History of AIDS

The Centers for Disease Control and Prevention published the first medical report of a new immunodeficiency disease in June of 1981.1 The report described five young homosexual men in Los Angeles diagnosed with Pneumocystis carinii pneumonia (PCP), a rare condition for otherwise healthy youth. This report was followed shortly by reports from New York and San Francisco of young men diagnosed with Kaposi's sarcoma, another rare disease, along with PCP.2 In 1982, what had become referred to as GRIDS (gay-related immunodeficiency syndrome) was redefined by the CDC as AIDS (acquired immunodeficiency syndrome). By 1985, 10,000 patients in America had been diagnosed with AIDS.3 Through 2004 in the United States, almost a million people had been diagnosed with AIDS; more than half had died. HIV infection is more difficult to monitor, but the CDC estimates that at the end of 2003, up to 1.2 million Americans were infected, with 1 in 4 being unaware of their infection.

While the first US medical reporting of what would be called AIDS happened in 1981, a review of medical records using current criteria for an AIDS diagnosis indicates that the earliest case was possibly in the 1950s5 and certainly occurred by the end of the 60's as a patient's stored tissue and blood samples tested positive for HIV.6 In 1999, the National Institutes of Health announced that the origin of HIV infection had been traced to an endangered species of chimpanzee in western Africa. Researchers genetically matched the chimpanzee virus SIVcpz with HIV-1 and determined that in at least three incidences, the simian virus had genetically recombined within the chimpanzee population to become a zoonose; an animal pathogen that can infect humans. Hunters become infected through exposure to the blood.7

Between the dawn of the pandemic in the early eighties to now, AIDS has shifted from being a white homosexual disease to a non-white heterosexual disease. The most dramatic demographic shifts are in race, gender and sexual orientation. In 1983, male-male sex accounted for 71% of infections; 43% in 2004. Whites accounted for 60% of infections in 1981 and Blacks accounted for 25%. In 2004, Blacks accounted for 50% of new infections and Whites 29%. By 1987, women comprised only 8% of infections but in 2004 rose to 27% of new infections.4 HIV infection has crossed all demographic boundaries.

Advances in testing and treatment

Driven by the dramatic increase of infection and the danger of tainted blood supplies, researchers developed an HIV blood screening test in 1985. Infections by blood transfusion have dropped from 2% in 1985 (252 cases)8 to almost 0% in 2004 (90 cases).4 Initial efforts at anti-retroviral therapies proved greatly disappointing, as single-drug therapies like AZT had a short period of repressing viral load, but then produced an explosive replication trend as drug-resistant virus overtook the treatment. In 1996 highly active anti-retroviral therapy (HAART, a combination of protease inhibitor drugs and reverse transcriptase inhibitors) replaced single drug treatment, slowing the progression of HIV infection to AIDS and significantly increasing the lifespan of AIDS patients.

Though HAART (now simply referred to as ART) treatment is a significant treatment breakthrough, no cure for AIDS has been developed. Nor has a vaccine. The best protection against contracting HIV is to eliminate exposure to the virus by practicing sexual abstinence, having a monogamous relationship with an uninfected partner and never sharing a needle, intravenous or otherwise, with anyone. Consistent condom use can significantly reduce exposure to infection.

1. Centers for Disease Control and Prevention. Pneumocystis pneumonia--Los Angeles. MMWR Morb Mortal Wkly Rep 1981; 30:250-2.
   
   
2. Centers for Disease Control and Prevention. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb Mortal Wkly Rep 1981; 30:305-8.
   
   
3. Centers for Disease Control and Prevention. Update: acquired immunodeficiency syndrome--United States. MMWR Morb Mortal Wkly Rep 1985; 34:245-8.
   
   
4. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Vol. 16. Atlanta, US: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.
   
   
5. Huminer D, Rosenfeld JB, Pitlik SD. AIDS in the pre-AIDS era. Rev Infect Dis 1987; 9:1102-8.
   
   
6. Garry RF, Witte MH, Gottlieb AA, et al. Documentation of an AIDS virus infection in the United States in 1968. Jama 1988; 260:2085-7.
   
   
7. Gao F, Bailes E, Robertson DL, et al. Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature 1999; 397:436-41.
   
   
8. Centers for Disease Control and Prevention. Acquired Immunodeficiency Syndrome (AIDS) Weekly Surveillance Report - United States AIDS Activity. Atlanta, US: US Department of Health and Human Services, Centers for Disease Control and Prevention, 1985.