In 1981 the US Centers for Disease Control and Prevention published a report of a rare lung infection in five “previously healthy young men in Los Angeles.”
“Cellular immune dysfunction associated with frequent exposure” and “sexually acquired disease” have been suggested. The patients were described as “homosexuals”. Two had died.
It was the first mention of what came to be known as Acquired Immunodeficiency Syndrome, or AIDS, a little over a year later.
Although the link had not yet been established, concerned doctors in San Francisco and New York simultaneously saw gay men who developed Kaposi’s sarcoma, cancerous lesions that affected the skin and mucous membranes.
Experts were baffled. The disease has usually only been seen in the elderly or in transplant patients.
Relive the Era: Channel 4’s drama, It’s A Sin, tells how AIDS hit the gay community in the 1980s
Meanwhile, immunologists at St Mary’s Hospital in London had drawn blood from hundreds of gay men who were suffering from swollen glands in the neck, armpits and groin – a sign that the body was trying to fight an infection – and found that many had similar. unexplained immune system abnormalities.
Within a year, similar stories surfaced in countries across Europe and Africa.
Possible reasons, undoubtedly shaped by the prejudices of the time, were given: Was it drug-related? Or because the body is overloaded with recurring sexually transmitted infections? Was it genetic?
Before it was AIDS, it was briefly referred to as gay-induced immunodeficiency, or GRID – although it quickly emerged that heterosexuals were also at risk.
Within a few years of these initial cases, the cause was identified: first it was named LAV / HTLV-III, later the human immunodeficiency virus, or HIV.
The virus, which has not been seen in humans before, attacks the immune system and weakens it. The body quickly succumbs to infections that it would normally beat away.
Unbridled Prejudice: 1986 report pointing to the terrible hysteria and homophobia of the day directed at people with AIDS
Blindness, severe muscle wasting, excruciating wounds and abscesses, and dementia were commonly observed. The decline in previously very healthy and often young people was breathtakingly rapid.
When the discovery of HIV was announced in America, then-US Secretary of Health Margaret Heckler suggested that a vaccine would be ready for testing within two years – a prediction that immunologists raised eyebrows at the time for optimism.
And as we all know by now, it was far from the mark. In fact, no effective vaccine has ever been found.
June of this year marks 40 years since that first case report, in which HIV infected an estimated 75 million people worldwide.
More than 150,000 cases have been recorded in the UK and nearly 59,000 have died here. But today a diagnosis of HIV is no longer a death sentence.
Modern drugs are more of a sort of manageable chronic disease for most in the UK – many patients are expected to have a normal life expectancy.
There are also drugs that can keep people from contracting the virus, and more recently there have been breakthroughs that mean the prospect of a cure is in sight.
It’s a scream of hysteria, homophobia, and fear that overshadowed the early decades of the AIDS epidemic, perfectly captured by Channel 4’s hard-hitting drama It’s A Sin.
The series follows a group of young friends whose lives were devastated by HIV in the 1980s and has had more than 6.5 million views on the All 4 streaming platform in the last month.
Behind the human tragedy, however, lies another story: a relentless scientific search for answers, amazing medical breakthroughs and dropouts, and experts and activists around the world who have come together in a common goal to bring death and suffering to life Put an end to.
Today the picture is a picture of hope. But it was a long and winding road.
Protesters at a Gay Pride parade through Manhattan, New York City, carry a banner that reads, “A.I.D.S .: We need research, not hysteria!” in June 1983
Pictured: Singer Jimmy Sommerville marches with Act Up outside Pentonville Prison in London
In memory of those early days in the 1980s, HIV expert Dr. Duncan Churchill: “It was unlike anything I had ever seen before, large numbers of men in their twenties, thirties, and forties died with no obvious solution.
“As a newly qualified doctor with a special interest in infectious diseases, it was a medical mystery that piqued my interest.”
Dr. Churchill now works at the NHS Trust of Brighton and Sussex Hospitals, but treats patients at the UK’s first dedicated AIDS ward at Middlesex Hospital, opened by Princess Diana in 1987.
He added, “I felt a strong connection with the patients because of the prejudice they faced. Rude comments were often thrown around.
“Parents who went to the station couldn’t imagine that their son was dying of AIDS – or even that they were gay. We were forced to cover up signs that said AIDS in case it annoyed visitors. ‘
Experts knew immediately that fighting this disease was not an easy task because of the unique properties of the HIV virus. HIV is a so-called retrovirus that rarely occurs in humans. The virus is zoonotic – like Covid, it was transmitted from animals to humans.
