AIDS at 30: A chance to treat is now a chance to prevent

Abstract

The question for tomorrow is how do we pay for it

Thirty years ago, on 4 June 1981, the Centers for Disease Control and Prevention published a small case series of previously healthy homosexual men in Los Angeles who had contracted pneumocystis pneumonia.1 A month later, 26 more cases were described, from New York as well as California, and including Kaposi’s sarcoma as one of their opportunistic diseases.

So it began.

Gay men were the initial focus, but then people with haemophilia, others receiving transfusions, and injection drug users were stricken. And stricken was the appropriate word. In those early days almost everyone with AIDS died, and most died within months of the appearance of symptoms. Many of the deaths were horrible: pneumonia, complicated by intractable diarrhoea, severe stomatitis, skin lesions, and more. Drugs commonly used to treat their infections and cancers didn’t work. I took care of a few early AIDS patients during my residency, and it was awful and frustrating for them, their loved ones, and their doctors and nurses.

It is stunning to look back and realise that in 30 years more than 60 million people have been infected with HIV and at least half of them have died from it.

In context, the medical reaction to the epidemic was remarkably rapid, but it seemed very slow at the time. In 1983, HIV was discovered, and by the next year was proved to cause AIDS. By 1985 we had a diagnostic test for HIV, so infections could be discovered in much earlier stages...