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June 5 Marks 35 Years Since First Report of AIDS

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Sunday, June 5th marks the 35th anniversary of the first report of what would come to be known as AIDS. The past 3 decades have included remarkable progress in the field -- including highly effective antiretroviral therapy and a pill that can prevent HIV infection -- but much remains to be done to make these advances available to all who need them.

The June 5, 1981, issue of Morbidity and Mortality Weekly Report, published by the U.S. Centers for Disease Control and Prevention (CDC), included an article about a mysterious cluster of Pneumocystis pneumonia (PCP) cases among formerly healthy gay men in Los Angeles. Not long thereafter, the July 4 issue of MMWR described multiple cases of PCP and a rare cancer, Kaposi sarcoma, in California and New York.

Describing the new sydrome in the New York Times, Lawrence Altman wrote, "The cause of the outbreak is unknown, and there is as yet no evidence of contagion. But the doctors who have made the diagnoses, mostly in New York City and the San Francisco Bay area, are alerting other physicians who treat large numbers of homosexual men to the problem in an effort to help identify more cases and to reduce the delay in offering chemotherapy treatment."

Before long similar cases began to appear throughout the country and around the world, affecting not only gay and bisexual men but also people with hemophilia, recipients of donated blood, people who inject drugs, and children born to women in these groups.

It soon became apparent that a previously unknown pathogen -- one that appeared to be both blood-borne and sexually transmitted -- was destroying the immune system, leaving infected people susceptible to a range of life-threatening opportunistic illnesses.

In an op-ed marking the 30th anniversary of the first report of AIDS in 2011, National Institutes of Allergy and Infectious Diseases director Anthony Fauci wrote, "The early years of AIDS were unquestionably the darkest of my career, characterized by frustration about how little I could do for my patients. At hospitals nationwide, patients were usually close to death when they were admitted. Their survival usually was measured in months; the care we provided was mostly palliative. Trained as a healer, I was healing no one."

In 1983 researchers announced the discovery of the human immunodeficiency virus, or HIV. The first drug that showed some efficacy against the virus, zidovudine or AZT, was approved in 1987, but it was not until 1996 that effective combination therapy using multiple antiretroviral drug classes became available.

The advent of effective treatment dramatically lowered death rates among people with HIV, first in the U.S. and other wealthy countries, and eventually in resource-limited countries. This week UNAIDS announced that there are now 17 million people worldwide receiving life-saving antiretroviral therapy (ART).

Yet despite these advances, much remains to be done.

UNAIDS estimates that nearly half of people living with HIV worldwide are still not on treatment, based on current U.S., European, and World Health Organization guidelines calling for all people diagnosed with HIV to start treatment promptly regardless of CD4 T-cell count.

In the U.S., the CDC's HIV care cascadeindicated that while 86% of people with HIV had been tested and diagnosed in 2011, just 37% had been prescribed ART and only 30% had undetectable viral load, which both halts disease progression and prevents onward transmission. (A recent study, however, suggested that fewer people may be living with HIV in the U.S. and a larger proportion may be on ART.)

In 2012 the U.S. Food and Drug Administration approved tenofovir/emtricitabine (Truvada) for HIV prevention. Data from the international iPrEx trial of men who have sex with men and transgender women showed that once-daily Truvada reduced the risk of HIV infection by 44% overall, rising to 92% among participants who took it consistently; in an open-label extension of iPrEx, no one who took Truvada at least 4 times a week became infected.

The CDC estimates that more than 47,000 people were newly diagnosed with HIV and more than 26,000 people were diagnosed with AIDS in the U.S. in 2013, indicating that effective treatment and prevention are not reaching everyone.

Both in the U.S. and worldwide, HIV disproportionately affects vulnerable groups including gay and bisexual men -- especially young gay men of color -- sex workers, and people who inject drugs, while stigma and criminalization discourage people living with and at risk for HIV from accessing the services they need. At the same time, aging and the issues of long-term survivors have become more prominent as people live longer with HIV.

6/3/16

Sources

MS Gottlieb, HM Schanker, PT Fan, et al. Pneumocystis Pneumonia -- Los Angeles. Morbidity and Mortality Weekly Report30(21):1-3. June 5, 2016.

LK Altman. Rare Cancer Seen in 41 Homosexuals. New York Times. July 3, 1981.