The history of HIV is filled with triumphs and failures; living and death. The HIV time line stretches before us, marking our past and reaching toward our future. But where will that future lead? What does the history of HIV show us? What have we learned throughout the history of HIV?
The HIV time line began early in 1981. In July of that year, the New York Times reported an outbreak of a rare form of cancer among gay men in New York and California. This “gay cancer” as it was called at the time was later identified as Kaposi’s Sarcoma, a disease that later became the face of HIV/AIDS. About the same time, emergency rooms in New York City began to see a rash of seemingly healthy young men presenting with fevers, flu-like symptoms, and a rare pneumonia called Pneumocystis. This was the beginning of what has become the biggest health care concern in modern history. Twenty-five years later the disease still plagues society. How did we get to this point? Take a look back at 25 years of HIV/AIDS.
While we talk about HIV/AIDS being 25 years old, in actuality it is believed that the syndrome has been around far longer. In 1959, a man residing in Africa died of a mysterious illness. Only decades later, after examining some blood samples taken from that man, was it confirmed that he actually died from complications related to an HIV infection.
As stated above, 1981 saw the emergence of Kaposi’s Sarcoma and Pneumocystis among gay men in New York and California. When the Centers for Disease Control reported the new outbreak they called it “GRID” (gay-related immune deficiency), stigmatizing the gay community as carriers of this deadly disease. However, cases started to be seen in heterosexuals, drug addicts, and people who received blood transfusions, proving the the syndrome knew no boundaries.
Researchers at the Pasteur Institute in France isolate a retrovirus that they believe is related to the outbreak of HIV/AIDS. Thirty-three countries around the world have confirmed cases of the disease that was once limited to New York and California. Controversy arises a year later when the US government announces their scientist, Dr. Robert Gallo, isolates a retrovirus HTLV-III, which he too claims is responsible for AIDS. Two years later it’s confirmed that HTLV-III and the Pasteur retrovirus are indeed the same virus, yet Gallo is still credited with its discovery. An international committee of scientists renames the virus HIV.
A Canadian flight attendant, nicknamed “patient zero” dies of AIDS. Because of his sexual connection to several of the first victims of HIV/AIDS, it is believed that he is responsible for introducing the virus into the general population.
- 8000 confirmed cases in the US
- 3700 confirmed deaths
The controversy surrounding the HIV/AIDS virus continues when Robert Gallo’s lab patents an HIV test kit that later is approved by the FDA. The Pasteur Institute sues and is later awarded rights to half of the royalties from the new test. At the same time, HIV/AIDS enters the public eye when Rock Hudson dies of AIDS and Ryan White is barred from his elementary school in Indiana.
A Treatment Arrives: After 6 years of watching people die, a new treatment emerges that is hailed as the first huge step in beating HIV/AIDS. The drug Retrovir (AZT, Zidovudine) is FDA approved and begins to be used in high doses to treat people infected with HIV; and not a minute too soon. Politically, HIV/AIDS is a topic that most avoid. But in response to public pressure, President Ronald Reagan finally acknowledges the HIV/AIDS problem and for the first time uses the term “AIDS” in a public speech.
- 100,000 to 150,000 cases of HIV and AIDS
After years of fighting to stay in school, and raging an even harder battle against the ravages of HIV/AIDS, Ryan White dies at the age of 19. That year, The Ryan White Care Act is enacted by Congress to provide government sponsored funds for the care of HIV/AIDS infected people.
- people living with HIV/AIDS rises to 1 million
Combination Therapy Arrives : The FDA approves the first drug to be used in combination with AZT. The addition of the drug Hivid marks the beginning of HIV/AIDS combination therapies, but a more disturbing development centers around HIV tainted blood. Three French senior health officials knowingly sell HIV tainted blood, resulting in the infection of hundreds of transfusion recipients, most of whom have hemophilia.
People who are infected and scientists alike are confused and concerned when a British study, the Concorde Trials, offers proof that AZT monotherapy does nothing to delay progression to AIDS in asymptomatic patients. As a result, the AZT debate emerges, with one side proclaiming AZT saves lives and the other denouncing AZT as useless; the “rethinker” movement is born.
