History

The CDC’s Morbidity and Mortality Weekly Report (MMWR) describes the men as having other unusual infections as well, indicating that their immune systems are compromised. Two of the give young men have already died by the time the report is published.

This edition of the MMWR marks the first official reporting of what will become known as the AIDS epidemic. The initial five-patient series was reported to the CDC by Dr. Michael Gottlieb, a member of the Council of Advisors to the AIDS Monument.

Today, Dr. Gottlieb is an Associate Clinical Professor of Medicine at UCLA’s David Geffen School of Medicine and still treats patients exclusively at APLA (AIDS Project Los Angeles) Health.

Following Gottlieb’s report to the CDC, he and his team would publish a more detailed report in the New England Journal of Medicine December 10,  1981.

Now it is known that HIV originated much earlier, in 1920, likely in the Democratic Republic of Congo around when HIV crossed species from chimpanzees to humans. Up until the 1980s, we do not know how many people were infected with HIV or developed AIDS.

While sporadic cases of AIDS were documented prior to 1970, available data suggests that the epidemic started in the mid- to late 1970s. By 1980, HIV may have already spread to five continents (North America, South America, Europe, Africa and Australia), and in this period, between 100,000 and 300,000 people could have already been infected

News stories in the Associated Press, the Los Angeles Times, and the San Francisco Chronicle capture the attention of the gay community and medical personnel nationwide.

In response to the outpouring of reports and concerns to the CDC, the Task Force on Kaposi’s Sarcoma and Opportunistic Infections is created to identify risk factors and to develop a case definition for the as-yet-unnamed syndrome.

After completing a three-year fellowship at the University of California San Francisco, Dr. Volberding was ready to become a cancer specialist under renowned virologist Dr. Jay Levy.  Instead, he would find himself on a lifelong journey of treating people living with HIV/AIDS and fighting the spread of the virus.

Dr. Volberding remembers his first patient with clarity.

“Twenty-two-year-old man, grew up in the Deep South, and as I recall he was estranged from his family,” Dr. Volberding tells the San Francisco Examiner almost 35 years later. “He ended up in San Francisco working basically sex for food, and had innumerable previous sexually transmitted infections.”

The man died within a few months, without his family present, Dr. Volberding recalls.

Around this same time, two doctors in the Bronx start to see HIV/AIDS symptoms in their patients.  Dr. Gerald Friedland sees cases of Pneumocystis pneumonia in injection drug users, and becomes one of the first to see the connection between IV-drug use and HIV transmission.

Pediatric immunologist Dr. Arye Rubenstein begins to identify the immunodeficiency of his pediatric patients, the children of drug addicts, as a symptom of what would be eventually called AIDS.

Dr. Rubenstein, who has been seeing this particular kind of immunodeficiency in children and sometimes in their mothers in his Bronx practice since the late 1970s, is one of the first to connect pediatric cases to the new disease affecting homosexual men.

These doctors who treat some of the first known cases of HIV/AIDS go on to do important, transformative work in the fields of treatment, research and public health policy.

In 1983, Dr. Volberding would establish what would make San Francisco General Hospital the model for HIV care: the country’s first AIDS treatment center (Ward 86).  Later the same year, he would join the medical team at Ward 5B, the first in-patient clinic for AIDS patients in the world.

Dr. Volberding would continue to treat HIV/AIDS patients until 2012, when he would become Director of the UCSF AIDS Research Institute.  Volberding would also become Co-Director of the Center for AIDS Research.

Dr. Friedland also would dedicate his life to AIDS treatment and research.  Following 10 years of working with HIV/AIDS patients in the Bronx, Dr. Friedland would become Director of the HIV/AIDS Program at Yale and Professor of Medicine and Epidemiology and Public Health at Yale School of Medicine.

Dr. Friedland would also become involved in HIV/AIDS international research aimed at providing access to antiretroviral therapy in developing regions of the world.  The major focus of his work becomes the integration of HIV and TB care and treatment in co-infected patients in South Africa.

