HIV/AIDS Pandemic Hits 30-Year Mark With Hope

May 29, 2011— -- Thirty years ago this week, researchers and clinicians were putting the finishing touches on an article intended for the June 5 issue of Morbidity and Mortality Weekly Report.

Titled "Pneumocystis Pneumonia -- Los Angeles," the seven-paragraph report was the first dispatch from the front lines of humanity's remarkable war against a previously unknown virus.

The war began with a complete lack of good news -- the new disease was almost 100 percent fatal, often within weeks or months. No one knew what caused it or how it was transmitted. No one knew how to prevent it, to treat it, and certainly not how to cure it.

Thirty years on, the HIV/AIDS pandemic is still raging, but the news from the front is more and more positive.

Infection can be prevented, if people have the will. The virus is increasingly well understood, as is the immune system and the host-pathogen interaction. The disease can be treated, although a cure remains out of reach.

Perhaps most important -- while many people still die because of the virus -- HIV is no longer a death sentence.

Dr. Anthony Fauci, now the head of the National Institute of Allergy and infectious Diseases, was a 10-year veteran of the NIH at the time, with a lab studying the immune system and host-pathogen interactions.

"I remember quite clearly," he told MedPage Today, as he recalled sitting in his office, leafing through that week's MMWR, and coming across the report from Los Angeles.

He knew Pneumocystis pneumonia -- usually abbreviated PCP -- as a disease usually seen in people with compromised immune systems, often cancer patients undergoing chemotherapy.

But the MMWR report struck him as a curiosity, until a month later when a second report from the CDC hit his desk.

Now there were 26 patients, not five.

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They were from Los Angeles, San Francisco, and New York. They were all gay and previously healthy. And some of them had Kaposi's sarcoma, another disease usually seen in people with compromised immune systems.

"At that point I just got goose pimples," Fauci said. "I said, 'Oh my goodness, we're dealing with something really new here'."

Despite the horrified reaction of friends and mentors, he made the immediate decision to turn his attention this new "curiosity of a disease."

It's a story repeated again and again by those who have been involved in the pandemic.

Dr. Carol Hamilton of Research Triangle Park, NC, is a senior scientist with FHI, a research professor at Duke University, and a clinician with decades of experience in treating HIV. She's also a member of the Infectious Diseases Society of America's Center for Global Health Policy and Advocacy.

But in 1981, she was working in public health in Utah, before going to medical school. And even there, she and colleagues were seeing strange illnesses among gay men -- lots of syphilis and gonorrhea, yes, but also a "very worrisome" infection that had no known cause.

"It was frightening, honestly," she told MedPage Today.

She had intended to practice obstetrics, but in medical school she found internal medicine and infectious disease -- especially HIV -- much more compelling.

"The HIV epidemic seemed to be the important issue of the age," she said.