Studies have now shown that the “jump” likely took place in Central Africa in the 1920s – and genetic analysis of virus samples suggests it arrived in the US around 1968.
Diana, Princess of Wales, comforts an AIDS patient at Middlesex Hospital in 1991
But the sexual liberation of the 1970s, coupled with the rise in international travel, increased its prevalence. One of the reasons HIV was so difficult to fight is because of its behavior.
Most other viruses hijack the body’s cells by injecting their viral DNA and replicating. Treatments can target this DNA, programming the immune system to recognize it and fight it off. Retroviruses, on the other hand, are far more difficult to fight.
As soon as the virus, found in blood and other body fluids, enters the body, it infects the cells by mixing its own genetic material with the human DNA in the cell.
This creates a mutated cell that spits out thousands of versions of itself within minutes and is largely undetectable by the immune system. Because of this process, viral copies change quickly, making targeted treatments or vaccines quickly unusable.
Worse, vaccines rely on a group of healthy immune cells called CD4 T cells to trigger the fighter response. These are the exact cells that the HIV virus targets.
In the mid-1980s, US health guards initiated animal testing of an HIV vaccine that used a genetically engineered protein to provoke human antibodies that fight HIV. But subsequent attempts on humans turned out to be unsuccessful.
“HIV is a total virus, excuse the language,” says Dr. Laura Waters, HIV expert and Chair of the British HIV Association.
“The starting point for vaccines is to find human antibodies to fight the infection – but HIV doesn’t set off any that protect against infection.”
“So the scientists weren’t sure what to do. Funding for vaccines declined as none proved to be particularly effective. ”
Early drugs focused on blocking an enzyme that helps the virus replicate when it first gets into the cell.
Under increasing pressure – with fears that the epidemic could get out of hand and potentially infect and kill millions each year – US health officials hastened medical trials of a drug called zidovudine, or AZT, which was previously used to treat cancer.
In 1987 – after just 20 months of research – AZT was approved in the US and the UK.
Despite the drug’s ability to increase its lifespan by about three years, it caused serious side effects: heart problems, nerve damage, debilitating nausea, and liver disease.
Dr. Waters said, “The drugs were toxic. Some patients had disfiguring fat loss on their faces because the drugs destroyed their healthy fat cells.
Others have permanent nerve damage or diabetes. But I also have patients who might be dead without these drugs. ‘
AZT stopped working even after a few months due to the rapid mutations of the virus. The drug was reformulated to give patients more time – but only a few years.
But then there was a breakthrough. Medical professionals at the US National Institute of Allergy and Infectious Diseases found that a combination of two versions of AZT and a third type of drug called a protease inhibitor can suppress the virus to undetectable levels and reduce the number of deaths .
This strategy fought the virus at various points in its life cycle by preventing cells from infecting, rapidly mutating, and spreading throughout the body.
Dr. Waters began her career when the new triple therapy known as antiretroviral therapy, or ART, was approved for use in the UK in 1996.
“It was an incredibly exciting time because HIV research was developing faster than many other areas of medicine,” she says. Every year there was a different development that saved thousands more lives.
“Suddenly it was no longer a death sentence and people could go on with their lives and live into the 60s and 70s.”
By the early 2000s, survival had skyrocketed and, thanks to various reformulations by manufacturers, drug side effects were close to zero, according to experts.
The pharmaceutical company Moderna – famous for its Covid-19 vaccine – may have finally cracked an HIV vaccine. Pictured: archive image
“Starting treatment within a few days of infection is ideal so that the virus cannot be used properly,” says Dr. Waters. “For most people, antiretroviral therapy (ART) suppresses the virus to the extent that it is undetectable in the blood or body fluids.”
While the patients initially had to take a large number of tablets, the three drugs had been combined into one daily pill in the mid-00s.
“It was a challenge to make sure people were actually taking their medication,” says Dr. Michael Brady, HIV counselor at King’s College Hospital in London.
“Taking a handful of pills a day is a constant reminder of her illness. The combination pill dramatically improved liability rates. ‘
By 2000, at least a third of those infected with HIV in the UK were taking ART treatment, with deaths halving.
Since then, researchers have developed injections of ART that are given every two months, negating the need for pills. They are expected to be available in the next year.
According to Dr. Waters’ reaching this stage wasn’t just due to effective treatment.
Rapid, readily available tests, promoted by easier access to more local specialized sexual health centers across the UK and the development of rapid tests, including those done at home, accelerated diagnosis and got patients to one faster crucial treatment.
Between 2000 and 2005, new HIV diagnoses rose from around 3,000 per year to 8,000, which was supported by routine tests for all women who go to hospital to give birth.