In 2018, on the occasion of delivering the keynote address at the 13th annual International Conference on HIV Treatment and Prevention, Dr. Friedland would tell TheBodyPRO:

“Many of these people living with HIV, I have cared for, for decades.  I know them extremely well. They know me.  We have gone through this together and have this close collegial relationship as a partnership, so it’s a wondrous pleasure to continue to provide.”

The other doctor working in New York City in 1981, Dr. Rubenstein, would decide to remain in the Bronx, caring for children with HIV AIDS.

He would receive a grant in 1983 from the National Institutes for Health to study the incidence of AIDS in women and children. In 1986, Dr. Rubenstein would establish that transmission of AIDS can occur in utero, and his breakthrough findings are published in the journal Clinical Immunology and Immunopathology.

By this time, Dr. Rubsenstein has treated more than a hundred HIV-infected children, and in the summer of 1985, he would open a day care center for pediatric AIDS patients at Albert Einstein College of Medicine in the Bronx.  He would become Chief of the Division of Allergy & Immunology at Children’s Hospital at Montefiore and Professor of Pediatrics, Microbiology & Immunology at Albert Einstein College.

In a 1987 interview with New York magazine, he would speak fondly of the parents, many of them former IV-drug users, of his pediatric patients:

“Many come from a low socioeconomic group, they’re poor, the family may have broken up, they may have used drugs, and now their child has AIDS because they gave it to him.  You wouldn’t be surprised if they threw up their hands, but many don’t.  They become the best parents in the world.  They straighten out their lives, they spend hours with their kids. They give up longing for material things and look for spiritual and religious values.”

At the event in Bethesda, the clinicians discuss Kaposi’s sarcoma and other opportunistic infections, and begin to develop recommendations for further studies in epidemiology, virology, and treatment.

The mothers of at least three of the children have disclosed that they use drugs and/or engage in sex work.  Dr. Rubinstein recognizes that the children are showing signs of the same illnesses affecting gay men, but his diagnoses are dismissed by his colleagues.

Ward 86 draws staff who are passionate about treating people with AIDS.  Over time, the clinic team develops the San Francisco Model of Care, which focuses on treating patients with compassion and respect; providing an array of health and social services in one facility; and collaborating closely with the local health department and community organizations.

The Foundation’s goal is to provide information on Kaposi’s Sarcoma (KS) to local gay men.  Still active today, the San Francisco AIDS Foundation continues to promote health, wellness, and social justice for communities most impacted by HIV, through sexual health and substance use services, advocacy, and community partnerships.

“A Cluster of Kaposi’s Sarcoma and Pneumocystis carinii Pneumonia among Homosexual Male Residents of Los Angeles and Orange Counties, California” describes a potential sexually transmitted agent as being the link to outbreaks of KS, Pneumocystis carinii pneumonia, and other infections recently found among young gay men.

The report describes a study of 19 case subjects from June 1, 1981 to April 12, 1982 involving biopsy-confirmed KS and/or PCP among previously healthy homosexual male residents in southern California.

Following a report of possible associations among the KS/PCP case subjects in Los Angeles and Orange counties, interviews were conducted with the eight subjects still living and with seven of the close friends of the 11 subjects who had died.

Through these interviews, the CDC was able to collect data on sexual partners for 13 of the 19 subjects. The study considered “sexual contact” to be established if the KS/PCP case subjects was reported to have “exposure” to another person that was either substantiated or not denied by the other person involved in the relationship (or by a close friend of that person).

Within five years of the onset of symptoms, nine of the KS/PCP case subjects had had sexual contact with others who had KS or PCP.  They consisisted of seven case subjects from LA County who had sexual contact with other patients from LA County, and two case subjects from Orange County had sexual contact with one patient with KS who resided outside California.

Four of the nine KS/PCP case subjects had been exposed to more than one patient who had KS or PCP. Three of the nine KS case subjects developed their symptoms after sexual contact with persons who already had symptoms of KS.  One of these three subects developed symptoms of KS about nine months after sexual contact, another subject developed symptoms 13 months after contact, and a third subject developed symptoms 22 months after contact.

