Dr Richard Hunt

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VIROLOGY - CHAPTER   SEVEN    
PART TWO

THE HISTORY OF THE DISEASE

HUMAN IMMUNODEFICIENCY VIRUS AND AIDS  

WEB RESOURCES

Diffuse, Undifferentiated Non-Hodgkins Lymphoma among Homosexual Males -- United States 

The first report of transfusion-related immune deficiency In December 1982: 
Possible Transfusion- Associated Acquired Immune Deficiency Syndrome (AIDS)

First report of hemophilia-related immune deficiency in July 1982: 
Pneumocystis carinii Pneumonia among Persons with Hemophilia A

Important milestones in the epidemiology of AIDS from CDC. Links to many of the important MMWR papers
 25 Years of AIDS

History of AIDS
Avert.org

It is likely that HIV first appeared in humans in Africa in the 1930's or 40's as a result of infection by simian immunodeficiency virus (SIV) from chimpanzees. Since there are several groups of HIV-1 (see part 6), it is likely that humans became infected by SIV on more than one occasion. The disease spread to the Caribbean but it was only when it appeared in the homosexual population of the United States that AIDS gained public attention.

In 1981, clusters of cases of Kaposi's sarcoma (figure 3B) were reported in patients in San Francisco and New York. This was an unusual occurrence since, in the United States, Kaposi's sarcoma was a rare disease that normally occurred in elderly men of Jewish or Mediterranean ancestry; however, these new clusters of patients were all young male homosexuals and the disease was much more aggressive. Other diseases associated with immuno-compromisation also arose in this same population; particularly of note were the occurrence of  Pneumocystis pneumonia (which is an opportunistic infection) and lymphadenopathy (diffuse, undifferentiated non-Hodgkins lymphoma).

Pneumocystis pneumonia, which is caused by a fungal parasite (Pneumocystis carinii - now renamed Pneumocystis jiroveci, Figure 3A), was also a very rare disease in the United States. During the period between 1967 and 1978, only five cases of this disease occurred in Los Angeles; however, in 1981 alone, five cases occurred in the same area. Again, all patients were young male homosexuals. The number of sex partners of  these patients appeared to be important in that the disease was particularly prevalent among promiscuous individuals and the partners of those individuals.

No cases of diffuse, undifferentiated non-Hodgkins lymphoma were reported in the young male (20 - 39 years old) population of the San Francisco area during the period 1977-1980. However, from March 1981 to January 1982, the unusual occurrence of four cases within 10 months was observed; again, these were in the homosexual male population.

During 1982, similar immunodeficiencies were found in hemophiliacs (July), persons who received blood transfusions (December) and intra-venous drug users who shared needles. Moreover, by January 1983, it was clear that the female sex partners of these patients also got the disease. In view of this, it was obvious that an infectious agent was involved; this agent was either passed during sexual intercourse or by receiving blood (or blood products) from another person. At the same time as these events were occurring in western countries, doctors in Uganda were observing a similar fatal wasting syndrome that they called slim disease.

The cell picture - the selective loss of T4 helper (CD4+) cells - suggests a virus. But the causative agent was difficult to identify at first because it does not grow on resting T4 cells. The discovery of HIV depended on the ability to grow the virus in vitro and this required the used of activated T4 cells.

The disease was originally termed Kaposi's Sarcoma and Opportunistic Infections (KSOI) and then Gay-Related Immune Deficiency (GRID) but we now know it as Acquired Immuno-Deficiency Syndrome (AIDS or SIDA in French and Spanish). AIDS is almost always fatal as a result of immuno-suppression and consequent opportunistic infections (unless chemotherapeutic intervention occurs). The epidemic has resulted in the deaths of more than half of AIDS patients.
 

The clue to growing HIV came with the realization that, while it did not grow on resting T4 lymphocytes, it would grow on T4 cells that had been activated with a cytokine called interleukin-1. The virus was isolated in 1984 by Luc Montanier (Pasteur Institute, Paris) and Robert Gallo (NIH, Bethesda, USA). Montanier called the virus lymphadenopathy virus (LAV) and Gallo, who had discovered the first human leukemia virus (HTLV-1), named the virus HTLV-3. Today we know it as human immunodeficiency virus (HIV).

A similar cellular picture is seen in some cases of feline leukemia and HTLV-1 infection, i.e. a selective loss of a specific class of cells giving rise to immune suppression, further suggesting that the cause of AIDS is a virus.

VIDEO

See a 17 minute video looking back 20 years to the early days of CDC's involvement in the AIDS epidemic

RealVideo  

VIDEO
Update on rapid testing for HIV

The perivenular infiltrate of Kaposi sarcoma shows a mixture of  spindle cells, inflammatory cells, and ectatic vascular spaces.  The Johns Hopkins Autopsy Resource (JHAR). Image Archive. 

Kaposi's sarcoma (skin). Bristol Biomedical Image Archive, University of Bristol. Used with permission

Skin showing AIDS-associated Kaposi's sarcoma    Bristol Biomedical Image Archive, University of Bristol. Used with permission

PART I HUMAN IMMUNODEFICIENCY VIRUS AND AIDS

PART II HIV AND AIDS, THE DISEASE

PART III COURSE OF THE DISEASE

PART IV  COFACTORS

PART V STATISTICS

PART XI  OTHER CELLS INFECTED BY HIV AND POPULATION POLYMORPHISM

PART VI  SUBTYPES AND CO-RECEPTORS

PART VII  COMPONENTS AND LIFE CYCLE OF HIV

PART VIII  LATENCY OF HIV

PART IX GENOME OF HIV

PART X  LOSS OF CD4 CELLS

APPENDIX I  ANTI-HIV VACCINES

APPENDIX II  DOES HIV CAUSE AIDS?

APPENDIX III  ANTI-HIV CHEMOTHERAPY