HIV AIDS historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [5]

Overview

The first case of AIDS was reported by CDC on June 5, 1981; in 1982, the term AIDS was coined. Although many cases have been identified as AIDS since then, the earliest cases of AIDS can be traced back to 1959 in Congo. A wide variety of theories has been postulated of the possible transmission of AIDS from animals to human like from Cameroon Chimpanzees and Congo Macaques. 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 less easily transmitted and is largely confined to West Africa.

Historical Perspective

Early History

AIDS, informally called the gay plague or GRIDS (Gay-related immune deficiency syndrome) was first reported June 5, 1981, when the U.S. Centers for Disease Control and Prevention recorded a clusters of Kaposi's sarcoma and Pneumocystis pneumonia among gay males in California and New York City. By year-end of 1981, there is a cumulative total of 270 reported cases of severe immune deficiency among gay men, and 121 of those individuals have died. On September 24 1982, the term “AIDS” (acquired immune deficiency syndrome) was introduced by thee CDC, and the first case definition was published: “a disease at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known case for diminished resistance to that disease. Soon after, clusters of Kaposi's sarcoma and Pneumocystis pneumonia were also reported among Haitians recently entering the United States, men with haemophilia, female sexual partners of AIDS patients, children born to possibly infected mothers, and among blood transfusion recipients with no obvious risk factors. The term AIDS (for acquired immune deficiency syndrome) was proposed by Bruce Voeller, among other researchers, concerned with the accuracy of the disease's name as the term "gay-related" did not accurately describe the full demographic that the disease affected.

In April 23, 1984, U.S. Department of Health and Human Services Secretary Margaret Heckler announced at a press conference that an American scientist, Dr. Robert Gallo, had discovered the probable cause of AIDS: the retrovirus subsequently named human immunodeficiency virus or HIV in 1986. The virus had previously been discovered by researchers at the Pasteur Institute in France, who called it lymphadenopathy-associated virus. It was given the acronym LAV and was subsequently renamed HIV. Three of the earliest known instances of HIV infection are a plasma sample taken in 1959 from an adult male living in Kinshasa, today part of the Democratic Republic of the Congo, HIV found in tissue samples from a 15 year old African-American teenager who died in St. Louis in 1969, and HIV found in tissue samples from Arvid Noe, a Norwegian sailor who died around 1976.

Identification of the Virus

Scanning electron micrograph of HIV-1 budding from cultured lymphocyte. - Source: https://www.cdc.gov/

May 1983: LAV

In May 1983, doctors from Dr. Luc Montagnier's team at the Pasteur Institute in France, reported that they had isolated a new retrovirus from lymphoid ganglions that they believed was the cause of AIDS. The virus was later named lymphadenopathy-associated virus (LAV) and a sample was sent to the U.S. Centers for Disease Control, which was later passed to the National Cancer Institute (NCI).

May 1984: HTLV-III

In May 1984 a team led by Robert Gallo of the United States confirmed the discovery of the virus, but they renamed it human T lymphotropic virus type III (HTLV-III). The dual discovery led to considerable scientific disagreement, and it was not until President François Mitterrand of France and President Ronald Reagan of the USA met that the major issues were resolved.

Jan 1985: LAV/HTLV-III

In January 1985 a number of more detailed reports were published concerning LAV and HTLV-III, and by March it was clear that the viruses were the same, from the same source, and was the etiological agent of AIDS

May 1986: HIV

In May 1986, the International Committee on Taxonomy of Viruses ruled that both names should be dropped and a new name, HIV (Human Immunodeficiency Virus), be used.

Early Case Definition

The 1985 World Health Organization AIDS surveillance case definition was developed in October 1985, at a conference of public health officials including representatives of the Centers for Disease Control (CDC) and World Health Organization (WHO) in Bangui, Central African Republic. For this reason, it became to be known as the Bangui definition for AIDS. It was developed to provide surveiling case definition of AIDS for use in countries where testing for HIV antibodies was not available.

It stated the following:

Exclusion criteria

1. Pronounced malnutrition
2. Cancer
3. Immunosuppressive treatment

Inclusion criteria with the corresponding score	Score
Important signs
Weight loss exceeding 10% of body weight	4
Protracted asthenia	4
Very frequent signs
Continuous or repeated attacks of fever for more than a month	3
Diarrhoea lasting for more than a month	3
Other signs
Cough	2
Pneumopathy|	2
Oropharyngeal candidiasis	4
Chronic or relapsing cutaneous herpes	4
Generalized pruritic dermatosis	4
Herpes zoster (relapsing)	4
Generalized adenopathy	2
Neurological signs	2
Generalized Kaposi's sarcoma	12

The diagnosis of AIDS is established when the score is 12 or more.

The 1985 WHO AIDS surveillance case definition was heavily criticised, for both medical and political reasons. The 1994 expanded World Health Organization AIDS case definition was introduced in 1994 to incorporate the statement that HIV testing should be done. However, if testing was unavailable, then the Bangui definition should be used.

