AIDS at 30: Killer has been tamed, but not conquered

McClatchy NewspapersJune 1, 2011 

WASHINGTON — On June 5, 1981, the U.S. Centers for Disease Control and Prevention issued a warning shot to the world when they reported the first known cases of what would soon be called AIDS.

In its Morbidity and Mortality Weekly Report, the CDC reported that five gay men had been hospitalized in Los Angeles with a rare strain of pneumonia that mainly afflicted people with compromised immune systems. Two of the men already had died.

The occurrence "in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual," the now-historic report reads. "The fact that these patients were all homosexuals suggests an association" between the pneumonia they developed and "some aspect of a homosexual lifestyle or disease acquired through sexual contact."

It wasn't until July 1982 that one of the worst global killers of all time would take its formal name as Acquired Immune Deficiency Syndrome. But it took longer for the public to understand that gay men weren't the only ones at risk.

In the years that followed, AIDS would engulf the world in fear as it spread among intravenous drug users, hemophiliacs, pregnant women and infants. Along the way, "safe sex" went from a catch phrase to a lifestyle for many.

"Once it became clear that it was in the blood supply and was caused by a virus, people went from total denial and complacency to much more of a panic mode," recalled James Curran, who headed the CDC's first task force on the mysterious disease back in 1981. "When those first five cases were reported, there were already 250,000 gay men in the U.S who were infected with the virus."

On the 30th anniversary of the CDC's groundbreaking report, the worldwide numbers for AIDS simply astound: more than 30 million dead, and another 33.3 million people who either live with the disease or HIV, the virus that causes it. Two-thirds of the world's AIDS and HIV patients live in sub-Saharan Africa.

In the U.S., where more than a million people have HIV or AIDS, the disease has killed more than 617,000 people.

The epidemic-turned-pandemic has destabilized nations and revolutionized medical research. It confronted cultural and social taboos and rewrote the book on political activism.

But even as 7,000 people around the world become infected with HIV each day, experts say Americans who never knew the terror of AIDS' early days have become complacent about prevention due to life-extending drug therapies that allow HIV patients to live relatively normal lives.

"There has been incredible progress over the last 30 years, but we're still in the thick of a major public health crisis, and unfortunately the sense of crisis in this country has waned," said Dr. Richard Wolitski, deputy director for behavioral and social science in CDC's Division of HIV/AIDS Prevention. "Today's young people have never known a time without effective HIV treatment, and we're asking them to act against a threat that seems remote, but is still very real."

One in five people in the U.S. with HIV don't even know it, which helps explain why a third of new HIV cases are revealed in the later stages, often within a year of developing full-blown AIDS.

Unlike the generalized epidemics that have ravaged poorer countries, the U.S. has a "series of concentrated epidemics," among certain demographic groups and in certain areas of the country, said Jeffrey Crowley, director of the White House Office of National AIDS Policy. For example, the District of Columbia's 3 percent HIV infection rate is one of the highest in the nation and rivals that of poor developing countries.

Nationally, some 56,000 Americans are infected each year with the HIV virus and nearly half are African American — blacks also make up about half the nation's AIDS and HIV patients, Wolitski said.

Men who have sex with men account for more than half of the nation's new infections — and they're the only at-risk group experiencing rising numbers of infections.

"This is extremely concerning," Wolitski said. "We're now seeing numbers of new infections among men who have sex with men that are higher than the ones that we saw at the end of the 1980s."

A series of medical breakthroughs in the mid-1980s helped stabilize and slow the spread of the disease. As new modes of transmission were discovered, new guidelines to halt transmission were announced, followed by the first anti-HIV drug, AZT, in 1986.

One of the biggest breakthroughs in the fight against AIDS came in 1985 when the first practical blood test for the HIV virus became available. Robert Gallo and his team of researchers at the National Institutes of Health developed the blood test in 1984 after they co-discovered HIV in 1983.

Gallo, who now directs the Institute of Human Virology at the University of Maryland, recalled meeting Curran in a Bethesda, Md., restaurant in March 1984 to see if the blood test had correctly spotted the virus in dozens of blood samples taken from both infected and healthy people.

"I walked out of there smiling that day," Gallo said, recalling how the test correctly identified each infected sample. "This test was, as I like to say, simple, sensitive, very specific and rapid."

The AIDS antibody test would protect patients worldwide from getting contaminated blood during transfusions and allow researchers to better track how the virus spread.

"It's the singular most important advancement in the history of the field," Gallo said.

Gallo, Curran and others are working to develop an HIV vaccine, and progress is being made.

"We have scientific evidence that a safe and effective HIV vaccine is possible," said a statement by Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases at NIH.

A 2009 clinical drug trial in Thailand showed for the first time ever that a vaccine could stop HIV infections in a modest share of participants. HIV researchers are studying blood samples from the trial to see what made it successful and whether it can be made more effective.

Scientists funded by NIH are also trying to design HIV vaccines based on the "protein structure of the surface spikes that HIV uses to attach to and infect human cells with the virus," Fauci's statement said. Parts of the spikes are vulnerable to antibodies that have been shown to block human cell infection by more than 90 percent of HIV strains worldwide.

"Now the scientists are mapping a strategy to create a vaccine that can stimulate a healthy person to make such broadly neutralizing antibodies," Fauci said.

Fauci's optimism reflects the growing international commitment to improve funding for AIDS prevention, treatment and research. Worldwide funding for AIDS programming increased from $1.6 billion in 2001 to nearly $16 billion in 2009, according to UNAIDS, the Joint United Nations Program on HIV/AIDS.

The extra money has provided results. According to the World Health Organization, AIDS-related deaths fell 19 percent from 2004 to 2009, while new HIV infections have fallen 19 percent worldwide over the last decade.

And with the falling cost of antiretroviral medications, poorer countries can now provide a year of drug therapy for about $137. The price break helped more than 5 million patients in low- and middle-income nations get AIDS medications in 2009, compared with 400,000 in 2003. Today, 53 percent of HIV-infected pregnant women have access to drugs that prevent transmission of the virus to their unborn children, compared to just 45 percent in 2008.

Curran said the lack of AIDS resources in poor nations continues to be a problem, but he's optimistic that advances in drug research will provide an HIV vaccine to ease the suffering.

"We've been pessimistic about HIV in the past, and the skeptics have been proven wrong," Curran said. "I hope the same thing will be proven again."

ON THE WEB

The 1981 CDC report of first AIDS cases

30-year timeline on AIDS

AIDS and HIV in your town

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