A history of infection: The HIV/AIDS pandemic

Today, May 18, is HIV Vaccine Awareness Day. Led by the National Institute of Allergy and Infectious Diseases, today presents us with an opportunity to thank all those who work to find a safe and effective HIV vaccine, as well as getting the opportunity to educate on the importance of this research.

Our team here at Page wanted to contribute by looking back at how far we have come in the history of HIV. This article will look at how a previously unknown pathogen evolved into a global pandemic in just a few decades, and discuss why raising awareness of the volunteers, community members, and researchers working to find a safe and effective vaccine to prevent HIV is so important.

Let’s start with a journey back in time…

On 18th May 1981, the New York Native published the following:?

“Last week there were rumours that an exotic new disease had hit the gay community in New York.”

Soon after, this disease had established itself as a global pandemic. The disease was HIV/AIDS.?

Human immunodeficiency viruses (HIV) are two species of virus that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS). The first clinically observed cases were reported in 1981 in New York City. Unusual numbers of gay men were showing symptoms of pneumocystis pneumonia, a rare infection that usually only affects people with significantly compromised immune systems. The CDC quickly became aware of these rising cases; however, not knowing what caused it, they often referred to the cases by their symptoms. The public media instead coined the term ‘GRID’, which stood for gay-related immune deficiency. This marked the beginning of a culture of stigmatism against those with the disease despite the evidence it was not isolated to the gay community.

The beginnings of HIV treatment

It wasn’t until 6 years later that the first flicker of hope would appear. In 1987, the FDA fast-tracked an abandoned cancer drug, Zidovudine (AZT), which would become the first approved treatment for AIDS. While AZT decreased deaths and opportunistic infections, it was pricey and had some serious adverse side effects. More importantly, it was not a cure or prevention.

As the pandemic grew in the ’80s and 90s, so did the media attention. Whilst the public saw the rise of HIV/AIDS through high-profile cases such as Rock Hudson and Freddie Mercury, they also saw governments worldwide fail to take appropriate action. At this time, many organisations sprang up to provide support and advocate for patients including, devoted to political action in New York, and the Terrance Higgins Trust, providing services related to HIV and sexual health in the UK. The first World AIDS Day took place in 1988 and actor Jeremy Irons wore the first Red Ribbon to the Tony Awards in 1991.

This high pressure resulted in the approval of saquinavir and other antiretrovirals which paved the way for highly active antiretroviral therapy (HAART). This became the standard of care in 1996. Nearly 2 decades after the emergence of HIV and AIDS, a dozen antiretroviral drugs were on the market. But still, approximately 5.6 million new HIV infections occurred in 1999, and current treatments were not enough.

Continued advancements in HIV treatment

By the early 2000s, HIV/AIDS treatment was so advanced that those infected could lead full, healthy lives, a massive step from the death sentence it had been just a decade before. It was also observed that sexual transmission does not occur when an HIV-positive patient’s treatment is working effectively. This was a vital discovery in helping to de-stigmatise the disease.

?A huge breakthrough came in 2007, when Timothy Ray Brown became the first person to be cured of HIV via a bone marrow transplant. Since then, as many as five more people have been cured. 2010 brought another leap in treatment, with evidence that taking a daily dose of antiretrovirals not only helped those who were HIV-positive, but also could protect healthy people from becoming infected. This became known as pre-exposure prophylaxis or PrEP, which can lower the risk of catching HIV to almost zero.

The current global burden of disease

Despite enormous progress, HIV is still a significant problem worldwide. In 2021, 650,000 people died from AIDS-related illnesses, and 1.5 million became newly infected. In addition, it is estimated that as of 2021, 14.9 million children worldwide had lost one or both parents due to AIDS-related illnesses. Many people don’t even know they have the disease, with only 75% of people living with HIV knowing their HIV status! The need for effective prevention is evident.

To add fuel to the fire, there is still an ongoing crisis of misinformation surrounding the HIV/AIDS pandemic. In 2011, the BBC reported that some churches in London claimed prayer would cure AIDS, with several people stopping their medication, sometimes on the direct advice of their pastor.

Unfortunately, this led to many deaths. Furthermore, a 2014 survey of the British public showed that people wrongly thought HIV was spread by kissing (16%), spitting (16%), and coughing or sneezing (5%). Clearly, we still have a long way to go.?

Summary

It was only around 40 years ago that we observed the first HIV/AIDS case. Since then, we have seen massive progress toward understanding the virus and stopping it. However, even now, 25% of people living with HIV don’t have access to treatment and can infect others.

Historically, vaccines have been the most effective way of preventing and even eradicating infectious diseases. A partially effective vaccine, along with existing HIV treatment and prevention strategies could decrease the number of people who acquire HIV, further reducing the number of people who can pass the virus on to others. By substantially reducing the number of new infections, we can stop the epidemic and #EndHIVEpidemic.

To learn what you can do to support the fight against HIV/AIDS, head to the National AIDS Trust here.