The other four KS/PCP case subjects in the group of 13 had no known sexual contact with reported cases. However, one KS case subject had an apparently healthy sexual partner in common with two persons with PCP; one KS case subject reported having had sexual contact with two friends of the non-Californian with KS; and two PCP case subjects had most of their anonymous contacts (greater than or equal to 80%) with persons in bathhouses.

The editorial note to the report included these points:

• An estimated 185,000-415,000 homosexual males lived in LA County in 1982.
• If one assumes each homosexual male in LA County has between 13 and 50 different sexual partners per year during 1977-1982, “the probability that seven of 11 patients with KS or PCP would have sexual contact with any one of the other 16 reported patients in LA County would seem to be remote.”
• With this same assumption, “the probability that two patients with KS living in different parts of Orange County would have sexual contact with the same non-Californian with KS would appear to be even lower.”
• Thus, observations in LA and Orange counties imply the existence of an unexpected cluster of cases.

The CDC then puts forth the hypothesis that infectious agents are being sexually transmitted among homosexually active males.

“Infectious agents not yet identified may cause the acquired cellular immunodeficiency that appears to underlie KS and/or PCP among homosexual males. If infectious agents cause these illnesses, sexual partners of patients may be at increased risk of developing KS and/or PCP,” the CDC report posits.

The CDC proposes another hypothesis:  “Sexual contact with patients with KS or PCP does not lead directly to acquired cellular immunodeficiency, but simply indicates a certain style of life. The number of homosexually active males who share this lifestyle may be much smaller than the number of homosexual males in the general population.”

The CDC goes on to suggest the possibility of exposure to “some substance (rather than an infectious agent)” leading to immunodeficiency among homosexual males that share a particular style of life.

The report cites a New York City-based report suggesting a connection between amyl nitrite (commonly referred to as “poppers”) and an increased risk of KS.  This hypothesis would later be scientifically disproved.

The article, “Epidemiologic Notes and Reports Pneumocystis carinii Pneumonia among Persons with Hemophilia A,” is the first report of immunosuppression in patients with hemophilia who have no other known risk factors for AIDS.

The first dedicated funding for AIDS research and treatment will be approved by Congress almost a year later, in July 1983.

CDC’s report, “Current Trends Acquired Immune Deficiency Syndrome (AIDS): Precautions for Clinical and Laboratory Staffs,” introduces precautions for medical personnel working with people exhibiting signs of AIDS.  The report notes that “airborne spread and interpersonal spread through casual contact do not seem likely.”

“Epidemiologic Notes and Reports Immunodeficiency among Female Sexual Partners of Males with Acquired Immune Deficiency Syndrome (AIDS) — New York” described the first cases of AIDS in women.

An American Red Cross interoffice memo blasts the CDC after its January 4 meeting, stating, “CDC is likely to continue to play up AIDS.”

The memo goes on to say;  “It has long been noted that CDC increasingly needs a major epidemic to justify its existence.  To the extent the [blood supply] industry sticks together against CDC, it will appear to some segments of the public at least that we have a self interest which is in conflict with the public interest, unless we can clearly demonstrate that CDC is wrong.”

Donor screening issues arose in mid to late 1982, when cases of AIDS in hemophiliacs were first reported, including the first transfusion-associated AIDS case in an infant.

Between December 1982 and December 1983, there were two critical events that presented opportunities for the blood services community to enact new donor screening and deferral policies to reduce the threat of HIV transmission through blood and blood products.

The first, which occured on January 4, 1983, was at the Public Health Service meeting convened by the CDC.  This meeting was widely publicized, and over 200 people attended, including representatives of the FDA, NIH, the National Hemophilia Foundation, the National Gay Task Force, blood banks, and the plasma fractionation industry.

This was where the blood services community first received data on the possibility of a transmissible agent within its blood supply.  CDC scientists recommended that blood banks implement specific donor screening measures (such as questioning donors about their risk behaviors and running blood donations through a series of tests).

Some participants in the Atlanta meeting and others in key decision-making roles expressed reservations about the validity of the CDC data and indicated that they did not believe the CDC to be a credible source of information regarding AIDS.  Following the conference, American Red Cross officials would encourage colleagues to resist recommendations from the CDC.

