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Health and Disease

The Evolution of HIV and AIDS

The human immunodeficiency virus (HIV) is a virus impacting over 38 million people in the world. Throughout time, our research has expanded on this once extremely fatal illness, and this article explores our progression of knowledge on such a virus.

Abstract

The human immunodeficiency virus, otherwise known as HIV, is causing one of the most widely discussed epidemics, occurring in both developed and developing countries today. This particular virus attacks cells that allow the body to fight infection: white blood cells or lymphocytes. The specific lymphocyte the virus attacks is the CD4 cell, which is a component of the adaptive immune system and responsible for killing infected host cells, activating certain immune cells, and most importantly, regulating immune response. Therefore, as time passes, HIV gradually weakens the individual’s immune system, eventually damaging its ability to defend itself. This virus spreads through contact with the bodily fluids of an HIV host, typically through unprotected sexual intercourse or the sharing of injection equipment. It can also be spread from child to mother either through birth or breastfeeding. Contrary to popular belief, an HIV diagnosis is not a death sentence. Many infected individuals are able to live a long and healthy life due to antiretroviral treatment, which is becoming increasingly accessible because of  improved policies in developing nations. Antiretroviral treatment reduces the viral load in the body, allowing the load to become so undetectable to the point where it cannot be successfully passed on to another individual. In turn, this allows the host to safely have offspring without transmitting the disease. The treatment for HIV patients has not always stayed consistent throughout the past years, but several key historical moments have allowed for the present-day combat against this disease.

Brief Overview of HIV

The 1980s was a significant decade in the discovery and the treatment of HIV. Sporadic cases of AIDs-like illnesses were documented in the 70s, however, by the 80s, over 100,000 people had been infected by HIV, which had successfully spread to North America, Europe, Africa, Australia, and South America. In 1981, five cases of the rare lung infection, Pneumocystis carinii pneumonia, had been recorded in healthy gay men residing in Los Angeles. By the end of that year, 270 reported cases of severe immune deficiency had been reported, all cases among gay men. As a plethora of similar cases among the same demographic were reported in 1982, a conclusion was made in Southern California that connected immune defiency related illnesses to homosexuality. The Centers for Disease Control (CDC) gave the illness a specific name, ‘AIDS,’ which stood for acquired immune deficiency syndrome, and was described as “a disease moderately predictive of a defect in cell mediated immunity, occuring in a person with no known case for diminished resistance to that disease.” At this point in time, AIDS cases had already been reported in European countries, and various international organizations had been set up to combat this virus. By the end of 1985, every region in the world had one reported case of AIDS, and as more heterosexual individuals were reported with the virus, organizations ruled out that it was an illness related to homosexuality. 

Theories on the Virus

During this time, multiple theories were made about the virus that produced this disease. In 1983, doctors in the Pasteur Institute in France predicted that a relatively newly discovered retrovirus, Lymphadenopathy-Associated Virus (LAV), could be the cause of AIDS. Utilizing the information about this virus, the CDC ascertained that the disease could not be passed to others by casual contact, food, water, air, or other surfaces. In 1984, the National Cancer Institute announced they had discovered another cause for AIDS, the retrovirus HTLV-III, and found it identical to the LAV previously predicted by the Pasteur Institute in France. The HTLV-III/LAV virus was transmitted through blood, compelling many countries to set up needle and syringe programs as concerns grew. By 1986, the International Committee on the Taxonomy of Viruses determined that HTLV-III/LAV would officially be called HIV (human immunodeficiency virus).

