After reading two CDC accounts of this strange set of symptoms among gay men, Anthony S. Fauci, MD, recalls redirecting his research efforts to combat a disease that didn't even have a name.
Sunday marked the 35th anniversary of the publication of the first report on what would later be recognized as AIDS, the disease that defined a generation of gay men but has also been the cause of “one of the most extraordinary accomplishments in biomedical research,” according to the federal scientist who has been there from the beginning.
In an interview posted on AIDS.gov, Anthony S. Fauci, MD, director of the National Institute for Allergy and Infectious Disease, describes with complete clarity reading the June 5, 1981, item in CDC’s Morbidity and Mortality Weekly Report, to this day the public health agency’s mainstay of developments in the field. (For the original MMWR post, click here.)
The description of 5 otherwise healthy gay men from Los Angeles with pneumocystis carnii pneumonia or PCP—a condition normally seen in cancer patients undergoing chemotherapy—struck Fauci as an “oddity,” and something “that you virtually never see with a normal immune system.”
The “real crusher,” as Fauci called it, came a month later on July 4, 1981, when a follow-up report reported 26 gay men, now from Los Angeles, San Francisco, and New York, not only with PCP but also Kaposi’s sarcoma and other opportunistic infections. Fauci knew instantly, “Oh my God, we’re dealing with something new.”
“My whole career and my life changed,” he said in the interview. Fauci has previously described how he quickly redirected his career toward investigating this odd new disease, to the consternation of mentors and colleagues. “This was important enough to change what I was doing and start pursuing this disease that didn’t even have a name at the time, much less an etiology.”
At 75, Fauci has seen the progression of research and treatment. In the early days, patients arrived so sick there was little to offer but palliative care. In recent years, CDC has declared that AIDS is now a “chronic illness,” which means that early detection and proper care can result in a lifespan very close to normal. He’s also seen the evolution in how persons with AIDS are treated by the healthcare system and society at large.
In a statement Sunday, President Barack Obama spoke of this evolution and the need to do more. Nearly 5 years ago, he said an AIDS-free generation "is within reach," and today the goal is end the epidemic by 2030.
“We’ve learned that stigma and silence don’t just fuel ignorance, they foster transmission and give life to a plague,” Obama said. “We’ve seen that testing, treatment, education, and acceptance can not only save and extend lives, but fight the discrimination that halted progress for too long.”
Other federal officials said that while stigma is not what it was in the 1980s, it can still prevent at-risk groups from getting tested or being educated about prevention.
A National HIV/AIDS Strategy has been updated through the year 2020. It calls for (1) reducing new infections, in part by intensifying prevention efforts where AIDS is most likely to occur; (2) increasing access to care by boosting care coordination and keeping track of patients right after diagnosis, to ensure treatment to keep viral loads low; (3) reducing AIDS-related disparities and health inequities and (4) achieving a more coordinated national response to HIV.
San Francisco has been at the forefront of AIDS prevention. A foundation in the city provides pre-exposure prophylaxis (PrEP) therapy, Gilead’s Truvada, at no charge to most clients making under $58,000 a year. Some 6000 clients, mostly gay and bisexual men, are taking the therapy.