THE INCEPTION OF HIV

The origin of HIV is a topic that has fascinated scientists for decades. It took a long time to fully understand what HIV and AIDS were, as well as how to prevent and treat them. Since the beginning of the AIDS crisis, millions of people have been infected with HIV, and sadly, millions have lost their lives as a result. These numbers highlight the devastating impact of this disease. However, with access to the right medications, HIV is no longer a death sentence. On World AIDS Day, we want to share the story of HIV and AIDS.

In this article, we will explore how HIV was discovered, when it progresses to AIDS, and its possible origins. We will also delve into the earliest treatments, the introduction of antiretroviral drugs, and the innovative approaches scientists are taking towards prevention and a potential cure. But first, let's start with the basics. HIV is a retrovirus that targets immune cells, particularly CD4 T cells. This virus uses RNA as its genetic material and has the ability to integrate its DNA into the host genome. This sneaky behavior is one of the reasons why HIV has been challenging to treat. In the next part, we will delve deeper into the complexities of HIV and AIDS treatment.

HIV is transmitted through bodily fluids such as blood, semen, vaginal fluid, and breast milk. This means that HIV can be spread through sexual contact, sharing contaminated needles, breastfeeding, and any other activities involving the exchange of fluids. However, it is important to note that saliva is not one of the fluids that can transmit HIV.

Saliva contains various substances, including antibodies and antimicrobial proteins, that prevent HIV from being infectious. Unless there is a significant amount of blood present in saliva, it cannot transmit the virus.

When a person is first infected with HIV, they may experience flu-like symptoms such as fever, headache, rash, sore throat, muscle, and joint pain. This is because the virus is infecting numerous cells and the immune system is actively trying to fight it off. However, within a few weeks, these symptoms typically subside as the person develops specific antibodies that can control the virus.

After this initial phase, individuals with HIV usually feel fine for a prolonged period, often lasting several decades. However, eventually, the virus can cause severe damage to the immune system by killing off a significant number of T cells. This leaves the body vulnerable to various pathogens that can be dangerous or infectious. At this stage, the person is diagnosed with AIDS, or acquired immune deficiency syndrome.

AIDS is typically diagnosed when the T cell count falls below 200 cells per microliter of blood, which is significantly lower than the normal range of 500-1500 cells. Additionally, the development of opportunistic infections is also an indicator of AIDS. These infections are typically easily fought off by individuals with a healthy immune system. However, due to the destruction of T cells by HIV, AIDS patients become susceptible to these infections and can become seriously ill or even die as a result.

It is important to recognize that these facts may seem familiar to some, but it is crucial to remember that during the 1980s, when HIV was first discovered, this knowledge was not widely known. Medical professionals at the time only knew that young, healthy gay men were suddenly falling ill without understanding the underlying cause.

An immunologist at UCLA was among the first to observe a pattern that caught his attention. From the fall of 1980 to the following spring, he encountered a series of five patients, all of whom were gay men in their 20s or 30s, suffering from an unusual form of pneumonia. These individuals had a fungus growing inside their lungs, which was typically harmless and would not normally infect the lungs. However, in these cases, it caused significant breathing difficulties. Additionally, the patients exhibited oral thrush, which refers to yeast infections in their mouths, and had low levels of CD4 T cells. By June, when the immunologist documented his findings in the CDC's weekly Mortality and Morbidity report, two patients had already succumbed to the illness. A month later, a dermatologist in New York shared a similarly alarming report, this time involving Kaposi's sarcoma, a rare cancer characterized by the development of purple lesions on the skin. Over a span of two and a half years, 26 young gay men in New York and LA were diagnosed with Kaposi's, some of whom also had the peculiar fungal pneumonia, and eight had died. At this point, scientists were completely unaware of the cause of this illness. They were uncertain whether it was due to a toxin or a pathogen, and they had no knowledge of how it was spreading. Consequently, they were unable to provide guidance on how to protect oneself. The connection to gay men, however, was undeniably significant, leading many to initially refer to the mysterious disease as GRID, which stood for gay-related immune deficiency.