Protease Inhibitors Arrive: Treatment options take another step forward with the introduction of power HIV-fighting drugs called Protease Inhibitors. The use of these drugs in combination with existing HIV/AIDS drugs proves effective in controlling HIV. These new “triple-therapies” give patients and scientists new hope in eliminating HIV/AIDS. But that hope is dashed when a year later, scientists find HIV/AIDS “hides” in reservoirs in the body, making total elimination of the virus virtually impossible.
In late 1996 data from AIDS Clinical Trials Group study 076 (ACTG 076) made it clear that Retrovir (AZT) used during pregnancy and at the time of delivery drastically reduces transmission of HIV from mother to child. Those findings led to protocols that now drastically reduce transmission from mother to child from 1 in 4 to less than 3%.
More than 15 years after the prediction there would be of an AIDS vaccine within 2 years, the first human trials in the United States of an HIV/AIDS vaccine begins. In a desperate attempt to get affordable HIV/AIDS drugs to the hardest hit areas of Africa, European drug companies ignore US patent laws and begin making generic versions of HIV/AIDS medications. In response, US drug companies file lawsuits to stop such practices. And sadly, 17 years after HIV/AIDS entered our culture, an African AIDS activist is beaten to death by neighbors after publicly admitting she was HIV infected.
The AIDS “rethinker” movement gets international attention and support when South African president Thabo Mbeki questions the use and effectiveness of HIV medications as well as offering doubt that HIV causes AIDS. In response, the international scientific community issues the Durban Declaration, offering proof that HIV and AIDS are indeed connected.
As scientists grow concerned over medication toxicity and effectiveness, US pharmaceutical companies drop their patent lawsuits, paving the way for European drug companies to manufacture and distribute cheaper HIV medications to the hardest hit areas of Sub-Saharan Africa. Cautious optimism emerges with the release of the first entry inhibitor, Fuzeon. Since 1981, 21 million people worldwide have died of AIDS, including 17 million from Sub-Saharan Africa.
- 31 million people are now living with HIV worldwide, the majority of whom are from African nations
As the emphasis on simpler therapies continues, regimen pill burdens are greatly improved with the release of two new combination drugs, Truvada and Epzicom as well as two new protease inhibitors, Reyataz and Lexiva. In December, the first generic formulation of an HIV medication is approved by the FDA, instilling hope that HIV medication prices may soon come down.
HIV statistics have become sobering to say the least.
- 4.9 million people were newly infected in 2005
- 40.3 million people worldwide living with HIV/AIDS.
And as the numbers continue to climb, work on an HIV vaccine has for the most part failed. Once thought to be “just around the corner” it has become obvious in 2005 that an HIV vaccine is still years away. Medication advances continue but long term side effects of HIV medication use are becoming more evident. So much so that experts now agree that for many patients, waiting to start HIV medications is the best course of action. Finally, 2005 saw a rise in HIV rates on college campuses and risky behavior among those people already infected is still a problem. Positive prevention messages are becoming a priority as syphilis and other STD rates of infection continue to rise sharply.
Experts conclude that HIV has its origins in the jungles of Africa among wild chimps. Experts go on to report that evidence suggests that the simian form of HIV (SIV) entered the human species and became HIV by way of monkey bites or ingesting monkey meat and brains. While the origins of HIV are clearer, the means to pay for HIV care and medications has become more complicated. A revamping of the Medicare / Medicaid systems has made getting medications difficult for many. India surpasses South Africa as the world’s largest HIV population and in the US infection rates of HIV are steady while STDs are on the rise.
The Centers for Disease Control (CDC) reports that since the US HIV epidemic began, over 565,000 people have died of AIDS.
Scientists at the University of North Carolina at Chapel Hill announce they have decoded the structure of an entire HIV genome. How this will affect the future of HIV treatment, prevention, and education is not entirely known. What we do know is that the more we know about HIV, the better we can fight its affects on public health in the US and around the world.