This Week in Science History saw, in 1981, the publication of an article that was the first to describe a new endemic disorder of the immune system – what would later become known as Auto Immune Deficiency Syndrome, or AIDS.
The paper was published by Michael Gottlieb through the American Centre for Disease Control and Prevention (the CDC) and was the first report of a disease that is now estimated to have killed over 25 million people since 1981. Death is usually caused by opportunistic infections that take advantage of the body’s reduced immune system – such as pneumonia.
At the time, Gottlieb was working at the UCLA Medical Centre, and the groups of symptoms shown by the homosexual men he examined did not fit any known disease. These included diarrhoea, fever, swollen lymph nodes and thrush infections in the mouth, something which often occurred in patients known to have reduced T lymphocyte numbers.
These cells are the part of the immune system that ‘seek and destroy’ invading pathogens like viruses and bacteria. Tests on Gottlieb’s patients confirmed they had a very low T cell count, particularly the T cells with a marker on their surface known as CD4.
Other symptoms included a particular form of pneumonia also seen in immuno-deficient children and Kaposi’s sarcoma, a form of skin cancer also related to reduced immune function.
Since then, many other symptoms have been recognised, since there are many infections that can take hold in AIDS sufferers.
Originally, the disease was not known as AIDS. The CDC referred to it by using the names of the associated infections such as ‘Kaposi’s Sarcoma and opportunistic infections’, but by the end of 1981, in the press it was known as GRID – Gay Related Immune Deficiency. However, in time it became apparent that not just homosexuals were affected, so in 1982, the name AIDS was coined and became the official name for the disease.
At this time, it was still not clear exactly what caused AIDS, but in 1983 and 84, two scientists, working in France and America respectively, isolated a virus from the lymph glands of individuals with AIDS and concluded that this virus was the cause of AIDS. There was significant controversy over the discovery of the virus, with each lab claiming to be the first to realise that this virus was the culprit, and it was not until 1986 that the name Human Immunodeficiency Virus was coined.
Gottlieb went on to be an important figure in AIDS research, being one of the first to trial AZT as a treatment. This drug is an antiretroviral drug and was the first drug approved to treat HIV infection. It is still used as part of the treatment today, combined with other antiretroviral drugs that slow the replication of the HIV virus in cells. These drugs can prolong life by 4-12 years for sufferers – without them, survival once AIDS develops is only around 9 months. However, these treatments are expensive and so are mainly only available in Western countries. In Sub-Saharan Africa, where around 2/3 of all AIDS sufferers live, these treatments are far too costly.
Unfortunately, there is as yet no cure for HIV as it has a very high mutation rate, meaning that once a drug is devised that will work on that particular strain, the virus has mutated and the drug will no longer work on it. Billions of dollars are spent each year trying to find a cure, but at the moment, the best cure is prevention, with global campaigns to increase condom use, and centres where drug addicts can pick up clean needles to reduce HIV spread.
Gottlieb’s paper was the first from the medical community to suggest that this disease was something serious and far reaching, and since its publication, our understanding of HIV and AIDS has greatly increased. The story does not have a happy ending yet, and we have many years of medical research ahead of us before we can see an end to this disease.