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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]

Overview

Thirty one years ago, on June 5, 1981, MMWR published a report of five cases of Pneumocystis carinii pneumonia (PCP) among previously healthy young men in Los Angeles. Since that day, more than 70 million cases have been reported.

Historical perspective

  • Three of the earliest known instances of HIV infection are:
  1. A plasma sample taken in 1959 from an adult male living in Kinshasa, today part of the Democratic Republic of the Congo.[2]
  2. HIV found in tissue samples from "Robert R.", a 15 year old African-American teenager who died in St. Louis in 1969.[3]
  3. HIV found in tissue samples from Arvid Noe, a Norwegian sailor who died around 1976.[4]
  • Two species of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent and more easily transmitted. HIV-1 is the source of the majority of HIV infections throughout the world, while HIV-2 is not as easily transmitted and is largely confined to West Africa.[5] Both HIV-1 and HIV-2 are of primate origin. The origin of HIV-1 is the Central Common Chimpanzee (Pan troglodytes troglodytes) found in southern Cameroon.[6] It is established that HIV-2 originated from the Sooty Mangabey (Cercocebus atys), an Old World monkey of Guinea Bissau, Gabon, and Cameroon.
  • Most experts believe that HIV probably transferred to humans as a result of direct contact with primates, for instance during hunting or butchery.[7]
  • A more controversial theory known as the OPV AIDS hypothesis suggests that the AIDS epidemic was inadvertently started in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a poliomyelitis vaccine.[8][9] According to scientific consensus, this scenario is not supported by the available evidence.[10][11][12]
  • A recent study states that HIV probably moved from Africa to Haiti and then entered the United States around 1969.[13]

History of known cases and spread

1955-1957: British sailor

The oldest documented case of the then-unknown syndrome was thought to have been detected that same year, when a 25-year-oldBritish sailor who had traveled in the navy between 1955 and 1957 (but apparently not to Africa), sought help at the Royal Infirmary of Manchester, England. He reported to have been suffering from puzzling symptoms, among thempurplish skin lesions, for nearly two years. His condition had taken a turn for worse during Christmas1958, when he started suffering from shortness of breath, extreme fatigue, rapid weight loss,night sweats and high fever. The doctors thought he might be suffering from tuberculosis and, even though they found no evidence of bacterial infection, they treated him for tuberculosis just to be safe, to no avail. The sailor continued to weaken and he died shortly after in August 1959. His autopsy revealed evidence of two unusual infections, cytomegalovirus andPneumocystis carinii pneumonia (PCP, later, when redetermined as P. jirovecii, renamedPneumocystis pneumonia), very rare at the time but now commonly associated with AIDS patients. His case had puzzled his doctors, who preserved tissue samples from him and for years retained some interest in solving the mystery. Sir Robert Platt, then president of the Royal College of Physicians, wrote in the sailor's hospital chart that he wondered "if we are in for a new wave of virus disease now that the bacterial illnesses are so nearly conquered". It was only 31 years later, after the AIDS pandemic had become well-known and widespread, that they decided to perform HIV-tests on the preserved tissues of the sailor, which eventually turned out a positive result. The case was reported in the July 7, 1990 issue of the British medical journal The Lancet; their claim was retracted in a letter in the January 20, 1996 issue where they admitted that the tissue sample was contaminated in the laboratory (Corbitt G, Bailey A, Williams G. HIV infection in Manchester, 1959 . Lancet 1990; ii: 51.)[14][15]

1959: Congolese man

One of the earliest documented HIV-1 infection was discovered in a preserved blood sample taken in 1959 from a man from Leopoldville, Belgian Congo (now Kinshasa, Democratic Republic of the Congo).[16] However, it is unknown whether this anonymous person ever developed AIDS and died of its complications. [2]

1959: Haitian clerk

Another early case was probably detected that same year, 1959, in a 48-year-old Haitian, who 30 years before had immigrated to the United States and at the time was working as a shipping clerk for a garment manufacturer in Manhattan. He developed similar symptoms to those just described for the British sailor, and died the same year, apparently of the same very rare kind of pneumonia. Many years later, Dr. Gordon R. Hennigar, who had performed this man's autopsy, was asked whether he thought his patient had died of AIDS; he replied "You bet" and added "It was so unusual at the time. Lord knows how many cases of AIDS have been autopsied that we didn't even know had AIDS. I think it's such a strong possibility that I've often thought about getting them to send me the tissue samples."[17]

1969: Robert R.

