Joe Mazziotta, MD
It has been 33 years since HIV and AIDS emerged as a major public health concern. During the last three decades much has changed;
unfortunately, as is the case with many preventable diseases, much has not.
In 1981, the first five cases of AIDS were described in an obscure publication that largely went unrecognized by the medical community. By the mid-1980s it was recognized that this unknown agent could be spread in body fluids including blood obtained by transfusion. Thus began the age of blood bank screening for infectious diseases as well as the recognition that the population at large was at risk of HIV infection.
It was not until scientists from the Pasteur Institute in France isolated a viral particle (HIV) from an infected patient that the agent responsible for AIDS was identified. By the late 1980s we saw the emergence of the first antiviral medication, AZT. Despite this, and the ability to detect the virus by lab test, there was very little influence on the spread of the disease. By the end of the decade, a large-scale public health initiative describing both how the disease was spread and “safer sexual practices” slowed the proliferation of the virus.
In the mid-1990s, a new class of medications called protease inhibitors showed a reduction in AIDS-related mortality. Likewise, it was realized that by reducing the amount of viral replication in an infected patient we can also reduce the risk of transmission of the virus to uninfected patients. Finally, it seemed that although HIV was not curable, it could be controlled allowing patients to lead longer more productive lives. It was also believed that these new medications would drastically reduce the number of new cases.
As we entered the new millennium, we quickly realized that science and technology could not substitute for human behavior. At a time when we were seeing major reductions in HIV-infected newborns as well as AIDS-related deaths we once again saw an increase in new HIV cases in adults. So now in 2013, despite the availability of over 25 medications that can successfully reduce HIV replication, we continue to fight an epidemic.
As it was in the 1980s, young people are dying from AIDS related illnesses. There also continues to be a huge stigma attached to HIV and AIDS. People are dying without being tested when testing is widely available. People who know they are infected are dying without ever trying medications. There are still many who practice high-risk sexual behaviors with the knowledge that they are putting themselves and their partners at risk.
These deaths are especially tragic because we have the tools necessary to diagnose and treat the disease. Those who are diagnosed early and remain adherent to their therapy can live with HIV as a chronic disease much like hypertension or diabetes. As we continue to fight this disease called AIDS, we must remember everything we have learned during the past three decades.