The ensuing resistance by blood banks to implementing the CDC’s donor screening measures is now viewed as a critical failure on their part in the effort to limit transmission of HIV early on in the epidemtic.

The second critical event would occur in December 15-16, 1983, when the Blood Products Advisory Committee of the FDA would convene a meeting to discuss all possible options of surrogate marker tests for HIV.  This meeting is notable for being the CDC’s second attempt to address the need to implement blood screening as a means to implement safeguards to the blood supply.

In the year between the two meetings, blood banks would continue to collect donations from unscreened members of the public.

The report “Current Trends Prevention of Acquired Immune Deficiency Syndrome (AIDS): Report of Inter-Agency Recommendations” is also notable in that it is the first to suggest that AIDS may be caused by an infectious agent that is transmitted sexually or through exposure to blood or blood products.

In 2008, Dr. Barré-Sinoussiwill share the Nobel Prize in Medicine for this discovery with her colleague, Dr. Luc Montagnier.

The publication lasts for two years, until mainstream scientific journals begin expediting publication for articles on AIDS.

In the CDC Report “Current Trends Update: Acquired Immunodeficiency Syndrome (AIDS) — United States,” CDC identifies all major routes of HIV transmission — and rules out transmission by casual contact.

At the December 15-16 meeting, the FDA’s Blood Products Advisory Committee facilitates a discussion of the options for HIV surrogate marker tests.  This conference is a follow-up to the one held in January 1983, where blood bank scientists remained unmotivated to begin blood screening.

After the January meeting, an American Red Cross interoffice memo stated, “CDC is likely to continue to play up AIDS.  It has long been noted that CDC increasingly needs a major epidemic to justify its existence.”

In the year between the two meetings, blood banks would continue to collect donations from unscreened members of the public.  The initial resistance by blood banks to implement the CDC’s donor screening measures is now viewed as a critical failure on their part in the effort to limit transmission of HIV early on in the epidemtic.

At the December 1983 meeting, industry representatives proposed the creation of a task force to deliberate the details of a recommendation made at the meeting by Dr. Dennis Donohue, director of the FDA’s Division of Blood and Blood Products.  Dr. Donohue proposed that hepatitis B anti-core testing be incorporated for routine plasma screening, since it would identify 90% of all potentially infectious or high-risk donors.

While Dr. Donohue was not enthusiastic about the task force approach, which was generally seen as the industry’s way to delay screening requirements, he agreed to it.

Today, many options are available to test for HIV (Human Immunodeficiency Virus), including an FDA-approved, at-home test called OraQuick.

Approved in 2012 for sale to anyone age 17 and older, the OraQuick In-Home HIV Test tests fluid from the mouth and delivers results in 20 to 40 minutes.  The kit does not require sending a sample to a lab.

HIV screening is covered in the U.S. by health insurance without a co-pay, as required by the Affordable Care Act.  If you do not have medical insurance, some testing sites may offer free tests.

When people know their HIV status, they have powerful information they can use to take care of themselves.

The FDA still regulates the tests that detect infection with HIV.  An estimated 1.1 million people in the U.S. are living with HIV, and about one in seven don’t know they have it, according to the CDC.

The CDC recommends that everyone between the ages of 13 and 64 years old be screened for HIV at least once as part of their routine health care. More frequent testing is recommended for people who have a higher risk of infection because of behaviors such as having sex without condoms, having sex with multiple partners, or injecting drugs using shared needles.

The CDC’s Morbidity and Mortality Weekly Report recommends that HIV-infected women delay pregnancy until more is known about the risks of transmission, and advised new mothers to avoid breastfeeding.

Transmission of the virus during pregnancy or labor and delivery is demonstrated by two reported AIDS cases occurring in children who had no contact with their infected mothers after birth.

With studies on the subject of pediatric AIDS is just beginning, the rate of perinatal transmission of HIV from infected pregnant women is unknown and the limited amount of available data suggests a high rate.

However, the report contends that perinatal transmission (from an infected mother to her newborn) is not inevitable.

