The History of HIV

The AIDS pandemic was—and some would argue still remains—the greatest global health crisis of modern history. While other epidemics were just as widespread and deadly (among them tuberculosis and malaria), the mounting waves of death caused by AIDS was simply unprecedented.

Over the span of a few short years, we saw AIDS-related deaths rise from a few hundred gay men in the U.S. to the hundreds of thousands across the farthest reaches of the planet. The fact that we had never seen disease like this and couldn't identify a way to stop it only added to the growing sense of panic among both the public and policy makers alike.

From "Death Sentence" to Normal Quality of Life

By the early 1990s, HIV/AIDS had become the number one cause of death among Americans aged 24 to 45. By 1999, it had eclipsed all other illnesses as the leading cause of death in Africa as well as the fourth leading cause of death worldwide.

Yet, for all of the fear and anger the disease caused, HIV transformed the very landscape of science and politics as we know it. It moved the medical profession from its patriarchal roots to one which advocated for the rights and protections of patients. It forced the fast-tracking of the drug approvals process while spurring researchers to develop many of the genetic and biomedical tools we take for granted today.

The simple fact that HIV has gone from being an almost uniformly fatal disease to one for which people can now live healthy, normal lives is nothing short of astonishing. Still, we have a long way to go and many lessons to learn before we can consider the crisis over. It is only by looking back that we can better understand the challenges yet to be faced as we move toward making HIV a thing of the past.


In May, the U.S. Centers for Disease Control and Prevention (CDC) reported that five gay men in Los Angeles, CA had developed a rare lung infection called pneumocystis carinii pneumonia (PCP) as well as an array of other diseases consistent with a collapsing immune system. By the time of the report's release, two of the men had already died.

By December, 270 similar cases were reported in what researchers were calling GRID (or gay-related immune deficiency). Of those identified, 112 had died of the disease within the course of the year.


As the disease began to spread beyond gay men to other population groups, the CDC introduced the term AIDS (or acquired immune deficiency syndrome) to the public health lexicon, defining it as a disease "occurring in a person with no known case for diminished resistance to that disease."


Researchers at the Pasteur Institute in France, including Françoise Barré Sinoussi and Luc Montagnier, identified a novel retrovirus which they christened LAV (lymphadenopathy associated virus) and suggested that it could be the cause of AIDS.

As the disease continued to spread beyond the gay community, the CDC affirmed that sex and blood exposure were the two major routes of transmission for the still-unnamed virus.


American researcher Robert Gallo announced the discovery of a retrovirus called HTLV-III (human T-tropic virus) which he believed was the cause of AIDS. The announcement sparked a controversy as whether LAV and HiTLV-III were the same virus and which country owned the patent rights to it.

By the end of the year, officials in San Francisco ordered the closure of gay bath houses—deemed public health hazards in the face of the growing wave of illnesses and death among local gay men.


In January, the CDC reported that AIDS was caused by a newly identified virus, followed shortly by news that the U.S. Food and Drug Administration (FDA) had approved the first HIV antibody test able to detect the virus in blood samples.

Meanwhile, reports emerged that Ryan White, an Indiana teenager, was denied entrance to his high school after having acquired AIDS from a blood transfusion. Two months later, actor Rock Hudson died of AIDS-related illnesses, becoming the first high profile celebrity to die of the disease.

The AIDS Memorial Quilt was conceived by activist Cleve Jones to commemorate the lives lost to HIV. Each 3x5 foot panel paid tribute to one or more people who had died of the disease.


In May, the International Committee on the Taxonomy of Viruses issued a statement in which it was agreed that the virus that causes AIDS would officially be named HIV (or human immunodeficiency virus).


American playwright Larry Kramer founded ACT UP (the AIDS Coalition to Unleash Power) in New York, NY to protest on-going inaction of the government to the growing AIDS crisis in the U.S.

Meanwhile, the U.S. and France agreed that LAV and HTLV-III were, in fact, the same virus and agreed to share patent rights, channeling the majority of the royalties to global AIDS research.

By March, the FDA approved AZT (zidovudine) as the first antiretroviral drug able to treat HIV. Soon after, they also agreed to accelerate the drug approvals process, reducing the procedural lag time by two to three years.


Elizabeth Glaser, wife of Starsky & Hutch star Paul Michael Glaser, founded the Pediatric AIDS Foundation (later renamed the Elizabeth Glaser Pediatric AIDS Foundation) after acquiring HIV from a blood transfusion.The charity soon became the world's largest funders of global AIDS research and care.

World AIDS Day was observed for the very first time on December 1st.


