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hiv - its early history


In the late 1970s, certain rare types of cancer and a variety of serious infections were recognised to be occurring in increasing numbers of previously healthy persons. Strikingly, these were disorders that would hardly ever threaten persons with normally functioning immune systems.

First formally described in 1981, the syndrome was observed predominantly to be affecting homosexual and bisexual men. Soon thereafter, intravenous drug users, haemophiliacs, and recipients of blood transfusions were recognised as being at increased risk for disease as well. It was also noted that sexual partners of persons displaying the syndrome could contract the disease.

Further study of AIDS patients revealed marked depletion of certain white blood cells, called T4 lymphocytes. These cells played a crucial role in orchestrating the body's immune defences against invading organisms. It was presumed that this defect in AIDS patients was acquired in a common manner. Then, in 1983 a T-celllymphotropic virus was separately discovered by Robert Gallo at the U. S. National Institutes of Health and Luc Montagnier at France's Pasteur Institute. The virus was at first given various names: human Iymphotropic virus (HTLV) 111, Iymphadenopathy-associated virus (LAV), and AlDS-associated retrovirus (ARV). It is now officially called human immunodeficiency virus (HIV), and the evidence demonstrates that it is indeed the causative agent for AIDS.

Several other strains have now been identified, HIV-2, is thus far relatively rare outside of Africa. Little is known about the biological and geographical origins of HIV. Apparently, however, this is the first time in modem history that the virus has spread widely among human beings. Related viruses have been observed in animal populations, such as Monkeys (SIV), Horses (EIV), Cattle (BIV) and Cats (FIV) but these do not produce disease in humans.

Kaposi's Sarcoma (KS) was a rare form of relatively benign cancer that tended to occur in older people. But by March 1981 at least eight cases of a more aggressive form of KS had occurred amongst young gay men in New York. At about the same time there was an increase, in the number of cases of a rare lung infection Pneumocystis carinii pneumonia (PCP). In April this increase in PCP was noticed at the Centers for Disease Control (CDC) in Atlanta. In June 1981, the CDC published a report about the occurrence, without identifiable cause, of PCP in five men in Los Angeles. This report is sometimes referred to as the "beginning" of AIDS, but it might be more accurate to describe it as the beginning of the general awareness of AIDS in the USA.

Around this time a number of theories were developed about the possible cause of these opportunistic infections and cancers. Early theories included, infection with cytomegalovirus, the use of amyl nitrite or butyl nitrate "poppers" and "immune overload". Because there was so little known about the transmission of what seemed to be a new disease, there was concern about contagion, and whether the disease could by passed on by people who had no apparent signs or symptoms. Just five months later, in December 1981, it was clear that the disease affected other population groups, when the first cases of PCP were reported in injecting drug users. At the same time the first case of AIDS was documented in the UK.

In 1982, the disease still did not have a name, with different groups referring to it in different ways. The CDC generally referred to it by reference to the diseases that were occurring, for example lymphadenopathy (swollen glands), although on some occasions they referred to it as KSOI, the name already given to the CDC task force. In contrast some still linked the disease to it's initial occurrence in gay men, with the Lancet calling it the 'gay compromise syndrome', whilst at least one newspaper referred to it as GRID (gay-related immune deficiency), and another newspaper described it as 'gay cancer'. The disease was also called 'community-acquired immune dysfunction'.

In June of the same year a report of a group of cases amongst gay men in Southern California, suggested that the disease might be caused by an infectious agent that was sexually transmitted. By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC. Later the first reports appeared that the disease was occurring in Haitians, as well as haemophiliacs. By August the disease was being referred to by it's new name of AIDS. The word AIDS was an abbreviation of Acquired Immune Deficiency Syndrome. The doctors thought 'AIDS' suitable because people acquired the condition rather than inherited it, because it resulted in a deficiency within the immune system, and because it was a syndrome, with a number of manifestations, rather than a single disease. Very little was still known about transmission and public anxiety continued to grow. By 1982 a number of AIDS specific voluntary organisations had been set up in the USA. In November 1982 the first AIDS organisation, the 'Terrence Higgins Trust', was formally established in the UK, and by this time a number of AIDS organisations were already producing safer sex advice for gay men.

The number of people who could become infected was to widen again at the beginning of 1983, when it was reported that the disease could be passed on heterosexually from men to women. At about the same time the CDC convened a meeting to consider how the transmission of AIDS could be prevented, and in particular to consider the newly emerged evidence that AIDS might be spread through blood clotting factor and through blood transfusions. The risk for haemophiliacs was so great because the blood concentrate that some haemophiliacs used, exposed them to the blood of up to 5000 individual blood donors.

In the UK there were public concerns about the blood supply with references in newspapers to "killer blood." The media more generally started to take notice of AIDS, with the screening of a TV Horizon programme, "the killer in the village", and a number of newspaper articles on the subject of the "gay plague."



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