Of three children born to women who became infected with HIV by artificial insemination from an infected donor, all were in good health and negative for antibody to the virus more than 1 year after birth.  Another child, born to a woman living with AIDS, was HIV-negative and healthy at birth and at 4 months of age.

In December 1985, a total of 217 cases of AIDS have been reported among children under age 13, and 60% of them have died.

Created by the Robert Wood Johnson Foundation, the AIDS Health Services Program seeks to replicate Ward 86’s San Francisco Model of HIV Care nationwide — but with an emphasis on tailoring programs to meet the needs in local context.

The goals of the program are to develop community-based services for persons with AIDS and to determine factors that facilitate or impede service.

The foundation starts with nine projects located in 11 communities: Atlanta, Dallas, Fort Lauderdale, Miami, Nassau County (NY), New Orleans, Newark, Jersey City, Seattle, and West Palm Beach.

The AIDS epidemic in each site varies substantially.  Lack of health insurance represents a problem for the majority of clients in states having the most restrictive Medicaid policies (Atlanta, New Orleans, and Dallas) and in communities where a large proportion of clients enter the program before their condition progresses to AIDS (Miami, Fort Lauderdale, and West Palm Beach).

Between 1987 and 1990, the average annual population with AIDS in program sites increase 126% (with increases ranging from 91% to 175%). During that period, the average increase in the number of persons alive with an AIDS diagnosis in these eleven cities is 191%, ranging from 181% to 257%.

The men and women attempting to build a network of coordinated services for persons with HIV/AIDS find themselves with an extremely difficult task.  As the epidemic progresses, there is a substantial increase in the scope of the epidemic as well as change in the racial, sex, and risk-group composition of HIV-infected persons.

Program staff have to cope with confusing state and federal policy, complicated by changes in medical treatment and in the conceptualization of AIDS. In 1986, AIDS is still perceived as an acute, fatal illness, and policies for expanding terminal care benefits are the focus of discussion. However, soon the focus would shift to early intervention and ongoing treatment programs for a new chronic disease.

The report, titled Perspectives in Disease Prevention and Health Promotion: Public Health Service Guidelines for Counseling and Antibody Testing to Prevent HIV Infection and AIDS, reflects the strong stance by the CDC against the unauthorized disclosure of personal information and inappropriate discrimination against those who seek to be tested.

Per the guidelines, health agencies should endeavor to provide ready, confidential access to HIV testing to those most at risk of HIV infection.

As examples, the report cites programs offering counseling and testing to gay men, IV-drug users, persons with hemophilia, the sexual and/or needle-sharing partners of these persons, and patients of sexually transmitted disease clinics.

The report also addresses the issue of false-positive HIV test results and its impact, stating that most false-positives are due to human error and more precautions should be used by medical personnel to ensure the accuracy of results.

“All laboratories should anticipate the need for assuring quality performance of tests for HIV antibody by training personnel, establishing quality controls, and participating in performance evaluation systems,” the report advises.

In a response to reports that some doctors are refusing to treat patients who are HIV-positive , the AMA advises physicians that it is unethical to deny care in such situations if the care required is within the doctor’s normal range of practice.

AMA ethics council also tells physicians that if a patient carrying the AIDS virus refuses to discontinue dangerous sexual practices, a doctor should notify public health authorities and even take it upon himself to directly inform individuals who may be in danger of infection.

The new AMA strictures conflict with California law, under which it is illegal for a doctor, without the patient’s consent, to tell anyone a person has tested positive for the AIDS virus or has AIDS.

The AMA states that no evidence exists that large numbers of doctors have refused to treat patients who tested positive for the AIDS virus.

But an AMA spokesperson concedes, “There have been physicians who have chosen to make public statements that they will not treat HIV-positive people. Those statements have generated tremendous amounts of discussion and debate.”

The guidelines recommend a regimen of two compounds to prevent the onset of PCP: trimethoprim-sulfamethoxazole and pentamidine.  The CDC bases its recommendations on a study of 60 adults living with AIDS, which suggest that those who received treatment have fewer episodes of PCP and lived longer, compared with untreated patients.

Trimethoprim-sulfamethoxazole, a combination of the antibiotics sulfamethoxazole and trimethoprim, commonly causes side effects in patients that include nausea, vomiting, diarrhea, and loss of appetite.