Treatment Evolution

In March of 1987, the antiretroviral drug, zidovudine (AZT), was approved by the FDA and introduced as the first treatment to combat HIV, along with the Western blot blood test, a more specific HIV antibody test. In 1990, as more young people were reported with HIV, AZT was approved to treat children with AIDS. By 1994, the first oral, non-blood HIV test was approved by the FDA as more and more individuals desired an easier method of testing. Soon after, the nation had entered a new period of highly-active antiretroviral treatment as the FDA finally approved the first protease inhibitor, ultimately allowing the immediate decline of AIDS-related deaths in clinical practices that incorporated the new treatment. The treatment was  effective to the point where there was a decline of 60% to 80% of deaths related to AIDS. As new HIV outbreaks were detected in Eastern Europe, Russia, India, Vietnam, Cambodia, and other countries of Southeast Asia, the estimated number of people living with the virus rose to twenty-three million by 1996. In the 2000s, there was more emphasis on treatments and methods to prevent transmission, rather than treatments for the infected after transmission. In 2006, it was discovered that male circumcision reduced the risk of female to male HIV transmission by more than 60%, and since this year, male circumcision has been promoted throughout clinical offices and hospitals. A few years after this discovery, an iPrEx trial was held in the United States and showed a reduction in HIV transmission of 44% among homosexual men who took pre-exposure prophylaxis (PrEP). After this was approved by the FDA in 2011, men who did not have HIV themselves were able to safely have intercourse with other men who had tested positive for HIV. Another trial geared towards HIV transmission and prevention occurred in 2011, discovering that an individual who had early initiation of an antiretroviral treatment was able to successfully reduce the risk of transferring HIV to their partner by 96%. By August, the FDA had approved Complera, a combination tablet consisting of emtricitabine, rilpivirine, and tenofovir disoproxil fumarate, giving individuals with HIV a more effective antiretroviral treatment option. Throughout time, treatments against HIV have dramatically improved; however, without policy change, such treatments would not be made accessible. 

Organization and Policies

By the end of 1986, eighty-five countries had reported 38,401 cases of AIDS to the World Health Organization, in which the Americas had reported the most compared to all other regions. As a result, the World Health Organization (WHO) launched the Global Program on AIDS in 1987 in order to raise awareness, generate evidence-based policies, and provide support to countries that conduct research on the virus. However, the U.S. Congress voted for a ban on entry into the nation for those living with HIV, and supported this ban into the 90s. In 1988, the WHO declared the first of December as the first World AIDS day, and the groundwork was laid out for an HIV/AIDS care system in the USA, later funded by the Ryan White Care Act. By the 1990s and based on past trends, it was thought that about 8-10 million people were living with HIV worldwide. In the beginning of the 90s, the Visual AIDS Artists Caucus launched the Red Ribbon Project to show empathy for those living with HIV, and the red ribbon symbol became a representation for the AIDS illness. In July of 1990, the United States enacted the Americans with Disabilities Act to prohibit discrimination against those with diabilities, including those living with HIV. As more treatments were becoming accessible to developing countries, the Joint United Nations organization addressing AIDS, UNAIDS, adopted the Millenium Development Goals. This included an initiative to reverse the spread of HIV, malaria, and TB, as well as reduce antiretroviral drug prices sold by major pharmaceutical companies. One of the methods in which the UN General Assembly utilized the assistance of the people, was through a Global Fund, initiated to support efforts by developing countries to combat the outbreaks of HIV. This fund was extremely successful, as within one year of its starting, it raised over $600 million grants in fundraising, and allowed developing countries to produce generic HIV medications and provide them to their citizens with reduced prices. In 2003, President W. Bush announced the United States President’s Emergency Plan for AIDS Relief, otherwise known as PEPFAR, a $15 billion plan to combat AIDS in developing countries or countries with a particularly high number of AIDS victims. A few years later, as stigma around the disease lessened, and the impact of HIV was combated globally, the travel ban, prohibiting HIV-positive individuals from entering the U.S., was lifted. Moreover, throughout the 2010s, HIV antiretroviral treatment reached new levels of accessibility due to the constant promotion of the treatment by the World Health Organization, and by 2017, more than 20 million people were on antiretroviral treatment. With the increase of treatment, more individuals are able to have an undetectable level of virus in their bloodstream, reducing the risk of transmission and spread. 

Prisha Ramnath, Youth Medical Journal 2020

References

~“History of HIV and AIDS Overview.” Avert, Avert, 10 Oct. 2019, http://www.avert.org/professionals/history-hiv-aids/overview. Accessed 7 October 2020

~”What Are HIV and AIDS?” HIV.gov, HIV, 5 June 2020, http://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids. Accessed 7 October 2020 

By Prisha Ramnath

Prisha Ramnath is a Junior at Clarksburg High School in Maryland, U.S. She is an avid app developer who wants to assist those with medical issues through technology. She is passionate about medicine, but specifically wants to focus on biomedical engineering in college.

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