The origin of AIDS: the last big pandemia of the 20th Century

AIDS (acquired immune deficiency syndrome) is a disease resulting from the advanced infection of the HIV (human immunodeficiency virus). HIV is known for attacking and destroying an important part of the immune system (the human body defences): the lymphocytes CD4, which are the orchestra conductors for the responses of the human body against germs. Without this conductors, the body is left exposed to many infections that in normal condition would not hurt us and we would be able to control.

At first, the virus infected shows a series of initial symptoms. Later, our defences achieve a partial control of the infection, and this becomes minimally expressive for a while, around 8 or 10 years although than may change in each individual. Eventually, if the infection remains untreated, the lymphocytes CD4 decrease down to a critical number, moment in which the infected individual gets into the actual AIDS and the aforementioned opportunistic severe infections begin to wreak havoc on the patient up to cause him death. Fortunately, since the end of the 90’s the course of this devastating disease has successfully been modified, thanks to the treatment known as HAART (High Active Antiretroviral Therapy), a combination of drugs that allows the patient to be infected by the virus without developing into an AIDS state and turning it into a chronic infection instead of a deathly one, as long as the affected keeps following the treatment correctly and the virus doesn’t become resistant to it.

Patient affected ny the Kaposi's Sarcoma. Source:
Patient affected ny the Kaposi’s Sarcoma. Source:

But last century back in the 80’s this goal seemed far unreachable. It is calculated that it was at the beginning of the 20th Century when the virus was transmitted from the primates to mankind somewhere in Africa (probably in Cameroon or the Democratic Republic of the Congo). From there the virus spread to the rest of the world around the mid twentieth century, but it wasn’t until 1980 that a series of closed and consecutive cases drew the attention of doctors: in Los Angeles five young homosexuals became ill with pneumocystosis, a pneumonia caused by a fungus harmless in the general population. Soon, in 1981, other young homosexuals were diagnosed in New York with a very rare skin cancer, the Kaposi’s Sarcoma. Other cases arose in these and other cities: fevers, chronic diarrhea, enlarged lymph nodes throughout the body, parasitic infections… And, inexplicably, all of them had in common a level below the minimum of CD4, the conductors for the immune response. What made those previously healthy young people experience such a huge drop in defences?

Immediately the researchers of the Center for Disease Control and Prevention (CDC) got down to work to seek the similarities between these sick people. Was it a transmissible disease? If that was the case, how was it transmitted and what protection was to be taken? Did it had anything to do with the alkyl nitrites (known as poppers), a drug used by some groups to increase sexual pleasure? Through exhaustive interviews with the affected, the conclusion was that the patients had had up to 10 times more sexual encounters than the average non-affected individual. The hypothesis of a sexually transmitted disease gained strength and it was quite likely that a virus was responsible for it. Failing, so far, to find something to put the blame on, the syndrome was called GRID (Gay-Related Immune Deficiency). Why at the time the homosexual community was the most affected by the disease? Probably by a sum of factors, resulting from the sexual revolution that the United States lived during the 60’s and 70’s. Bath houses, locals where was easy to have multiple sexual contact between strangers, had proliferated in cities like San Francisco. Besides, the discovery of penicillin in the 40’s had allowed to cure with just an injection diseases previously very invalidating like syphilis. This had resulted in probably a decrease in risk awareness.

Anyway, soon arose different cases: drug addicts, heterosexual women and men, and patients with haemophilia. This last ones required regular transfusions of blood products, and it was obvious they had contracted the disease through blood exchange, based on infected donors. The virus hypothesis gained strength, and also meant that the disease was going beyond stigmatized and blamed groups: it could affect anyone. As sad as it sounds, this fact finally convinced some areas of the scientific community in increasing its efforts and resources on researching the disease. The name GRID no longer had sense, so in 1982 it started to become known as AIDS.

In 1983 Robert Gallo and Luc Montagnier, American and French virologist respectively, started a run to achieve the isolation of the mysterious virus, with a final victory for Montagnier and his team of the Pasteur Institute. It had demonstrated the causal role of HIV in AIDS. Although what was really important was to find a drug to specifically fight the virus and its gears: AIDS patients died one after another, without any possible cure or hope to be offered to them. Rock Hudson, the famous Hollywood actor, had unsuccessfully received injections of a substance called HPA-23 and died shortly after. Neither took long for scammers to emerge with promises of a fast and expensive cure. But the key for the change was AZT or zidovudine,a drug extracted from herring sperm that inhibits the key enzyme for the virus to carry out its function. In order to be able to prove its effectiveness, lack of toxicity and to be approved as a treatment for the infection, various stages and years of clinical trials were theoretically required. However, it was difficult not to use universally a medicine when the feeling was that it worked… very well. A lot of patients showed a spectacular recovery of their defences in a short time. As a result of that and of the media pressure, in a record time in 1986 the commercialization of the AZT was approved. From there it started a new chapter in the history of the disease, although it would still take years to slow down AIDS mortality, as well as to reduce the huge discrimination and blaming suffered by the infected.

In orange, cases of AIDS in Catalonia, Spain (1981-2013). In purple, cases of new HIV infeccions). Source: CEEISCat, Generalitat de Cataluña
In orange, cases of AIDS in Catalonia, Spain (1981-2013). In purple, cases of new HIV infeccions). Source: CEEISCat, Generalitat de Cataluña

Nowadays, the emergence of new cases of HIV infection is stable in Catalonia, while the cases of AIDS clearly decrease, proving the key role of the pharmacological treatment. The current big challenges are to reduce the advent of new cases by, mainly, the use of condoms, and also to stop the emerging resistances to the drug, usually derived fro an irregular on inadequate use of the medicine. And we must not forget about Africa, where there is the main focus of infected and where AIDS is still causing real havoc, usually because of the lack of access to the treatment.

Anna Seguí i Grivé

NOTe: The main source used for this article is the book “Beyond Love” by Dominique Lapierre. Refere to it for more information.

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