IDSA 2011: A Brief History of HIV/AIDS, Part I

BOSTON, MA—Arriving on stage last night in a black fedora, with the Indiana Jones theme blaring behind him, Michael Saag, MD, professor of medicine and director of the Center for AIDS Research at the University of Alabama at Birmingham, joked that he was pleased to accept the first annual IDSA archaeology award. He then slipped into his role as the first opening plenary session speaker at the annual meeting of the IDSA and took the crowd through a whirlwind history of HIV and AIDS, digging back well before the landmark report in June 1981 of five previously healthy gay men in Los Angeles with strangely weakened immune systems—and looking toward a future when we might be able to speak of the end of AIDS.

The real story, he explained, started sometime in the first few decades of the 20th century, when a chimpanzee in Cameroon slaughtered for bushmeat transmitted a virus to humans, which spread elsewhere in Africa, then to Haiti and the rest of the world via air travel and human-to-human transmission. Though the deadly disease wouldn’t burst onto the world stage until 1981, Saag explained that there were undoubtedly sporadic cases throughout the preceding decades.

1981-1987

“Imagine what it would be like if suddenly cases were showing up in your emergency departments that had unusual diseases—young people with some weird immune deficiency,” Saag told the audience. “How long does it take before patterns are recognized? How long does it take before a syndrome is defined?”

Gradually, physicians and researchers learned more about the mysterious disease. Kaposi’s sarcoma was clearly associated with it. Gay men were its primary victims, but then female partners of straight men contracted it, as did hemophiliacs and infants.

“Imagine how tough this was as a provider,” said Saag. “Not just seeing people your age dying and not being able to do much, but having a sense that you might catch this taking care of them and yet hanging in there, day after day, doing your job like a fireman or a policeman or a soldier, putting yourself in the line of action.”

The cause remained unknown. Was it the result of drug use? A fungus? Ultimately, the cause was identified as a virus called human immunodeficiency virus (HIV). The search for an effective treatment turned up zidovudine (AZT), an anti-retroviral drug originally formulated to treat cancer. The downside was that it required patients to take many pills each day and had unpleasant side effects.

To read about the rest of Saag’s speech, click here.