By August, the CDC reported that the number of AIDS cases in the U.S. has reached 100,000.


The death of Indiana teenager Ryan White in April sparked a wave of protests as government officials were accused of continued inaction. The U.S. Congress responded by approving the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act of 1990, designed to provide federal funding to community-based HIV care and services providers.


AIDS became the number one leading cause of death for American men aged 24 to 45.


The CDC expanded the definition of AIDS to include people with CD4 counts under 200. By June, President Bill Clinton signed into law a bill allowing for the ban of all immigrants with HIV.


AIDS became the leading cause of death among all Americans aged 24-45.

Meanwhile, results of the landmark ACTG 076 trial were released, which demonstrated that AZT given just before delivery could dramatically reduce the risk of HIV from mother to child during pregnancy. The results were quickly followed by the issuance of the first guidelines from the U.S. Public Health Service (USPHS) calling for the use of AZT in pregnant women with HIV.


The FDA approved Inivirase (saquinivir), the first protease inhibitor-class drug introduced into the antiretroviral arsenal. The use of protease inhibitors ushered in an era of HAART (high active antiretroviral therapy) in which a combination of three or more drugs was used to treat HIV.

By the end of the year, 500,000 Americans were reported to have been infected with HIV.


The FDA approved the first viral load test able to measure the level of HIV in a person’s blood as well the first HIV home testing kit and the first non-nucleoside-class drug called Viramume (nevirapine).

In the same year, the USPHS issued its first recommendations on the use of antiretroviral drugs to reduce the risk of infection in people accidentally exposed to HIV in healthcare settings. The USPHS' recommendation for post-exposure prophylaxis (PEP) formed the basis for preventive treatment in cases of sexual exposure, rapes, or accidental blood exposure.

The AIDS Memorial Quilt, consisting of over 40,000 panels, was laid out on the National Mall in Washington, D.C. and covered the entire span of the national public park.


The CDC reported the widespread use of HAART had dramatically reduced the risk of HIV-related illnesses and deaths, with mortality rates dropping by an astonishing 47 percent compared to the previous year.

Meanwhile, the United Nations Programme on HIV/AIDS (UNAIDS) reported that nearly 30 million people had been infected with HIV worldwide, with southern Africa accounting for nearly half of all new infections.


The CDC issued the first national HIV treatment guidelines in April, while the U.S. Supreme Court ruled that the Americans with Disabilities (ADA) Act covered all people living with HIV.


The World Health Organization (WHO) reported that HIV was the leading cause of death in Africa as well as the fourth leading cause of death worldwide. WHO further estimated that 33 million people had been infected since the start of the epidemic and that over 14 million had died as a result of HIV-associated diseases.


The XIII International AIDS Conference in Durban, South Africa was shrouded in controversy when then-President Thabo Mbeki, in the opening session, expressed doubt as to whether HIV causes AIDS. At the time of the conference, South Africa had (and continues to have) the largest population of people living with HIV in the world.


The Global Fund to Fight AIDS, Tuberculosis, and Malaria was founded in Geneva, Switzerland to channel funding to HIV programs in developing countries. At the time of its founding, 3.5 million new infections were reported in sub-Saharan Africa alone.

Meanwhile, in an effort to step up HIV testing in the U.S., the FDA approved the first rapid HIV blood test able to deliver results in as little as 20 minutes with a 99.6 percent accuracy.​


President George H.W. Bush announced the formation of the President’s Emergency Plan for AIDS Relief (PEPFAR), which became the largest HIV funding mechanism by a single donor country. Unlike the Global Fund, which provided countries a measure of sovereignty over how the funds could be used, PEPFAR took a more hands-on approach with greater degrees of program oversight and measures.

The first HIV vaccine trial, using the AIDVAX vaccine, failed to reduce infection rates among study participants. It was the first of many vaccine trials which ultimately failed to achieve reasonable levels of protection for either people with HIV or those hoping to avoid the disease.

Meanwhile, the next generation nucleotide-class drug, Viread (tenofovir), was approved by the FDA. The drug, which was shown to be effective even in people with deep resistance to other HIV medications, was quickly moved to the top of the U.S. preferred treatment list.


According to the WHO, over one million people had been placed onto antiretroviral therapy, a 10-fold increase since the launch of the Global Fund and PEPFAR efforts.

In the same year, researchers with the National Institutes of Health (NIH) reported that clinical trials in Kenya and Uganda were stopped after it was shown that male circumcision could reduce a man’s risk of getting HIV by as much as 53 percent.

Similarly, the CDC issued calls for HIV testing for all people aged 13 to 64, including a one-time yearly testing for individuals considered to be at high risk.