Pentamidine, given as an aerosol in a nebulizing device, commonly causes adverse effects including coughing, difficulty breathing, difficulty swallowing, and chest pain or congestion.

The Public Health Service recommends physicians to start this treatment with:

• any HIV-infected adult patient who has already had an episode of PCP, and
• those whose CD4+ cell count is less than 200/mm3 (or less than 20% of total lymphocytes).

CD4+ cells would soon be referred to as “T-helper” or “T4 cells,” because one of their main goals is to send signals to other kinds of immune cells, which then destroy infectious particples.

Patients with CD4+ cell counts of less than 100/mm3 (or less than 10%), as well as patients with oral thrush or persistent fever, are at particularly high risk for PCP, the report states.

According to HIV.gov, a healthy T cell count should be between 500 and 1,600 T cells per cubic millimeter of blood (cells/mm3).

In a front-page article by Gina Kolata in The New York Times, Dr. Fauci calls for a new system that would allow patients far greater access to experimental drugs.

This marks a major turnaround in government policy, which restricts access to experimental drugs with the reasoning that patients would have no reason to join a clinical trial if they could get a drugs by other means.

The CDC issues a report reviewing the PHS recommendations for the management of occupational exposures that may place workers at risk of acquiring HIV infection, with a focus on those administering AZT treatment.

The FDA licenses Murex SUDS HIV-1, a 10-minute diagnostic test kit which can be used by health professionals to detect the presence of HIV Type 1.

As the only rapid enzyme immunoassay (EIA) approved for diagnostic use in the U.S., the test is manually performed by mixing a small amount of the patient’s blood with an antibody agent to which only HIV-1 antibodies will attach.

This test is considered by researchers to be part of the third wave of HIV tests, following the ELISA and Western Blot tests of the mid-1980s.  A 1993 clinical trial analyzing almost 2,000 test samples would show the SUDS HIV-1 test to give false-positive results at a relatively high rate.

The Women’s Interagency HIV Study establishes a multi-center, prospective, observational cohort study of women living in the U.S. who are either HIV-infected or at risk for HIV acquisition.

The program would play an important role in the National Institute of Allergy and Infectious Diseases’ effort to understand the current epidemiology of HIV infection, disease progression, treatment use and outcomes, and related co-morbidities among U.S. residents with HIV.

Understanding differences in HIV disease and treatment outcomes between women compared to men, and in different racial and ethnic groups, is a critical public health goal.  The clinical research consortium is an integral part of the NIAID portfolio of research on HIV in women.

The guidelines follow a report to the CDC about a case of HIV transmission from a screened, antibody-negative donor to several transplant recipients.

Titled, Guidelines for Preventing Transmission of Human Immunodeficiency Virus Through Transplantation of Human Tissue and Organs. the report seeks to reduce “the already low risk of HIV transmission by transplantation of organs and tissues.”

FDA says the test, which uses fluid from the mouth instead of blood, will be available only from doctors and will be administered only by people trained to do so.

“As long as a positive test is followed up with a blood test and as long as there is appropriate counseling available, it is a reasonable thing to do,” Dr. Jeff Lawrence tells The New York Times.  Dr. Lawrence is a consultant to the American Foundation for AIDS Research.

Studies show that for every 100 people infected with HIV, the oral-fluid-based test will miss one or two, and for every 100 people who are not infected, test results will be incorrectly positive for approximately two people.

In its review of Syringe Exchange Programs — United States, 1994-1995, a report by the National Academy of Sciences. the CDC expresses support for needle-exchange programs, stating that they are effective in reducing HIV transmission associated with drug injection.

The report states that as of December 1994, 35.3% of the 435,319 cases of AIDS reported among adults are associated with IV drug use.  In addition, injection of illegal drugs is the risk behavior most frequently associated with heterosexual and perinatal transmission of HIV in the U.S.

The goal of needle-exchange programs is to reduce HIV transmission associated with IV drug use by providing sterile syringes in exchange for used, potentially HIV-contaminated syringes.

