there are variations in probability of relatedness of HIV-1B env sequences. In addition, it is pointed out that IDU behaviors are associated with psychiatric morbidities.

HIV-1 and HIV-2 both cause AIDS in humans, and both originated in nonhuman primates in Africa before several cross-species transmission events introduced them into humans. Of more than seven such events, only one, creating the HIV-1 M group of viruses, resulted in the AIDS pandemic. Studying the evolution and epidemiology of the viruses has many uses beyond tracing their origins. Evolutionary analyses are critical for vaccine design, for identifying drug resistance mutations, for designing therapeutic drugs, and for many other purposes. This chapter provides a brief overview of the evolution of human and simian immunodeficiency viruses. Evolution is the result of a complex interplay between mutations, selection pressures in individual infected hosts, selection pressures across populations of hosts, and recombination between virus lineages.

Zika virus is an arbovirus in the Flavivirus family that includes yellow fever, West Nile, dengue, and Japanese encephalitis viruses. Zika virus was discovered in a sentinel monkey in Uganda in 1947. Subsequently, this virus was detected over the years in Africa and Asia. Human-to-human transmission of Zika virus was described in the USA, from a scientist who contracted the infection in Senegal in 2008. Zika virus is an emerging pathogen and the point of this review is to highlight its epidemiology, clinical features, and molecular biology. The detection of Zika virus demonstrates association with the other related viruses that are more pathogenic. Although Zika virus is a relatively non-lethal virus, it is potentially dangerous as it is genetically related to more virulent and perilous viruses: e.g., yellow fever, West Nile, dengue, and Japanese encephalitis viruses. It could conceivably mutate into a more pathogenic form. Under the current conditions of emergent viruses, human behaviors, modern technology, mobile society, urbanization, and global climate changes, we suggest continued monitoring of Zika virus because of the dangers posed by the members of the virulent virus group to which it is related.