Where we stand with HIV/ AIDS
Two brief clinical papers in 1981 provided the first hints that a new epidemic had emerged for the US and the world. One reported a cluster of a rare, fungal pneumonia. The other reported several cases of a rare cancer — Kaposi sarcoma. The patients, all of whom were gay males, died within short intervals of diagnosis. Experts at the US Center for Disease Control (CDC) and National Institutes of Health (NIH) began an urgent search for a cause.
Other reports from abroad documented a worldwide prevalence of the new disease.
Subsequent clinical reports identified some children with inherited bleeding disorders (hemophilia) and recipients of blood transfusions as victims of the disease.
Remarkable work by scientists around the world led to the identification of a new pathogen, soon named human immunodeficiency virus (HIV). The virus targeted a specific cell in our immune defenses, first invading the cell before installing itself in that cell’s DNA. Before dying, the infected cell became a factory for producing HIV, which spread infection to other like cells.
Routes of transmission of the new disease were worked out in 1983. Blood, blood products, semen, vaginal and rectal mucus, and breast milk could serve as vehicles. This information led to universal safeguards for health-care workers to protect against potentially infected fluids.
Intensive research clarified the action of HIV. Beginning at the time of infection the virus slowly erodes the body’s immune defenses over a period of years. When
the vital cells fall below a critical level certain cancers and bacterial, fungal, and parasitic infections develop. This is the stage of acquired immunodeficiency syndrome (AIDS). Eight to 10 asymptomatic years may elapse between infection with HIV and the development of AIDS.
Following identification of the causative virus, scientists developed a screening blood test in 1984. The FDA licensed the test the following year.
Spread of HIV among persons with hemophilia was traced to contamination of pooled supplies of blood components that were administered to prevent or to treat episodes of bleeding. Many boys and young men with hemophilia were infected and died as a consequence of the injections.
News of the epidemic initially prompted panic and efforts to isolate HIV-infected persons. Ryan White, a teenaged boy from Indiana, developed HIV in 1984 from contaminated injections for hemophilia. His ban from attending school attracted nationwide attention to the plight of patients with HIV/AIDS. In the remaining five years of his life he and his supporters fought to remove much of the stigma attached to the disease. Shortly after Ryan’s death in 1990, Congress passed the Ryan White CARE Act, which assured care for poor and uninsured persons with HIV/AIDS.
The Americans With Disabilities Act of 1990 prohibited discrimination against persons with disabilities, including HIV/ AIDS, in hiring and use of public transportation and accommodations.
The first effective medication, AZT, was licensed in 1987. An array of novel drugs effective against HIV/AIDS followed.
With careful management, a person with HIV/ AIDS can have a long and fulfilling life. His disease can be contained but not cured. He will require lifelong medication for his illness, often supplemented with medication for other infections which he may have acquired as a result of his weakened immune system.
In 2014, more than 37,000 new HIV diagnoses were made in the U.S., down from 45,000 in 2008. More than 6,500 deaths were attributed to AIDS in 2014. In the peak year of 1995, more than 41,000 Americans died of AIDS-related illness. An estimated 1.1 million Americans were living with HIV in 2014. Fifteen percent did not know that they were infected. More than 625,000 Americans have died of HIV-AIDS since the epidemic began.
Seventy per cent of U.S. cases in 2014 occurred in gay or bisexual men. Heterosexual contact accounted for 23 percent. IV drug use with shared needles accounted for most of the remainder. This fraction will increase with the expansion of the opioid epidemic.
Worldwide, an estimated 36.7 million people live with HIV. An estimated 1.8 million are newly infected each year, and more than one million people die of AIDS. Poverty and poor public health systems contribute to lack of testing and availability of medications for many of those persons who are infected.
Despite extensive research, a vaccine to prevent HIV infection has been elusive. Such a vaccine remains the best hope for finally controlling this devastating epidemic.
Given the crucial role of the CDC and NIH in detection and research of HIV/AIDS and other potentially catastrophic diseases it is disturbing to see substantial cuts in the budgets for both agencies in the budget currently before Congress. Both institutions represent vital shields for the public’s health.
Contact Clif Cleaveland at ccleaveland@ timesfreepress.com.