On June 5, 1981, the issue of Morbidity and Mortality Weekly report (MMWR) had a peculiar article. But before we get to that, I should mention that MMWR, published by the US Center for Disease Control, is the premier publication for public health issues in the US and the gold standard for such reporting in the world. That issue left medical professionals, scientists and public health experts scratching their heads.
In this report, exactly 40 years from the date that I am writing this article, five cases of previously healthy white gay men in Los Angeles were reported to have contracted a rare lung infection called Pneumocystis pneumonia (pronounced New-mo-sis-tis).
These cases were unusual because Pneumocystis pneumonia was caused by a type of fungus that was a very common microorganism and only caused disease in people whose immune systems were damaged. Consequently, prior to these cases, this rare pneumonia was seen in people who had cancers that suppressed their immune system or had it suppressed by cancer chemotherapy.
It might be seen in people who had had an organ transplant and were receiving drugs that suppressed the immune system so the body wouldn’t reject the organ. But these five men had none of these conditions. The pneumonia could be treated but before long, they would catch it again or either some other unusual infection or unusual cancers would pop up.
Eventually, they died just as more and more cases were being seen in gay men.
We didn’t know it at the time but we were seeing the first US cases of a then fatal disease that was eventually named Acquired Immune Deficiency Syndrome or AIDS. Pneumocystis pneumonia became the leading cause of death for people with AIDS but there were other infections and cancers, as well.
We didn’t even know what caused this disease for two more years until in 1983, a team of researchers in the US at the National Institutes of Health and a team in France at the Pasteur Institute both independently discovered a virus. The virus was first called Human T-cell Lymphotropic Virus-III or HTLV-III but was later changed to Human Immunodeficiency Virus or HIV. There was no cure or treatment for this fatal disease.
Well, 40 years and over 32 million deaths later, a lot has happened. But let me say that again: Over 32 million people have died from AIDS since 1981. Think about that. You should also understand that a substantial proportion of these were black people.
In the US, there have been over 700,000 deaths from HIV, a number that may soon be surpassed by the coronavirus pandemic in this country. Again, most of these have been black people. Based on the early reports of the AIDS epidemic, the assumption was that this was a white gay men’s disease.
With the intense homophobia of the 1980’s and 1990’s and stigma against the gay community, we were slow to recognize that HIV doesn’t discriminate based on race, gender or sexual orientation.
It kills black, white, LatinX, Native American and Asian. It kills gay and straight and has killed far more heterosexuals than gay people. It kills male and female. It really doesn’t care about our labels and how our society is established.
Our failure to understand that early on was a missed opportunity until our communities were ravaged. Black LGBQ communities but also black heterosexual women were among the most heavily affected.
Fast forward to 2021, forty years, there have been phenomenal scientific and medical accomplishments. A disease that was highly fatal 40 years ago with no treatments is now a chronically manageable disease with over 25 approved drugs and more approved combinations. Many patients can be controlled on a single pill combination once a day.
We have a treatment now approved that is a once monthly injection and could possibly be dosed every two months.
More promising long-acting agents are coming down the pipeline. Broadly neutralizing antibodies are a promising type of treatment that have renewed our hope of curing this infection. There are also several medicines that can prevent a person from getting infected. In some countries, people with HIV infection can live nearly a normal lifespan.
Thanks to the scientists, clinicians, epidemiologists, public health experts and activists, it is a lot easier to live with HIV than it is to die from it. Forty years is a long time. A lot has happened. Make sure to get the best care if you have HIV and if you don’t, protect yourself. Condoms work but PrEP is effective also. Share the information you learn with family and friends who can use it. Let’s hope it doesn’t take another 40 years to get a cure. We are definitely working on it!
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