Three decades ago, the June 5, 1981, issue of Morbidity and Mortality Weekly Report (MMWR) reported on five previously healthy young gay men in Los Angeles diagnosed with pneumocystis carinii pneumonia (PCP), an infectious disease usually seen only in people with profoundly impaired immune function. As a specialist in infectious diseases and immunology, I had cared for several people with PCP whose immune systems had been weakened by cancer chemotherapy. I was puzzled about why otherwise healthy young men would acquire this infection. And why gay men?
One month later, the MMWR wrote about 26 cases in previously healthy gay men from Los Angeles, San Francisco and New York, who had developed PCP as well as an unusual form of cancer called Kaposi’s sarcoma. Their immune systems were severely compromised. This mysterious syndrome was acting like an infectious disease that probably was sexually transmitted. My colleagues and I never had seen anything like it. The idea that we could be dealing with a brand-new infectious microbe seemed like something for science fiction movies.
Little did we know what lay ahead.
Soon, cases appeared in many groups: injection-drug users, hemophiliacs and other recipients of blood and blood products, heterosexual men and women, and children born to infected mothers. The era of AIDS had begun.
I changed the direction of my career to study this disease and began a 30-year journey through this extraordinary global health saga. The early years of AIDS were unquestionably the darkest of my career, characterized by frustration about how little I could do for my patients.
In the first couple of years, few scientists were involved in AIDS research, and there was very little funding to study the disease. The first major research breakthrough came in 1983 with the discovery of the human immunodeficiency virus, or HIV, and then in 1984, with proof that it caused AIDS. Our knowledge of HIV/AIDS rapidly grew with the development of a diagnostic test in 1985 that revealed the frightening scope of the pandemic. Our desperately ill patients were just the tip of the iceberg.
There is a stunning contrast between how I felt as a physician-scientist in the 1980s and the optimism I feel today as more infections are prevented and lifesaving drugs increasingly become available throughout the world. Annual funding for HIV/AIDS research at the National Institutes of Health exceeds $3 billion, thanks to consistent support from Congress and each successive administration.
In the 1980s, patients received a prognosis of months. Today, a 20-year-old who is newly diagnosed and receives combination anti-HIV drugs according to established guidelines can expect to live 50 more years. Furthermore, HIV treatment not only benefits the infected individual but can reduce the risk of transmitting the virus to others.
The HIV story, however, is far from over. There have been more than 60 million HIV infections throughout the world, with at least 30 million deaths. In 2009, 2.6 million people became infected with HIV and 1.8 million died; more than 90 percent of cases occurred in the developing world, two-thirds in sub-Saharan Africa. For every infected person put on lifesaving therapy, two to three people are newly infected. To control and ultimately end the pandemic, we will need to treat many more HIV-infected people.
Lifesaving HIV/AIDS programs at home and abroad must be strengthened despite global constraints on resources. Enormous challenges remain and must be met by the next generation of scientists, public health officials and politicians throughout the world. History will judge us as a global society by how well we address the challenges in the next few decades of HIV/AIDS.
Anthony S. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
