In the short time since the first cases of the AIDS epidemic were reported in 1981, scientists have identified the viral cause of the illness, the basic modes of transmission, accurate tests for the presence of infection, and effective drugs that slow or halt the progression of the disease. During that same period, governments and grassroots organizations around the world were spurred into action to meet the growing need for AIDS education, counseling, patients’ rights, and clinical research. Despite these advances, critics observe that many governments were slow to respond to the crisis. For example, United States president Ronald Reagan did not discuss AIDS in public until 1987, more than six years after the start of the AIDS epidemic. By that time, 41,000 Americans had already died from the disease. AIDS advocates believe that the lack of federal support for AIDS research in these early years delayed the development of an effective vaccine or a cure for the disease.
Origin of the Virus
Using computer technology to study the structure of HIV, scientists have determined that HIV originated around 1930 in rural areas of Central Africa, where the virus may have been present for many years in isolated communities. The virus probably did not spread because members of these rural communities had limited contact with people from other areas. But in the 1960s and 1970s, political upheaval, wars, drought, and famine forced many people from these rural areas to migrate to cities to find jobs. During this time, the incidence of sexually transmitted infections, including HIV infection, accelerated and quickly spread throughout Africa. As world travel became more prevalent, HIV infection developed into a worldwide epidemic. Studies of stored blood from the United States suggest that HIV infection was well established there by 1978.
In 1970, at about the same time that the HIV epidemic was taking hold in Africa, American molecular biologist David Baltimore and American virologist Howard Temin independently discovered the enzyme reverse transcriptase, which could be used to identify retroviruses. Over the next ten years, many retroviruses were identified in animals. But not until 1980, shortly before the first AIDS cases were recognized in the United States, did American virologist Robert Gallo identify the first human retroviruses, HTLV-I and HTLV-II (HTLV stands for human T cell lymphotropic virus).
Other studies demonstrated that these human retroviruses were more closely related to a retrovirus found in African chimpanzees than to each other. This discovery suggests that the human retroviruses may have evolved from retroviruses that originally infected chimpanzees. The chimpanzee retrovirus likely infected people and underwent mutations to form the human retrovirus. In 1999 scientists confirmed that HIV spread from chimpanzees to humans on at least three separate occasions in Central Africa, probably beginning in the 1940s or 1950s.
Disease First Identified
Beginning in June 1981 the CDC published reports on clusters of gay men in New York and California who had been diagnosed with pneumocystic pneumonia or Kaposi’s sarcoma. These two rare illnesses had previously been observed only in people whose immune systems had been damaged by drugs or disease. These reports triggered concern that a disease of the immune system was spreading quickly in the homosexual community. Initially called gay-related immunodeficiency disease (GRID), the new illness soon was identified in population groups outside the gay community, including users of intravenous drugs, recipients of blood transfusions, and heterosexual partners of infected people. In 1982 the name for the new illness was changed to acquired immunodeficiency syndrome, or AIDS.
While the disease was making headlines for the speed with which it was spreading around the world, the cause of AIDS remained unidentified. Fear of AIDS and ignorance of its causes resulted in some outlandish theories. Some thought the disease was God’s punishment for behaviors that they considered immoral. These early theories created a social stigma surrounding the disease that still lingers.
Scientists quickly identified the primary modes of transmission—sexual contact with an infected person, contact with infected blood products, and mother-to-child transmission. From these modes of transmission it was clear that the new illness was spread in a specific manner that matched the profile of a viral infection. In 1983 French cancer specialist Luc Montagnier and his colleagues isolated what appeared to be a new human retrovirus from AIDS patients. They named it lymphadenopathy virus (LAV). Eight months later Gallo and his colleagues isolated the same virus in AIDS patients, naming the virus HTLV-III. Eventually, scientists agreed to call the infectious agent human immunodeficiency virus (HIV). In 1985 a new AIDS-causing virus was discovered in West Africa. Named HIV-2, the new virus is closely related to the first HIV, but it appears to be less harmful to cells of the immune system and reproduces more slowly than HIV-1.
Research leading to the development of the ELISA test was conducted simultaneously by teams led by Gallo in the United States and Montagnier in France. In 1985 the ELISA test to identify HIV in blood became available, followed by the development of the Western Blot test. These tests were first employed to screen blood for the presence of HIV before the blood was used in medical procedures. The tests were later used to identify HIV-infected people, many of whom did not know they were infected. These diagnostic tests also helped scientists study the course of HIV infection in populations.
Defining the Illness
The CDC presented its first definition of AIDS in 1982. The CDC recommended that physicians diagnose AIDS if a person has an illness known to be caused by immune deficiency, as long as there is no known cause for this immune deficiency (people who undergo radiation therapy or who take certain drugs may impair their immune systems). As more information became known about the course of HIV infection and the nature of the virus itself, this definition of AIDS was revised repeatedly to expand the list of illnesses considered diagnostic indicators of the disease. Early definitions were based on the opportunistic infections commonly found in HIV-infected men. As a result, many women who did not have symptoms covered in the official AIDS definition were denied disability benefits and AIDS-related drug therapies.
The current definition of AIDS was created in 1993 and includes 26 opportunistic infections and cancers, known as diagnostic indicators, that affect both men and women. The definition also emphasizes the importance of the level of CD4 cells in the blood. Today doctors make the diagnosis of AIDS in anyone with a CD4 count below 200 cells per microliter of blood, regardless of the associated illnesses they may have.