In 1969, a 15-year-old African-American male known to medicine as Robert R. died at the St. Louis City Hospital from aggressive Kaposi's sarcoma. AIDS was suspected as early as 1984, and in 1987, researchers atTulane University School of Medicine confirmed this, finding HIV-1 in his preserved blood and tissues. The doctors who worked on his case at the time suspected he was a prostitute, though the patient did not discuss his sexual history with them in detail.[18][19][20][21] [22]

1969: Arvid Noe

In 1976, a Norwegian sailor named Arvid Noe, his wife, and his nine-year-old daughter died of AIDS. The sailor had first presented symptoms in 1969, four years after he had spent time in ports along the West African coastline. Tissue samples from the sailor and his wife were tested in 1988 and found to contain the HIV-1 virus (Group O).[23][24] [4]

1977: Dr. Grethe Rask

The next documented western death from AIDS was that of Dr. Grethe Rask in 1977. Rask, a Danish surgeon, had worked in the Congo in the early 1970s.

Gradual spread

It appears that either HIV existed in very low levels in the United States in periods prior to1981, or it may have gone extinct in the United States at times, with the present infection established in the USA about1976. HIV in Africa likewise was at first at levels too low to be noticed. In the United States and Africa HIV was at first mostly found only in residents of large cities. The infection is now more widespread in rural areas, and has appeared in regions such as China and India, where it was previously not evident.

Author Randy Shilts mentioned that what was later called AIDS became evident in the gay community in the Fire Island, New York area in the four years after the 1976 Bicentennial celebrations. The infection tended to double in numbers about every nine to ten months. It therefore took a couple of years before a new disease was suspected because there were at first not enough symptomatic individuals to be noticed.

1981: Official start of epidemic

The AIDS epidemic officially began on June 5, 1981, when the U.S. Centers for Disease Control and Prevention in itsMorbidity and Mortality Weekly Report newsletter reported unusual clusters of Pneumocystis pneumonia (PCP) caused by a form of Pneumocystis carinii (now recognized as a distinct species Pneumocystis jirovecii) in five homosexual men in Los Angeles.[1]

Over the next 18 months, more PCP clusters were discovered among otherwise healthy men in cities throughout the country, along with other opportunistic diseases (such as Kaposi's sarcoma[25] and persistent, generalized lymphadenopathy [26]), common in immunosuppressed patients.

The disease was originally dubbed GRID, or Gay-Related Immune Deficiency, but health authorities soon realized that nearly half of the people identified with the syndrome were not homosexual men. In 1982, the CDC introduced the term AIDS to describe the newly recognized syndrome, though it was still casually referred to as GRID.

1982: the name AIDS appears

In June 1982, a report of a group of cases amongst gay men in Southern California suggested that a sexually transmitted infectious agent might be the etiological agent,[27] and the syndrome was initially termed 'GRID' (Gay-Related Immune Deficiency[28]). However, the same opportunistic infections also began to be reported amonghemophiliacs,[29] heterosexualintravenous drug users, and Haitian immigrants.[30]

By August 1982, the disease was being referred to by its new name: Acquired Immune Deficiency Syndrome (AIDS).[31] It got these names in other languages:-

  • Afrikaans: VIGS (Verworwe Immuniteits Gebrek Sindroom)
  • Portuguese: SIDA (Síndrome da Imunodeficiência Adquirida)
  • French: SIDA: (Syndrome d'Immuno-Déficience Acquise)
  • Spanish: SIDA: (Síndrome de Inmunodeficiencia Adquirida).[32]
  • Russian: SPID: (Синдром Приобретенного Имунно Дефицита)
  • Irish Gaelic: SEIF (Siondróm Easpa Imdhíonachta Faighte)