The first international AIDS conference in two years, the event is one of the more eagerly anticipated scientific meetings in years. Data on promising new drug treatments for AIDS, insights into the ways HIV infects cells, and the mechanisms of “host resistance” to that attack are scheduled to top the agenda.

Remarkable gains in using combinations of costly new and old drugs promise to slow the progression of AIDS and to allow many people infected with HIV to live longer and healthier lives, conference presenters announce to attendees.

With 15,000 delegates, journalists and commercial exhibitors in attendance, it is the largest conference so far.  The theme is “One World, One Hope.”

While it seems that AIDS may finally become a managable disease in developed countries, less developed nations are struggling to scrape together the resources to provide necessary treatment and services to people with HIV and AIDS.

Data would be released at the conference that estimate a total of 21.8 million people to be currently living with HIV/AIDS, the vast majority of whom live in developing countries.

Ending the 16-year incline of cases, 1996 data shows that AIDS-related deaths dropped 23% from 1995 to 1996.

Experts credit the downturn with the availability of aggressive new therapies that keep infected patients healthier, as well as the possibility that fewer people are becoming infected in the first place.

The positive trends do, however, mask a troubling development: cases among women and heterosexuals who do not use drugs, particularly minorities, are on the rise.

African-American women are particularly at risk. In 1994, officials at the Centers for Disease Control reported that black women were almost 15 times as likely as white women to test positive for HIV.

”My new cases among women are often young women, coming in with a first pregnancy who are being tested as part of that pregnancy and finding out that they are HIV-positive,” said Dr. Mary Young, who treats AIDS patients at Georgetown University here.

“The gay community has done a wonderful job of getting the message out. But I don’t know that we target young African-American women very well.”

The new estimates do not represent an actual increase in the numbers of HIV infections, but reflect a more accurate way of measuring new infections. A separate analysis suggests that the annual number of new infections was never as low as 40,000 and that it has been roughly stable since the late 1990s.

FDA announces that it has approved the 100th antiretroviral drug under the President’s Emergency Plan for AIDS Relief (PEPFAR).  Of the more than 100 products that have received either full or tentative FDA approval under the program, 29 are branded drugs and 71 are generics.

This achievement reflects a five-year-old regulatory process designed to fast-track the delivery of cheap HIV drugs to the developing world through the PEPFAR program.

The FDA process was launched in May 2004, in response to a call from activists, clinicians and members of Congress to use the WHO’s pre-certification drug list to make purchases of generic medications for PEPFAR-funded programs.  Instead, a process was devised to allow the FDA to certify generic antiretrovirals (ARVs) for PEPFAR purchase, even if the branded drug was still protected by U.S. patent laws.

HHS Secretary Kathleen Sebelius said in a statement, “This milestone exemplifies the dedication, caring, and hard work of all who strive to better the lives of those infected with or affected by HIV/AIDS.”

Published by the CDC and subsequently in JAMA, the American Medical Association’s journal, a report by Jacek Skarbinski, M.D., and Eli Rosenberg, M.D. announces that persons living with HIV who are retained in care and have achieved viral suppression are 94.0% less likely to transmit HIV than HIV-infected undiagnosed persons.

“Unfortunately, too few persons living with HIV have achieved viral suppression,” the report concludes. “These estimates of the relative number of transmissions from persons along the HIV care continuum highlight the community-wide prevention benefits of expanding HIV diagnosis and treatment in the United States.”

The report recommends the implementation of improvements at each step of the continuum to reduce HIV transmission.

“Through stronger coordination of efforts among individuals, HIV care providers, health departments, and government agencies, the United States can realize meaningful gains in the number of persons living with HIV who are aware of their status, linked to and retained in care, receiving ART, and adherent to treatment,” state the researchers.

It will provide data on the use of newer HIV medications during pregnancy, helping to ensure that women living with HIV and their infants receive the best available treatments.

But the long-term study (1999-2015), which followed nearly 150,000 veterans, also found that patients with long-term viral suppression still had excess cancer risk compared to HIV-negative patients.

The simulations are consistent with 840,000 actual HIV DNA sequences contained in a global public HIV database, according to the study published in Nature Microbiology.