The CDC reported that 565,000 Americans had died of HIV since the beginning of the epidemic. It was also reported that the incidence of new infections among men who have sex with men was on the rise, with rates nearly doubling among young gay men between the ages of 13 and 18.

No less dismaying was the fact that of the 1.2 million Americans estimated to be living with HIV, as many as 20 to 25 percent remained wholly unaware of their status.


Timothy Brown, popularly known as the "Berlin Patient," was reported to have been cured of HIV after receiving an experimental stem cell transplant. While the procedure was deemed to be too dangerous and costly to be viable in a public health setting, it gave rise to other studies hoping to repeat the results.


The Obama administration officially ended the U.S.'s HIV immigration and travel ban.

In November, researchers with the IPrEx Study reported that the daily use of the combination drug Truvada (tenofovir + emtricitabine) reduced the risk of infection in HIV-negative gay men by 44 percent. It was the first study to endorse the use of pre-exposure prophylaxis (PrEP) to reduce the risk of HIV in non-infected individuals.


The HPTN 052 Study was officially named Breakthrough of the Year by Science Magazine after it demonstrated that people on antiretroviral therapy were 96 percent less likely to transmit HIV to a non infected partner if able to sustain an undetectable viral load. The study confirmed the use of Treatment as Prevention (TasP) as a means to prevent the spread of HIV in serodiscordant (mixed status) couples.


Despite reversal in HIV-related deaths, health officials in South Africa reported that the number of new infections had increased over the previous year by more 100,000, mainly among teens and younger adults.

The FDA officially approved the use of Truvada for PrEP. It came at a time when the U.S. reported just over 50,000 new diagnoses, a figure that had remained largely unchanged since 2002.


President Barack Obama signed the HIV Organ Policy Equity (HOPE) Act into law, which allows for the transplantation of organs from an HIV-positive donor to an HIV-positive recipient.

UNAIDS announced that the new infection rate in low- to middle-income countries had dropped by 50 percent as result of expanded HIV treatment programs. They also reported that an estimated 35.3 million people were infected with HIV.

The FDA approved the integrase inhibitor-class drug Tivicay (dolutegravir) which was shown to have fewer side effects and greater durability in people with deep drug resistance. The drug was quickly moved to the top of the U.S. preferred HIV drugs list.


The implementation of Affordable Care Act (ACA) expanded health insurance to individuals previously denied coverage. Before the law went into effect, less than one in five Americans with HIV had private health insurance.

Meanwhile, scientists at Oxford University investigating both historic record and genetic evidence, concluded that HIV likely originated in or around Kinshasa in the Democratic Republic of Congo. It is believed that a hybrid form of the simian immunodefiency virus (SIV) jumped from the Pan troglodytes troglydytes chimpanzee to man as a result of either blood exposure or ingesting bush meat.


The Strategic Timing of Antiretroviral Treatment (START) Study was released to delegates at the International AIDS Society Conference in Vancouver, Canada. The study, which showed that HIV therapy provided at the time of diagnosis could reduce the risk of serious illness by 53 percent, elicited calls for immediate changes in public policy.

Four months later, the WHO issued updated guidelines recommending HIV treatment at the time of diagnosis irrespective of CD4 count, location, income, or stage of disease. They further recommended the use of PrEP in those at substantial risk of acquiring HIV.

On World AIDS Day, the CDC reported that annual HIV diagnoses in the U.S. had dropped by nine percent, with the steepest declines among heterosexuals and African American women. By contrast, younger gay men remained at high risk of infection while African American gay men were reported to have a 50/50 chance of acquiring HIV in a lifetime.

On December 21st, the FDA "lifted" its 30-year-old ban on blood donations from gay and bisexual men. The decision incited anger from AIDS activists, who criticized the FDA’s decision to allow only those men who had not had sex for a year to donate, insisting the decision was discriminatory and no less than a de facto ban.


According to the WHO, 38.8 million people were infected with HIV and nearly 22 million people had died of HIV-associated causes since the beginning of the epidemic.

With evidence that universal treatment of HIV could reverse infection rates, the United Nations launched its 90-90-90 strategy aimed at identifying 90 percent of people living with HIV, placing 90 percent of positively identified individuals on treatment, and ensuring that 90 percent of those on therapy were able to achieve undetectable viral loads.

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Article Sources
  • U.S. Department of Health and Human Services (DHHS). "A Timeline of HIV/AIDS." Office of the Assistant Secretary for Health and Office of the Assistant Secretary for Public Affairs; Washington, D.C.; September 18, 2016.