Related Chapters

AIDS origin

References

  1. 1.0 1.1 Gottlieb MS (2006). "Pneumocystis pneumonia--Los Angeles. 1981". Am J Public Health. 96 (6): 980–1, discussion 982–3. PMID 16714472.
  2. 2.0 2.1 Zhu T, Korber BT, Nahmias AJ; et al. (1998). "An African HIV-1 Sequence from 1959 and Implications for the Origin of the Epidemic". Nature. 391 (6667): 594&ndash, 597. doi:10.1038/35400. PMID 9468138.
  3. Kolata G (1987-10-28). "Boy's 1969 death suggests AIDS invaded U.S. several times". The New York Times. Retrieved 2006-06-19.
  4. 4.0 4.1 Hooper E (1997). "Sailors and star-bursts, and the arrival of HIV". BMJ. 315 (7123): 1689&ndash, 1691. PMID 9448543.
  5. Reeves JD, Doms RW (2002). "Human Immunodeficiency Virus Type 2". J. Gen. Virol. 83 (Pt 6): 1253&ndash, 1265. PMID 12029140.
  6. Keele BF, van Heuverswyn F, Li YY; et al. (2006). "Chimpanzee Reservoirs of Pandemic and Nonpandemic HIV-1". Science. 313 (5786): 523–6. doi:10.1126/science.1126531. PMID 16728595.
  7. Cohen J (2000). "Vaccine Theory of AIDS Origins Disputed at Royal Society". Science. 289 (5486): 1850&ndash, 1851. doi:10.1126/science.289.5486.1850. PMID 11012346.
  8. Curtis T (1992). "The origin of AIDS". Rolling Stone (626). pp. 54&ndash, 59, 61, 106, 108. Retrieved 2008-03-10.
  9. Hooper E (1999). The River : A Journey to the Source of HIV and AIDS (1st ed.). Boston, MA: Little Brown & Co. pp. 1&ndash, 1070. ISBN 0-316-37261-7.
  10. Worobey M, Santiago ML, Keele BF; et al. (2004). "Origin of AIDS: contaminated polio vaccine theory refuted". Nature. 428 (6985): 820. doi:10.1038/428820a. PMID 15103367.
  11. Berry N, Jenkins A, Martin J; et al. (2005). "Mitochondrial DNA and retroviral RNA analyses of archival oral polio vaccine (OPV CHAT) materials: evidence of macaque nuclear sequences confirms substrate identity". Vaccine. 23: 1639&ndash, 1648. doi:10.1016/j.vaccine.2004.10.038. PMID 15705467.
  12. "Oral Polio Vaccine and HIV / AIDS: Questions and Answers". Centers for Disease Control and Prevention. 2004-03-23. Retrieved 2006-11-20.
  13. Gilbert MT, Rambaut A, Wlasiuk G, Spira TJ, Pitchenik AE, Worobey M (2007). "The emergence of HIV/AIDS in the Americas and beyond". Proc. Natl. Acad. Sci. U.S.A. 104 (47): 18566–70. doi:10.1073/pnas.0705329104. PMID 17978186.
  14. [1]
  15. http://www.newsrx.com/newsletters/AIDS-Weekly/1996-01-29/01299613278859AW.html "Researchers Admit Being Wrong About Suspected 1959 AIDS Case". AIDS Weekly. January 29, 1996.
  16. [2]
  17. http://www.aegis.org/news/ct/1987/CT871004.html
  18. [3]
  19. http://www.tulane.edu/~dmsander/Abstracts/rr99.html
  20. http://hivinsite.ucsf.edu/InSite?page=kb-01-03
  21. http://ww2.aegis.org/news/ct/1987/CT871003.html
  22. KOLATA, GINA (October 28, 1987). "BOY'S 1969 DEATH SUGGESTS AIDS INVADED U.S. SEVERAL TIMES". New York Times.
  23. [4]
  24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2897596&dopt=Abstract
  25. MMWR Weekly, June 11, 1982
  26. MMWR Weekly, May 21, 1982
  27. MMWR Weekly, June 18, 1982
  28. The New York Times - June 18, 1982
  29. MMWR Weekly, July 16, 1982
  30. MMWR Weekly July 09, 1982
  31. Marx et al., 1982
  32. Direction Générale De La Santé, 1982

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