Thirty years ago, the disease we now call acquired immune deficiency syndrome (AIDS) first came to clinical attention.
A June 1981 report by the Centers for Disease Control described an outbreak of a rare form of pneumonia among gay males and IV drug users in New York. CDC served as the repository for the drug used to treat this form of pneumonia. A cluster of requests for the drug alerted public-health experts to a unique outbreak.
A July report documented the occurrence of a rare malignancy, Kaposi’s sarcoma, among gay males in California. A usually indolent tumor turned much more aggressive in this group of patients, all of whom died.
Cases of the strange, new disease appeared among hemophiliac subjects in 1982. European physicians reported that continent’s first patients. Studies indicated an impaired immune system in the victims. The term AIDS was created. Public health campaigns emphasized safer sexual practices.
As cases began to appear among newborn, children and non-IV drug users, scientists determined that AIDS had an infectious cause. In the first two years of the epidemic, 3,000 cases were reported, of whom one-third died. Numbers of victims rapidly increased in the United States, Europe and Africa.
The initial breakthrough came with the discovery that AIDS was characterized by a reduced level of a subgroup of white blood cells. These were termed CD 4, helper lymphocytes. CD 4 cells protect our bodies from infectious agents that usually cause either mild or no illness in healthy people.
In 1984, scientists in Paris and Washington identified a virus, termed human immunodeficiency virus (HIV), as the cause of AIDS. HIV could be transferred to fetuses and by blood, semen, breast milk and other bodily fluids. Soon, a test to screen donated blood for HIV was licensed.
In the first five years of the epidemic, at least 40,000 cases occurred in 84 countries. In 1987, AZT, the first drug to treat HIV specifically was licensed. AZT ushered in a steady array of pharmaceuticals to attack HIV at various points of its entry into CD 4 cells.
Acute infection with HIV may cause mild, flu-like symptoms — low-grade fever, aches, sore throat, swollen lymph nodes — for one to two weeks. The virus attaches to CD 4 cells and through a complex process insinuates itself into the DNA of those cells. Infected cells produce more viral particles, which are released when the cell dies. During a quiet period that may last up to 10 years, a patient will often remain asymptomatic while being infectious. CD 4 levels relentlessly fall until the victim falls prey to a variety of bacterial, viral and parasitic infections and various malignancies. The diagnosis of AIDS is made at this point.
My first patient with AIDS was a young man with a type of hemophilia, an inherited bleeding disorder. At that time, bleeding events were treated with IV infusions of a clotting factor extracted from large pools of plasma from thousands of donors. No one realized that the clotting factor was infected with HIV. As a consequence, thousands of hemophiliac sufferers died of AIDS. When Ryan White, a teenage boy with hemophilia was diagnosed with AIDS, he was expelled from his public school. A backlash against this action prompted the first national laws prohibiting discrimination against AIDS sufferers.
A close family friend in South Carolina died of AIDS, after an infected blood transfusion administered during heart surgery. This remarkable woman used the remaining months of her life to speak on behalf of kind treatment of all people with AIDS.
Data from the CDC and the United Nations estimate that 34 million people worldwide are infected with HIV. Since 1981, at least 30 million people have died of AIDS. Of the estimated 1 million Americans living with HIV today, at least 20 percent are unaware that they are infected. An estimated 56,000 new cases are diagnosed each year in the United States.
Because of remarkable advances in drug therapy, AIDS is now a chronic disease. With careful management, a patient can expect to live for 20 years or longer. Therapy costs $15,000 to $20,000 yearly. High costs of diagnostic tests and drugs mean that many AIDS sufferers in developing countries receive no therapy. So far, attempts to devise a preventive vaccine have failed.
Success in treatment carries with it the risk that societies and individuals will drop their guard against this devastating illness.
Email Clif Cleaveland at firstname.lastname@example.org.
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