What did we learn from AIDS?

Ignored by the White House in 1982

The 25th CROI in Boston provided an opportunity for Harold W. Jaffe from the Atlanta-based Centers for Disease Control and Prevention (CDC) to look back into the development and evolution of AIDS research, and lessons learned since the start of the epidemic in the first plenary session.

In 1981, Ronald Reagan was President of the United States. On June 5th that year the Center for Disease Control and Prevention (CDC) published in its Morbidity and Mortality Weekly Report (MMWR) a report on five young homosexual men interned in three Los Angeles clinics were treated for Pneumocystis Carinii Pneumonia (now known as Pneumocystis Jiroveci Pneumonia). All three had a cytomegalovirus infection and a candida mucosal infection. On July 3rd, 1981, the MMWR was reporting on an increasing number of Kaposi's sarcomas. Initially, the causes of this epidemic immunodeficiency were suspected to be infectious agents, environmental toxins, and immune system overloads. Some experts saw the sniffing drug Poppers as a key cause of this rising epidemic.

By late 1981, AIDS was recognized by the CDC as an independent disease. But at a White House press conference on October 15, 1982, Larry Speakes, the president's deputy press secretary, replied to a question about the CDC announcement of AIDS as an epidemic with more than 600 cases with a disregarding: “What's AIDS?" and a joking attitude towards the journalist that pressed him on the issue.

Guidelines based on epidemiological studies

Between December 1982 and January 1983, the CDC included transfusion recipients, persons with hemophilia, children whose mothers were affected by AIDS, women whose male sexual partners were affected by AIDS and intravenous drug addicts as the groups at risk of infection. In March 1983, the CDC, the US Food and Drug Administration (FDA) and the National Institute of Health (NIH) published the first guidelines on HIV/AIDS prevention. "In retrospect, these recommendations were entirely correct, although they were based exclusively on epidemiological studies", said Harold Jaffe.

LAV and HTLV-III = HIV

Only 2 months later, in May 1983, a research group led by Luc Montagnier published its findings on the lymphadenopathy virus (LAV), which was suspected to be the cause of AIDS. In May 1984, the researchers in Robert Gallo’s team identified the Human T-lymphotropic virus type III (HTLV-III) as the cause. By March 1985 it was clear that LAV and HTLV-III were identical. In 1985 the first ELISA antibody test was approved by the FDA and in 1986 the name Human Immunodeficiency Virus (HIV) was established.

As for the African continent, the first reports of cases in the region were provided by European clinics in 1983, and since then, further reports on the spread of AIDS came directly from institutions in the continent itself. The transmission routes of HIV were unclear for a long time, and numerous false hypothesis of its spread circulated. In an attempt to educate the population, many American households received the brochure "Understanding AIDS" in 1988.

High therapy costs

In the homosexual scene particular, various AIDS activist groups were formed, such as ACT UP (founded in 1987), and in the same year Zidovudine, an antiretroviral also known as azidothymidine, was the first therapeutic agent approved for the prevention and treatment of HIV/AIDS. In response to the epidemic, the FDA introduced a fast-track procedure to accelerate the approval of drugs for the treatment of life-threatening or other serious diseases.

However, the high cost of HIV medications has been a widespread problem, especially in developing countries. In 2003, President George W. Bush announced the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to combat the AIDS epidemic worldwide. Organisations were eventually added to the initiative and by mid-2017 some 20.9 million people worldwide had received HIV infection treatment within the scheme.

Lessons from the AIDS epidemic

"What can we learn from the early AIDS epidemic?" asked Jaffe. In his opinion, the experience shows us the importance of smart clinicians and hints from simple studies. Meanwhile, the evolution of the epidemic showed that the value of multidisciplinary teams and the commitment of those affected cannot be overestimated. In addition, it is of great importance to seriously note and act upon the fears of the general population, risk population, and health workers.

To Jaffe, the world was surprised by the AIDS epidemic, but recently we have also been surprised by the likes of MERS, chikungunya, Zika virus, Ebola, and cholera. In most cases, however, Jaffe believes that we are now better prepared for such new epidemics. In 2005, for example, the member states of the WHO adopted the International Health Regulation (IHR), which enables the international community to prevent or respond to acute health threats putting human populations at risk. However, only two thirds of the participating countries have met the necessary requirements to ensure IHR compliance by 2014.

At present, pointed Jaffe, the new tools of the digital age, such as electronic medical records and social media, make the detection and monitoring of new infections easier. In today's world, however, with the rise of the fake news and alternative facts paradigms, the question is whether a brochure like "Understanding AIDS" back in its day, would be believed at present. "I don't know," says Jaffe.

Source:
Jaffe HW. The early days of AIDS: Looking back and thinking ahead. 25th CROI, Boston, March 5, 2018, Abstract 12. http://www.croiconference.org/sessions/early-days-aids-looking-back-and-thinking-ahead

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