Monday, June 6, 2011

Thoughts on the AIDS/HIV 30th

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

The first reports of the infection which would come to be known as AIDS appeared in the June 5, 1981 issue of CDC’s MMWR.  The 5 cases reported in the MMWR involved young homosexual men being treated for Pneumocystic carinii pneumonia.  All were in Los Angeles, California during the period October 1980-May 1981.
I did not become aware of this disease until the fall of 1982 as an intern in Baton Rouge, LA.  Our patient presented with Kaposi sarcoma.
Last week I had a short discussion with a friend who is an HIV expert here in Little Rock, AR.  He graduated from medical school a year ahead of me.  He first recalls hearing of HIV when the NEJM article appeared in December 1981.  He mentioned taking note of the article and thinking he would never see any of those cases.
We both marveled over how the diagnosis of HIV has gone from an automatic death sentence to a chronic disease the person can live with.  LIVE with HIV.
He noted the change came in the 1995 with the introduction of highly active antiretroviral therapy (HAART).  My friend went from feeling like he might need to give up treating AIDS/HIV patients (too many deaths were taking it’s toil on him) to feeling hopeful for his patients.
We both noted that prevention continues to fail.  He mentioned he often will have a patient with a birth date of 1987 or so who will present to his office.  Not good as this age group has always had HIV prevention discussed in the media, etc during their lifetime.
Even though HIV is not the death sentence it once was, prevention needs to remain a major focus.
It is important to know your HIV status so that treatment can begin early. It is especially important to be tested yearly if you participate in any of these behaviors:
  • Have injected drugs or steroids or shared equipment (such as needles, syringes, works) with others
  • Have had unprotected vaginal, anal, or oral sex with men who have sex with men, multiple partners, or anonymous partners
  • Have exchanged sex for drugs or money
  • Have been diagnosed with or treated for hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD), like syphilis
  • Have had unprotected sex with someone who could answer yes to any of the above questions
If you test positive for HIV, then it is important to see a doctor, preferably one with experience treating people living with HIV.

Pneumocystis Pneumonia --- Los Angeles: CDC MMWR, June 5, 1981 / 30(21);1-3
Gottlieb et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men. NEJM (1981) 305:1425-1430
Kent A. Sepkowitz, M.D.; AIDS — The First 20 Years; N Engl J Med 2001; 344:1764-1772
Aging with AIDS: Living longer, living with loss; Linda Dahlstrom; MSMBC News, June 2, 2011

1 comment:

Chrysalis said...

There is also a rise to be aware of in HIV among people over 50. This age group recovering from divorce, widow or widowerhood, may be reentering the dating pool and now be subjected to those who were infected years prior.

The population well into their 70s and so forth, may still be enjoying their sexuality and sharing intimacy. Some feel this age group is not as adapt at asking for protection to be used during love making, and that they are not fully aware of the risk amongst their own peers.

It's important for physicians to remember...their elderly patients can still be active and come to them with symptoms that are in fact symptoms of sexually transmitted diseases, and they should be screened when necessary.

Wonderful advances in this area, but still not a cure. All people are susceptible.