The simulations could allow state health departments to track the spread of HIV and provide a powerful new tool to help prevent new HIV infections.

“We looked for special genetic patterns that we had seen in the simulations, and we can confirm that these patterns also hold for real data covering the entire epidemic,” said Thomas Leitner, a computational biologist at Los Alamos and lead author of the study.

HIV is particularly interesting to study in this manner, Leitner noted, as the virus mutates rapidly and constantly within each infected individual.  The changing “genetic signatures” of its code provide a path that researchers can follow in determining the origin and time frame of an infection, and the computer simulations are now proven to be successful in tracking and predicting the virus’s movements through populations.

The study followed 3,700 MSM in New South Wales, Australia, who were taking PrEP with high levels of adherence.

As the first empirical study to test PrEP’s population-level effectiveness, the program found that HIV infections declined in the study cohort and also statewide in Australia’s most populous state, New South Wales.

The report concludes that rapid, targeted, high-coverage PrEP implementation is effective to reduce new HIV infections at the population level.

Less than a year later, Andrew Grulich, MD, head of the HIV Epidemiology and Prevention Program at the Kirby Institute at UNSW Sydney, would present follow-up data supporting the initial study at the 10th International AIDS Society Conference on HIV Science in Mexico City.

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The research project seeks to examine the safety and use of two HIV prevention tools — PrEP and a vaginal ring — for young women and girls under the title “REACH” (Reversing the Epidemic in Africa with Choices in HIV prevention).

One in four new infections in sub-Saharan Africa were women and girls aged 15-24 – despite making up 10% of the population.

“Women in less-developed countries disproportionately bear the burden in terms of ill health when facing food insecurity or a shock or disaster like drought that impacts the ability to get food or harvest food,” said Kelly Austin, associate professor of sociology at Lehigh University.

Essentially, lack of resources can lead to sexual assault, marriages of economic necessity and the resultant transmission of HIV.

Conducted for 1.5 years, the study would go on to show that the vast majority (97%) of the 247 participants used the vaginal ring and daily oral PrEP some or all of the time.  Fewer than 3% of participants would use neither of the products, according to laboratory tests for adherence.

“In many ways, these results exceeded even our own expectations, yet at the same time, it’s not surprising to find that these young women have the capacity and desire to protect themselves against HIV,” explains Gonasagrie (Lulu) Nair, MBChB, MPH, REACH protocol chair, Centre for Medical Ethics and Law, Faculty of Medicine, at Stellenbosch University in South Africa.  “They simply need to feel empowered and have the agency to make choices based on what they feel is right for them.”

Nina Martinez, 35, is the living donor. She donated her kidney to an anonymous recipient after the friend she had hoped to give it to died last fall. Martinez acquired HIV when she was 6 weeks old through a blood transfusion and was diagnosed at age 8.

“I wanted to show that people living with HIV were just as healthy.” Martinez says in a news conference held to announce the medical break-through. “Someone needed that kidney, even if it was a kidney with HIV. I very simply wanted to show that I was just like anybody else.”

Martinez first learned of the opportunity for her to donate a kidney in 2013, when the HIV Organ Policy Equity Act (HOPE Act) passed in Congress.  Yet, until she saw a storyline on the medical drama Grey’s Anatomy a few months later, she didn’t realize where her own life would intersect with kidney donation.

The HOPE Act was introduced on February 14, 2013, in the Senate by Sens. Barbara Boxer (D-CA), Tammy Baldwin (D-WI), Tom Coburn (R-OK), and Rand Paul (R-KY) and in the House by Rep. Lois Capps (D-CA).  The Senate passed the legislation by unanimous consent, and about six months later, the House passed it by unanimous consent.

The doctors at Johns Hopkins say the recipient is doing well.

“This is the first time someone living with HIV has been allowed to donate a kidney, ever, in the nation, and that’s huge,” says Dorry Segev, M.D., Ph.D., professor of surgery at Johns Hopkins.  “A disease that was a death sentence in the 1980s has become one so well-controlled that those living with HIV can now save lives with kidney donation — that’s incredible.”