At the beginning of the decade of the 80's a "new disease", which eventually was going to be named AIDS, was frequently reported affecting mostly homosexual men. Was it really a "new disease"?, actually no. Later in the 80's Garry et al (1) published a paper where it was confirmed that in 1968 a sexually active teenage boy had developed over a period of almost two years extensive lymphedema of the genitalia and lower extremities, chlamydial infection widely disseminated and chlamydial organisms isolated from numerous body fluids and organs. The boy died in 1969 of disseminated Kaposi sarcoma. In 1988 Western blot test was performed on serum and autopsy tissue specimens from this patient, frozen since 1969. This test demonstrated that this sexually active teenager was infected with the human immunodeficiency virus type 1.
Huminer et al (2) in a search of the medical literature published since 1950 found 19 examples of probable AIDS cases. These cases met the Centers for Disease Control's definition of the syndrome and had a clinical course suggestive of AIDS. Average age of these patients was 37 years with a male to female ratio of 1.7:1. Three of these patients had disseminated Kaposi sarcoma and the rest had opportunistic infections mostly Pneumocystis carinii pneumonia. All these patients died within 1 month to 6 years after the original manifestations. This historical data seems to support the idea that unrecognized cases of AIDS have existed sporadically as far back as 1950. Non-documented anecdotal reports also describe patients in Africa afflicted and eventually dying of complications of opportunistic infections today essentially associated to AIDS.
It is interesting to note that in many occasions history repeats itself and this can be corroborated when comparing the history of AIDS with that of syphilis (3-5).
It took almost five hundred years to find a definite cure for syphilis we hope that this is not going to be the case for AIDS.
When the first cases of AIDS were described in the 80's it did not take long to realize that it most likely was a disease sexually transmitted. By then the fact was well known that patients in immunosuppression, due to organ transplant, could develop Kaposi sarcoma or even Pneumocystis carinii pneumonia. Comparison soon led to the assumption that whatever was the causative agent of this "new disease", it was affecting the immune system. The inability to easily find a "visible" organism brought in the viral theory. Eventually the virus was isolated and it was discovered that it was a retrovirus. Until then only three or four conditions have been described that were produced in humans by retroviruses and all of them affected cells of the immune system. From then on research took on an accelerated pace. AIDS had placed the scientific minds into the most advanced stages of research. Today we know that there are at least two different types of AIDS viruses, we also know the viral genetic composition almost to its minutest detail. We have learned about cell receptors and which cells are at risk of being infected. We have developed therapeutic strategies (protease inhibitors) that even if they do not represent a cure at least are prolonging the life of affected individuals.
We also know that for the virus to infect the macrophages, the cell needs two receptors the CD4 and the CCR-5 (6,7). This later receptor is coded by a gene also known as the CCR-5 gene, when this gene is defective the CCR-5 receptor will also be defective. It seems that patients with the abnormal CCR-5 receptor are the so-called AIDS long time survivors. It is speculated that individuals which are homozygous for the abnormal CCR-5 receptor may not be infected by the AIDS virus. This is a theory which opens new doors for research and which links genetic make-up with the capability of acquiring AIDS.
These advances in medical research are giving the scientists more time to eventually come to the discovery of effective vaccination or treatment for AIDS. It is not possible to predict when scientist will solve the AIDS problem but in looking back and comparing to syphilis we know that Schaudin isolated the treponema pallidum over four hundred years after the initial European cases of syphilis were described. Gallo and coworkers identified the AIDS virus type 1 only four years after the initial cases of AIDS were reported in United States. We hope that a cure for this "new disease" of the 80's, AIDS, is just around the corner.
1. Garry RF et al. Documentation of an AIDS virus infection in the United States in 1968. Jama 1988; 260:2085-7.
2. Huminer D; Rosenfeld JB; Pitlik SD. AIDS in the pre-AIDS era. Rev Infec Dis 1987; 9:1102-8.
3. Felman YM. Syphilis. From 1495 Naples to 1989 AIDS. Arch Derm.1989; 125:1698-700.
4. Bibel DJ. Santayana's warning unheeded: the parallels of syphilis and acquired immune deficiency syndrome (AIDS). Sexually Transmitted Dis. 1989;16:201-9.
5. Anderson PC. Syphilis and AIDS. International J Dem. 1988; 27:297-8.
6. Michael NL et al. The role of viral phenotype and CCR-5 gene defects in HIV-1 transmission and disease progression. Nat Med 1997; 3:338-40
7. Trkola A et al. CD4-dependent, antibody-sensitive interactions between HIV-1 and its co-receptor CCR-5. Nature 1996; 384:184-7.