A Brief History of HIV

Key Moments in the Fight Against the Greatest Global Epidemic

The history of HIV is filled with triumphs and failures as the world faced what would become the greatest global epidemic of modern times. What began with but a handful of infections grew to a pandemic that today affects over 36 million people worldwide.

People gathered around a sick man in bed at home
Bruce Ayres / The Image Bank / Getty Images

The HIV timeline began early in 1981 when the New York Times reported an outbreak of a rare form of cancer among gay men in New York and California. This "gay cancer," later identified as Kaposi sarcoma, is a disease that became the very face of the disease in the 1980s and 1990s.

In that same year, emergency rooms in New York City began to see a rash of otherwise healthy young men presenting with fevers, flu-like symptoms, and a rare type of pneumonia called Pneumocystis. No one could have imagined that these unusual, isolated cases would foreshadow a global outbreak, killing millions of people within the course of a few years.


1981 saw the emergence of Kaposi sarcoma and pneumocystis pneumonia among gay men in New York and California. When the Centers for Disease Control reported the new outbreak, they christened it GRID (or gay-related immune deficiency), stigmatizing the gay community as carriers of the deadly disease. However, cases soon started to appear among heterosexuals, drug user, and hemophiliacs, proving the syndrome knew no boundaries.


Researchers at the Pasteur Institute in France isolated a retrovirus that they believe is related to the outbreak of HIV. By that time, 35 countries around the world had confirmed cases of the disease that had, up until that point, only appeared to affect the U.S. Controversy arose soon after when the U.S. government announced one of their scientists, Dr. Robert Gallo, had isolated a retrovirus called HTLV-III, which they claimed was responsible for AIDS.

Two years later, it is finally confirmed that HTLV-III and the Pasteur retroviruses are the same, leading an international committee to rename the virus HIV (human immunodeficiency virus).


A Canadian flight attendant, dubbed "Patient Zero," dies of AIDS-related complications. Because of his sexual connection to several of the first victims of HIV, it is erroneously reported that he is responsible for introducing the virus into North America. By this time there were 8,000 confirmed cases in the U.S., resulting in an alarming 3,500 deaths.


The controversy surrounding the HIV continues when Gallo's lab patents an HIV test kit that later is approved by the U.S. Food and Drug Administration (FDA). The Pasteur Institute sues and is later awarded rights to half of the royalties from the new test. In that same year, HIV enters the public consciousness with the death of Rock Hudson and news that 14-year-old Ryan White is barred from his elementary school in Indiana for having HIV.


The first HIV drug, known as Retrovir (AZT), is approved by the FDA. After six years of ignoring the disease and refusing to acknowledge the crisis, President Ronald Reagan finally uses the word "AIDS" in a public speech. By this point, there is believed to be between 100,000 and 150,000 cases of HIV worldwide.


After years of leading the fight against HIV stigma in the U.S. Ryan White dies at the age of 19. That year, the Ryan White Care Act is enacted by Congress to provide government-sponsored funds for the care of people living with HIV. By this stage, the number of people living with HIV worldwide has now ballooned to nearly a million.


The FDA approves the first drug to be used in combination with AZT known as Hivid, marking the medical community's first foray into combination therapy. It is followed soon after by Epivir (lamivudine) which is still commonly used today.


A British study known as the Concorde Trials concludes that AZT monotherapy does nothing to delay progression to HIV. As a result of this report, a new movement emerges to deny that HIV exists or that a virus of any sort is even linked to the disease.


Treatment takes another major step forward with the introduction of power HIV drugs called protease Inhibitors. When used in triple therapy, the drugs prove effective in not only suppressing the virus but enabling people to restore the immune system to near-normal levels. The protocol is immediately dubbed highly active antiretroviral therapy, or HAART.


The AIDS Clinical Trials Group study 076 reported that the use of AZT during pregnancy and at the time of delivery reduced the transmission of HIV from mother to child to just 3%. In that same year, less than 12 months after HAART is introduced, the HIV death rate in the U.S. plummets by 35%.


The first human trials in the United States begin to test the VAXGEN HIV vaccine. (It was the first of many such trials for which we have yet to find a viable candidate.)


The AIDS denialist movement gets international attention when South African president Thabo Mbeki declares at the International AIDS Conference that "a virus cannot cause a syndrome." By this time, nearly 20 million people have died from AIDS worldwide including nearly 17 million in sub-Saharan Africa.


As the medical community is faced with a growing tide of drug resistance among people on HAART, a new drug called tenofovir is released which appears able to overcome even cases of deep, multi-drug resistance. Shortly before Thabo Mbeki is ejected from the presidency in South Africa, the first generic HIV drugs are approved in the country, opening the door to the single-largest drug treatment roll-out in history.


Scientists at the University of North Carolina at Chapel Hill announce they have decoded the structure of an entire HIV genome, allowing scientist to develop newer diagnostic tools and targeted treatment for HIV. It is largely this effort that led to the development of integrase inhibitors which are now used for the first-line treatment in the U.S.


The iPrEX study is the first of many trials which shows that the HIV drug Truvada could be used by HIV-negative people prevent getting infected. The strategy, known as HIV pre-exposure prophylaxis (PrEP), is today commonly prescribed to protect people at high risk of infection.


A study conducted by North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) reports that a 20-year-old started on HIV therapy can expect to live well into his or her early 70s. This is the first of many such confirmations describing the impact of antiretroviral therapy on life expectancy.


The World Health Organization and the United Nations Programme on HIV/AIDS (UNAIDS) announces an ambitious plan to end the HIV pandemic by 2030 by diagnosing 90% of people living with HIV worldwide, placing 90% on HIV therapy, and achieving an undetectable viral load in 90% of those. Dubbed the 90-90-90 strategy, the program is faced with ever-shrinking contributions from donor countries and ever-increasing rates of drug resistance and treatment failures worldwide.


Indiana experiences the largest outbreak of HIV since the 1990s due to widespread opioid epidemic and resistance by then-Governor Mike Pence to allow a needle exchange program in his state on "moral grounds." As a result, over 200 cases are reported within a few week in and around the town of Austin, Indiana (population 4,295).


Following the release of the Strategic Timing of Antiretroviral Treatment (START) study in late-2015, the World Health Organization and the U.S. Department of Health and Human Service, among others, recommends that HIV treatment be started at the time of diagnosis. As opposed to delaying treatment, the new strategy has been proven to reduce the risk of serious illness by 53%.


Now in its 36th year, the epidemic continues to claim a million lives each year and adds another 1.8 million new infections to the tally in 2017. There are now an estimated 36.7 million people living with HIV worldwide of which 20.9 million are on antiretroviral therapy. In total, over 76 million people have been infected with HIV since the start of the pandemic of which 35 million people have died.


World AIDS Day marks its 30th anniversary with the theme "Know Your Status."

3 Sources
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  1. Grant RM, Lama JR, Anderson PL, et al. Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men. N Engl J Med. 2010; 363:2587-2599. doi:10.1056/NEJMoa1011205

  2. Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8(12):e81355. doi:10.1371/journal.pone.0081355

  3. INSIGHT START Study Group, Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, Avihingsanon A, Cooper DA, Fätkenheuer G, Llibre JM, Molina JM, Munderi P, Schechter M, Wood R, Klingman KL, Collins S, Lane HC, Phillips AN, Neaton JD. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015 Aug 27;373(9):795-807. doi: 10.1056/NEJMoa1506816

By Mark Cichocki, RN
Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years.