Numerous individuals would refer to it as the "gay cancer" or "gay plague." However, this illness did not solely affect gay men. It was also appearing in hemophiliacs, individuals whose blood does not clot properly and require clotting factors derived from other people's blood. Doctors were also observing cases in intravenous drug users, women, infants, and heterosexual men. Notably, 20 recent immigrants from Haiti had fallen ill, and none of them identified as gay. These clues were significant as they indicated to scientists that the disease, now known as AIDS, was likely infectious and transmitted through blood. Similar diseases, such as hepatitis B, spread in comparable ways. Consequently, in March of 1983, the CDC issued a warning for doctors to exercise caution regarding blood transfusions and acknowledged that the disease seemed to spread through both homosexual and heterosexual intercourse. Debates regarding specific modes of transmission, including the potential spread through saliva, would occur later. The question remained: what was the infectious agent responsible? Scientists raced to determine the cause of the disease. French molecular biologist Luc Montagnier suspected a virus since the blood products used by hemophiliacs were filtered for bacteria and fungi. However, viruses were too minuscule to be captured. Thus, Montagnier, along with his colleague Françoise Barré-Sinoussi, examined cells obtained from AIDS patients and discovered a retrovirus. Around the same time, Robert Gallo at the NIH in the US also identified a retrovirus in samples from AIDS patients. Both research groups published their findings in May 1983, and shortly thereafter, another team discovered yet another retrovirus. Initially, these viruses were assigned different names, and it was not immediately evident that they were the same entity. However, they were indeed the same, and in 1986, the cause of AIDS was officially named HIV. Therefore, HIV was the culprit, but the origins of the virus and the reasons behind the epidemic's emergence in the era of extravagant hairstyles and Michael Jackson remained unknown.

While certain researchers were scrambling to identify the specific factor that caused AIDS to be infectious, others observed that macaque monkeys also appeared to suffer from a disease similar to AIDS. One group made the decision to extract blood samples from these ailing monkeys, and in 1985, they discovered a virus that bore resemblance to HIV. Eventually, this virus was named SIV, which stands for simian immunodeficiency virus. Researchers began to speculate that HIV may have originated from our primate relatives, crossing the species barrier. After extensive research, they determined that the virus responsible for the epidemic closely resembled the chimpanzee version of SIV, and it was the chimpanzees who transmitted it to humans. However, the question remained: how exactly did this transmission occur? To put it bluntly, most scientists agree that the reason SIV made the leap into humans, known as a spillover, was due to our consumption of bushmeat, which includes wild game such as monkeys and chimps. This theory is referred to as the cut-hunter hypothesis. During the process of butchering a chimpanzee, the hunter's hand may come into contact with SIV-infected chimp blood through a small cut, or a small amount of blood may splatter into their mouth. The virus is similar enough to human biology to infect the hunter, and if the virus is subsequently transmitted to enough people over time, it evolves into the HIV we are familiar with today. These spillover events have occurred multiple times, as evidenced by the rapid mutation of the virus and the identification of various lineages, each corresponding to a different spillover. The current epidemic can be traced back to a single lineage known as 'M' for main. By studying chimpanzee urine and feces, researchers believe that the chimps who transmitted this particular version of the virus to humans resided in the forests near the Congo, specifically in southwestern Cameroon. Additionally, based on the oldest blood samples containing HIV, which date back to 1959 and 1960, scientists estimate that HIV-1 first infected humans around 1908. If this seems like a long time ago, it is because it takes a considerable amount of time for a virus to establish itself.

In the 1920s, it is believed that the virus made its way down the river, carried by an individual, to the growing city of Kinshasa, which was then known as Leopoldville under Belgian colonial rule. Due to the scarcity of women, apart from prostitutes, experts speculate that HIV spread through this route, as well as through the use of injectable drugs by the colonizers to treat tropical and venereal diseases.

During this time, disposable syringes were not yet available, and nurses had to treat numerous patients with only a few syringes. As a result, the syringes may have been rinsed with alcohol before being used on the next patient. Ironically, the very methods intended to prevent the spread of disease may have inadvertently encouraged it.

Over time, infected individuals from Kinshasa traveled to other locations, inevitably carrying the virus with them. Due to the rapid mutation of the virus, it is possible to categorize it into nine different subtypes, providing insight into how HIV spread globally from Central Africa. Several subtypes spread to other parts of Africa, while Subtype C made its way south and eventually reached India. Subtype B, on the other hand, traveled to Haiti and then, through a series of historical circumstances, arrived in the United States.

In 1960, when the Belgians departed from the Congo, French-speaking Haitians began migrating to the Congo to work as professionals such as doctors and lawyers. However, with the establishment of Zaire in 1965, these immigrants felt unwelcome and returned to Haiti, bringing HIV with them. In Haiti, the virus spread rapidly, possibly due to a plasmapheresis center where individuals could receive payment for donating their blood plasma. The center utilized a machine that mixed the blood of multiple donors, facilitating the transfer of viruses.

By 1982, an astonishingly high number of nearly 8 percent of young mothers in a slum in Port-au-Prince were HIV-positive. It is believed that HIV entered the United States around 1969, likely through a single infected individual or unit of plasma from Haiti.

It took nearly ten years for anyone to realize, however, by that time, it had become irreversible. The outbreak had commenced, spreading not only across the Americas but also infiltrating Europe and Asia.

With its presence established, our utmost priority was to devise strategies to combat this deadly virus.