THE FINAL BATTLE IN THE WAR AGAINST HIV AND AIDS
by Benjamin Weeks
It was in June, 1981 when the Centers For Disease Control and Prevention (CDC) published an article in its weekly bulletin, Morbidity and Mortality Weekly (MMWR) that first reported what would later become known as the AIDS epidemic. The report described five young men treated at three different Los Angeles hospitals for peumocytosis, two of whom died by the time the article appeared. Pneurmocytosis rarely causes death in patients with healthy immune systems. This 1981 MMWR report was the first battle cry in the war between HIV and humanity and the criers announcing the battle were physicians, but by the epidemiologists who noticed the unusual rate of a protozoal lung infection in young men. The initial phases in the battle with HIV, one of disease recognition, would remain with the epidemiologist who were positioned to see the stream of reports of healthy young homosexual men who succumbed to a wide range of infections. Only the epidemiologists could see behind the veil of the myriad opportunistic infection to the fact that there was single, sexually transmitted agent causing immunodeficiency in those who were exposed.
Once the epidemiologists pointed to a single cause, the scientist were off to the races in the next stage of the battle against AIDS. In record time between the recognition of a new infectious disease and the identification of the cause, Luc Montagnier and Robert Gallo reported in 1983 to the scientific community that the cause of this immunodeficiency was found and this news was released in a press report to the world in 1984. These reports told the world of a virus that infects the master cell of the immune system, the T4 cell. This T4 cell is for the immune system what a general is for an army. The immune system has many divisions with multiple different weaponry and ranges and the T4 cell coordinates all of these aspects of the immune system in order to keep the body free of all infection. Without the T4 cell, the army of the immune system loses communication and coordination and the individual is left exposed to any microbe that has the opportunity to come along and manifest itself as an infection in the person’s body. And in the end, without the immune system, this person will die from that opportunistic infection. By 1986 this virus came to be known as the Human Immunodeficiency Virus (HIV).
Winning the war with a virus is accomplished by the elimination of the virus from the body and this is accomplished by the immune system. As a public health strategy the goal is to develop a vaccine which will protect people from the spread of the virus. Once everyone is immunized, the virus will stop spreading and the infection is not just eliminated from an individual, but also from the population. So as soon as the virus was identified, the effort to develop a vaccine was swiftly undertaken.
In order to also address the population among us already infected with HIV, the mid to late 1980’s were spent developing methods to detect HIV infection prior to the onset of opportunistic infection. In doing so treatments could be developed and put in to place to cure HIV infection before immunodeficiency could lead to a destructive infection. Therefore during this time, drugs, such as AZT were developed to stop the growth of the virus and give the immune system a chance to rid the body of the HIV. With the advent of the ELISA test to determine if a person was infected and the development of AZT, the mood in the infectious diseases community was quite high spirited and optimistic that this disease would soon be a thing of the past. But the battle was still just beginning. Vaccine development programs were not succeeding and AZT seemed to have limited effectiveness.
As we slipped out of the 80’s and into the 90’s it became clear to the scientific and health community that we would be in a much longer battle that anticipated. We discovered that the virus mutates at incredibly fast rates, making vaccine development unpredictable and tricky and as of yet, elusive. The mutation of the virus also leads to viral resistance to drugs putting pharmaceutical companies on the defensive and the virus in the driver’s seat. And while we have made advances in extending life, 27 years after recognizing this disease, we are nowhere close to eliminating it from the world population.
Over 30 million people worldwide are now living with HIV infection or active AIDS. So where and how will the last battle with HIV be played out? With the development of a drug or vaccine? Perhaps. But the leaders of the 2008 International AIDS Conference in Mexico city this past August emphasized that our greatest battle now is the delivery of good health care and treatment to those who need it. Distribution of drugs, treatments and medical expertise to underdeveloped and poor rural areas suffering from high HIV infection rates is now overwhelming. In addition to the delivery and distribution of treatment, the establishment of prevention programs and education is a huge priority in the battle. We need to open up communities to education about HIV prevention and fight many of the social stigmas surrounding sexual behavior that prevent people from seeking education and treatment. The social taboos surrounding AIDS has always been in the forefront in the battle against AIDS and it will be here where the last battle takes place. Not in the laboratory, for even if we had a pill or a vaccine, as wonderful as that would be, we would still have to catch up to 30 million people and their sexual practices and partners to deliver the goods. The last battle with AIDS will be the actual delivery of treatment and education and yes, this last battle will have to involve the hearts of men and women to deal compassionately without bias and help set stigmas aside. And yes, this last battle will take place in the hearts of governments and peoples to open their societies to ensure human rights, women rights individual liberties and the rights of all people to adequate and effective health care.