Famous Cases

David Carr

David Carr (November 1933 - August 31, 1959) was a sailor from Reddish, Manchester. He died at a relatively young age owing to multiple complications that were at the time inexplicable to his doctors at the Manchester Royal Infirmary. In 1990, more than three decades after his death, stored tissue samples from his body were tested positive for HIV. Given the date of his death, he was suspected to have been the first victim of AIDS in the West. The case gained wide coverage when the Sunday Express printed an exposé that revealed Carr's identity to the public. However, further tests were carried out in the mid-1990s by the eminent American scientist Dr David Ho, who found that Carr's tissue samples had been contaminated and who thus disproved the earlier AIDS diagnosis. Carr's case is extensively documented in Edward Hooper's massive work on the history of AIDS, The River.

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-old British 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 them purplish skin lesions, for nearly two years. His condition had taken a turn for worse during Christmas 195, 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 and Pneumocystis 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.)

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). However, it is unknown whether this anonymous person ever developed AIDS and died of its complications.

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."

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 at Tulane 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.

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).

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.

Historical Theories of Transmission

A variety of theories exist explaining the transfer of HIV to humans, but no single hypothesis is unanimously accepted, and the topic remains controversial.

From Cameroon Chimpanzees (Contested)

The most widely accepted theory is so called 'Hunter' Theory according to which transference from ape to human most likely occurred when a human was bitten by an ape or was cut while butchering one, and the human became infected.

Researchers announced in May 2006 that HIV most likely originated in wild chimpanzees in the southeastern rain forests of Cameroon (modern East Province) rather than in Kinshasa, Democratic Republic of Congo (formerly Zaire), as had previously been believed. Seven years of research and 1,300 chimpanzee genetic samples led Dr. Beatrice Hahn of the University of Alabama, Birmingham, to identify chimpanzee communities near Cameroon's Sanaga River as the most likely originators. Presumably, someone in rural Cameroon was bitten by a chimp or was cut while butchering one and became infected with the ape virus. That person passed it to someone else.

Calculating based on a fixed mutation rate, the jump from chimpanzee to human likely occurred during the French colonial period (1919–1960). Comparative primatologist Jim Moore suggests that this may have been the result of colonial practices of forced labour, which could have suppressed the immune system of the initial hunter enough to allow the virus to infect and take hold. Likewise, forced immunisations (using one needle on many patients) may have sped the virus's spread through Cameroon and beyond.

The Times published an article in 1987 stating that WHO suspected some kind of connection with its vaccine program and AIDS-epidemic. The story was almost entirely based on statements given by one unnamed WHO advisor. The theory was supported only by weak circumstantial evidence and is now disproven by unraveling the genetic code of the virus and finding out that the virus dates back to the 1930s.

From Congo Macaques via OPV (Contested)

Freelance journalist Tom Curtis discussed one controversial possibility for the origin of HIV/AIDS in a 1992 Rolling Stone magazine article. He put forward what is now known as the OPV AIDS hypothesis, which suggests that AIDS was inadvertently caused in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a polio vaccine.

Although subsequently retracted due to libel issues surrounding its claims, the Rolling Stone article motivated another freelance journalist, Edward Hooper, to probe more deeply into this subject. Hooper's research resulted in his publishing a 1999 book, The River, in which he alleged that an experimental oral polio vaccineprepared using chimpanzee kidney tissue was the route through which simian immunodeficiency virus (SIV) crossed into humans to become HIV, thus starting the human AIDS pandemic.

This theory is contradicted by an analysis of genetic mutation in primate lentivirus strains that estimates the origin of the HIV-1 strain to be around 1930, with 95% certainty of it lying between 1910 and 1950.

In February 2000 one of the original developers of the polio vaccine, Philadelphia based Wistar Institute found from its stores a vial of the original vaccine used in the vaccination program. It was analyzed in April 2001 and no traces of either HIV-1 or SIV were found in the sample. A second analysis showed that only macaque monkey kidney cells, which cannot be infected with SIV or HIV, were used to produce the vaccine. While the analysis was done on only one vial of vaccine, some scientists have concluded that the polio vaccine theory of the origins of HIV is not possible.

However the sample tested was never used in the Congo nor was it ever claimed by Hooper that the original vaccines were contaminated, the OPV hypothesis claims instead that HIV was introduced in the Congo at the Stanlyvile laboratory as the local administers amplified the original vaccine using infected Chimp kidneys (local amplification was widely practiced at the time) for the 1 million to whom it was forcefully administered. As such there is no hard evidence to dismiss the OPV hypothesis.

Edward Hooper rejects the dates calculated using a fixed mutation rate on the basis that phylogenetic dating of "the most recombinogenic organisms known to medical science", immunodeficiency viruses, is "inherently incapable of making any allowance for recombination."

Durban Declaration

The Durban declaration was a statement signed by over 5,000 physicians and scientists at the 2000 International AIDS Conference in Durban, South Africa, affirming that HIV is the cause of AIDS. The declaration was drafted in response to statements by South Africa president Thabo Mbeki, who questioned the link between HIV and AIDS. At the Durban conference, 5,000 scientists from all over the world, including eleven Nobel prize winners, signed a statement calling the evidence that HIV causes AIDS "clear-cut, exhaustive and unambiguous."