Surviving and Thriving 

 
 

The emergence of AIDS

Map of sexual contacts among homosexual men with AIDS, from William Darrow, PhD, et al., “Cluster of Cases of the Acquired Immune Deficiency Syndrome,” American Journal of Medicine, March 1984

Map of sexual contacts among homosexual men with AIDS, from William Darrow, PhD, et al., “Cluster of Cases of the Acquired Immune Deficiency Syndrome,” American Journal of Medicine, March 1984

It started with a whisper—a constellation of rare conditions striking young, gay men in New York, San Francisco, and Los Angeles. The first published reports of these cases appeared on June 5, 1981. That week, the Morbidity and Mortality Weekly Report (MMWR) reported five cases of pneumocystis carinii (PCP), a pneumonia that until then had primarily affected infants or adults taking immunosuppressive drugs1.  All of the cases involved young gay men in Los Angeles who were also suffering from oral and anal candidiasis (thrush) and cytomegalovirus (CMV). Treating these conditions proved difficult because it wasn’t clear what was really behind them. Patients could be infected for years before showing symptoms, then deteriorate within a matter of months. Multiple conjectures arose—contamination of recreational drugs, the effects of multiple opportunistic infections, an unknown type of cancer, or even a new infectious agent2.
 
Several groups began studying the outbreaks, including the National Institutes of Health (NIH) and the Centers for Disease Control (CDC) in the United States, and the Pasteur Institute in France. It was a CDC technician, Sandra Ford who noticed a troubling number of pentamidine orders being used to treat PCP in 1981. It was the CDC that published MMWR, bringing the unusual clusters of opportunistic infections to the attention of many health professionals3.
 
The nomenclature of the disease changed frequently as the epidemic emerged, reflecting different hypotheses on its nature and origin, as well as societal fears. Some researchers linked AIDS to sexual promiscuity and drugs, something they called “the gay lifestyle hypothesis,” as though the disease were divine retribution for an unholy lifestyle. In 1982, the term GRID appeared. While the acronym appeared in scientific publications, it is short for Gay Related Immunodeficiency Syndrome, an inaccurate description considering that cases had already been reported in heterosexuals. Such an acronym begs the question—can non-gay individuals have a “gay disease”? The CDC proposed that GRID be renamed “AIDS,” defining it according to the presence of a “life-threatening opportunistic infection” and the patient’s relative health and youth. At the same time, however, inside and outside the gay community, some people referred to the condition as “gay cancer”. To avoid such social stigma, some parts of Africa called the disease “Slim”, because of how quickly those affected by the disease lost weight. It wasn’t until AIDS started affecting non-homosexual populations that researchers suggested an infectious agent as the disease’s source.
 
The NIH’s National Cancer Institute (NCI) and the Pasteur Institute emerged as leaders in AIDS research. By 1983, the Pasteur Institute team, led by Luc Montagnier, believed that they had isolated the retrovirus that causes AIDS. They called it lymphadenopathy-associated virus (LAV) and developed a test for identifying carriers of the infection. They applied for a US patent that year, but the patent stalled. The following year, in 1984, the NCI team, led by Robert Gallo, published four articles in Science, describing a retrovirus they called human T-lymphotrophic virus III (HTLV III), which caused AIDS4. They also applied for a patent on their test for identifying carriers of the infection. While the French application stalled, the American application was approved, granting the NCI all the commercial revenue of an AIDS diagnostic kit. In response, the Pasteur Institute sued the US government.
 
The French researchers had good reason to be angry. HTLV III was identical to LAV, the Pasteur Institute’s virus. While it was possible that Gallo’s team had used contaminated samples, it is also possible that they had used the Pasteur Institute’s samples, and published them as their own. A subsequent ethics investigation declared Gallo innocent of intentional wrong doing 5, but the controversy caused a great deal of confusion and antipathy.  The retrovirus was renamed the Human Immunodeficiency Virus (HIV) in 19866

 

Reading List

  1. Pneumocystis pneumonia–Los Angeles. MMWR Morb Mortal Wkly Rep. 1981 Jun 5;30(21):250-2. PubMed PMID: 6265753. Epub 1981/06/05. eng.
  2. Durack DT. Opportunistic infections and Kaposi’s sarcoma in homosexual men. N Engl J Med. 1981 Dec 10;305(24):1465-7. PubMed PMID: 6272112. Epub 1981/12/10. eng.
  3. Oppenheimer GM. In the Eye of the Storm: The Epidemiological Construction of AIDS. In: Fee E, Fox DM, editors. AIDS: The Burdens of History. Berkeley, CA: University of California Press; 1988. p. 268-92.
  4. Gallo RC, Salahuddin SZ, Popovic M, Shearer GM, Kaplan M, Haynes BF, et al. Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science. 1984 May 4;224(4648):500-3. PubMed PMID: 6200936. Epub 1984/05/04. eng.
  5. Chang SY, Bowman BH, Weiss JB, Garcia RE, White TJ. The origin of HIV-1 isolate HTLV-IIIB. Nature. 1993 Jun 3;363(6428):466-9. PubMed PMID: 8502298. Epub 1993/06/03. eng.
  6. The Office of NIH History and Stetten Museum, National Institutes of Health. In Their Own Words: NIH Researchers Recall the Early Years of AIDS.