The CDC’s Morbidity and Mortality Weekly Report described the men as having additional infections, indicating that their immune systems were compromised. Two of the young men were already dead by the time the report was published.
The edition of the MMWR marked the first official reporting of what would become known as the AIDS epidemic. The initial five-patient study was reported to the CDC by Dr. Michael Gottlieb, a young immunologist at UCLA (University of California Los Angeles).
Dr. Gottlieb encountered his first patient with unusual infections in November 1980, when one of his medical school residents reported a young patient suffering from a severe yeast infection in his throat. When the patient began having breathing difficulties, Dr. Gottlieb arranged to receive a scraping of his lung tissue through a non-surgical procedure. He was astounded by the test results.
The patient tested positive for Pneumocystis carinii pneumonia (PCP) in addition to oral candidiasis, also known as thrush. Dr. Gottlieb then reached out to a colleague who specialized in the new science of T-cells, the white blood cells important to the immune system. The colleague tested the patient’s blood and found that the sample had no T-helper cells, a result so astounding that he ran the test again, with the same results.
In February 1981, Dr. Gottlieb would come across another young man suffering with Pneumocystis carinii pneumonia (PCP) and depleted T-cells, and shortly after that, a third patient was referred to him. Thorough examinations of the patients about their lifestyles yielded the information that were gay, but Dr. Gottlieb couldn’t determine how their sexual identity was relevent.
A fourth PCP patient appeared in April 1981, and then a report of a fifth man who already died (an autopsy found PCP). Seeing an alarming trend, Dr. Gottlieb contacted an editor at the New England Journal of Medicine, the most prestigious medical journal in the U.S., and was told that the submission-review-publication process would take at least four months. He believed this information needed to get out to the medical community fast, so he instead submitted his report to the CDC’s weekly newsletter, the Morbidity and Mortality Weekly Report (MMWR), a weekly report read by medical officials concerned with infectious disease and public health.
Assisting Dr. Gottlieb in publishing his report was Dr. Wayne Shandera, who worked in the Los Angeles County Department of Public Health as a CDC liaison.
“Gottlieb talked through the charts while Shandera put the information into the dry, turgid prose that the MMWR preferred,” wrote Randy Shilts in his epic recounting of the early years of the AIDS pandemic, And the Band Played On: Politics, People, and the AIDS Epidemic. “The report noted the links between PCP, CMV (cytomegalovirus), and the oral candidiasis that commonly preceded the pneumonia.”
Dr. Gottlieb’s report also stated, “The fact that these patients were all homosexuals suggests an association between some aspect of homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population.”
Of course, the five Los Angeles men in Dr. Gottlieb’s report were not the only early cases of the disease that years later would be called AIDS. In 1979, 1980 and 1981, previously healthy men in New York City and San Francisco were their seeing doctors and baffling them with a range of symptoms that included fatigue, enlarged lymph nodes, flat purple lesions, oral candidiasis, shortness of breath, eczema, fevers, and amebic dysentery. Their medical charts would be marked with notes like “fever of unknown origin,” “Kaposi’s sarcoma,” “cytomegalovirus,” and “toxoplasmosis.” But the traditional treatments for these conditions were not working.
Now it is known that HIV originated much earlier, around 1920, likely in the Democratic Republic of Congo when HIV crossed species from chimpanzees to humans. Up until the 1980s, there is no record of 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, it is possible that up to 300,000 people were already infected.
In April of 1980, the CDC received a report on Ken Horne, a gay man in San Francisco who was diagnosed with Kaposi’s sarcoma. Horne died on November 30, 1981. The CDC would retroactively identify Horne as the first American patient of the AIDS epidemic.
Following Dr. Gottlieb’s report in the CDC’s MMWR, he and his team published a more detailed report in the New England Journal of Medicine on December 10, 1981.
Today, Dr. Gottlieb is an Associate Clinical Professor of Medicine at UCLA’s David Geffen School of Medicine and still treats patients exclusively at AIDS Project Los Angeles (APLA Health). He is also a member of the Council of Advisors to STORIES: The AIDS Monument.
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Morbidity and Mortality Weekly Report | Centers for Disease Control and Prevention, “Pneumocystis Pneumonia – Los Angeles,” June 5, 1981
American Journal of Managed Care, “A Q&A With HIV/AIDS Pioneer Dr Michael Gottlieb” by Maggie L. Shaw, June 4, 2021
And the Band Played On: Politics, People, and the AIDS Epidemic by Randy Shilts
www.Be In The Know.org, “Origin of HIV and AIDS”
PBS News Hour, “America’s HIV Outbreak Started in This City, 10 Years Before Anyone Noticed” by Nsikan Akpan, October 26, 2016
www.History.com | A&E Television Networks, “AIDS Crisis Timeline”
The New England Journal of Medicine, “Pneumocystis carinii Pneumonia and Musocal Candidiasis in Previously Healthy Homosexual Men — Evidence of a New Acquired Cellular Immunodeficiency” by Michael S. Gottlieb, M.D., Robert Schroff, Ph.D., Howard M. Schanker, M.D., Joel D. Weisman, D.O., Peng Thim Fan, M.D., Robert A. Wolf, M.D., and Andrew Saxon, M.D.; December 10, 1981