This promising picture formed the basis for an ambitious new target set by the United Nations in 2012. Countries have been asked to hit 90 to 90 to 90: 90 percent of people diagnosed with HIV, 90 percent in treatment, and 90 percent percent of those taking drugs whose virus levels are so low that they cannot be detected in tests are.
One pill a day and I’m fitter than ever
When Becky Mitchell was diagnosed with HIV eight years ago, she admits, “My first question to my doctor was,” What is going to happen to me? “
Says the 46-year-old Devon fitness trainer, “I’ve worked with someone with HIV so I knew it wasn’t a death sentence, but it was so unexpected.
My first thought was that I couldn’t get sick because of various sporting events. ‘
When Becky Mitchell was diagnosed with HIV eight years ago, she admits, “My first question to my doctor was,” What is going to happen to me? “
Today, even though Becky says she feels “better than ever”.
She immediately started antiretroviral therapy and is now taking a single pill a day. The virus is in their blood to an undetectable level.
“My activity tracker tells me I’m about a 20-year-old’s fitness,” says Becky, an avid cyclist. “My general health is better than ever.
“I just wish more women knew that this wasn’t just gay men,” she says.
Becky became infected after having sex with a former boyfriend.
“I took it at face value when he said no precautions were necessary,” she says. “But he knew he had HIV and didn’t tell me.”
Becky had felt tired and generally uncomfortable, then one of the man’s ex-girlfriends pointed out the truth to her and she immediately sought a test.
She adds, “He had also failed to take his HIV medication properly – if he had, he would not have transmitted it.
“There is a perception that you have to be promiscuous to catch it. But not you – it can happen to anyone. ‘
All of this would reduce the circulation of the virus and break the chains of transmission.
Then, in 2016, another breakthrough came. Studies in 14 European countries of 1,100 gay and heterosexual couples over an eight-year period showed that despite an HIV-bearing partner, not a single transmission occurred while taking ART drugs. This was despite thousands of unprotected sexual acts.
According to Dr. Michael Brady it was a “gradual change” that finally made the prospect of complete HIV eradication possible. He said, “We never expected the drugs to reduce the risk of HIV transmission to near zero.”
For the past decade, international scientists have experimented with preventive drugs given to people at risk of infection. The treatment known as PreP destroys proteins on the outside of virus particles that help them penetrate the cells of the body and prevents infections from building up.
Studies have shown that the pill taken every day reduces transmission by 86 percent.
In 2017, the UK was one of the first countries in the world to offer treatment to all citizens at risk. The following year, Britain achieved the UN target of ’90 -90-90 ‘.
In recent times, a number of fascinating cases have opened new avenues of research.
Two men, one in London and one from the United States, saw the virus disappear from their bodies after experimental stem cell transplants from donors with a rare genetic mutation that protects against HIV.
Similar treatments have shown promising results for multiple sclerosis patients. But up to 40 percent of those who undergo a stem cell transplant, formerly known as a bone marrow transplant, do not survive.
More promising, the same amazing effect occurs with drug treatment. In 2019, a 36-year-old Brazilian was said to have been “cured” when doctors found no traces of HIV in his body 14 months after the ART treatment was stopped.
Other hopes for curative treatment are based on astonishing cases of infected patients who appear to be genetically immune to the virus – and who can keep their viral load at undetectable levels without drug treatment.
Last year, researchers found no traces of HIV in a 66-year-old California woman, despite being diagnosed with the virus in 1992.
The scientists believe that these outliers are able to drive virus particles into a section of human DNA where they are “silenced” by the immune system.
If they can figure out the gene that few can use to do this, a cure would be at their fingertips.
Elsewhere, the pharmaceutical company Moderna – famous for its Covid-19 vaccine – could finally have cracked an HIV vaccine.
The jab uses sophisticated gene editing technology to train the immune system to produce a wide variety of HIV-like particles and to introduce the body to many mutations. Tests are currently being carried out on humans.
Today 97 percent of people living with HIV in the UK are not infectious thanks to ART treatment.
In other countries the struggle is far from over. Hundreds of thousands of infections occur every year, mainly in Africa and Eastern Europe.
But the new diagnoses in the UK are below 4,000 a year and falling ten percent annually.
And so came another goal last year, this time from UK Health Secretary Matt Hancock: No new infections by 2030.
Will we achieve it? Dr. Waters is cautiously optimistic.
“It is possible,” she says. “The key is to help people not be afraid of HIV by telling them that a diagnosis is not life-limiting, just somewhere in the background.
“A diagnosis can even produce positive, healthy changes in people’s lives. If I had said that a few decades ago, people would have thought I was crazy. ‘