From ignorance to a potential cure: the history of HIV breakthroughs
5 MARCH 2019 Anne Gulland, global health security correspondent and Sarah Newey
The news that a man in London has potentially been “cured” of HIV through a stem cell transplant shows how far the world has come since Aids first burst into global consciousness in the 1980s.
HIV is thought to have originated in the 1920s in Leopoldville, the capital of the Belgian colony of Congo when the virus crossed from monkeys into humans and was spread through prostitution.
How many people were infected in the early 20th century is unknown and first reports of what we now know as Aids came in the late 1970s and early 1980s, when groups of gay men began to report a rare lung infection and an unusually aggressive cancer called Kaposi’s sarcoma.
By the end of 1981, there were 270 reported cases of severe immune deficiency among gay men – 121 of whom died. The transmission was thought to be sexual and a new disease was born: gay related immune deficiency.
After the same disease was reported in haemophiliacs the Centers for Disease Control in the United States coined the term Aids: acquired immune deficiency syndrome.
Early breakthroughs
The first major breakthrough in the understanding of HIV/Aids occurred in 1984, when researchers in the US and France announced that they had discovered the cause of the syndrome: the retrovirus HTLV-II.
There was still no treatment for what was a terrifying disease that laid waste to huge swathes of gay men and intravenious drug users in the 1980s and 1990s. Hysteria was rife and Aids was dubbed the “gay plague”: in 1987 the US placed a travel ban on visitors with HIV, which was only lifted in 2010.
For the UK, 1987 proved a turning point. It was the year in which Conservative health secretary Norman Fowler convinced a sceptical Margaret Thatcher to approve the now famous “tombstone” public information advertisements, which warned the public: “Don’t die of ignorance”. The powerful and frightening ads are widely credited with slowing the epidemic in the UK markedly.
The same year Princess Diana opened the UK’s first HIV/Aids ward at Middlesex Hospital, defying expectations when she shook the hand of an Aids patient. This challenged the widespread stigma associated with the disease and the notion it could be passed on by touch. The images went around the globe.
That year the first antiretroviral drug – AZT – was also approved for use in the US, paving the way for the disease to go from being a certain death sentence to the long-term but manageable condition it is today.
Celebrity involvement
In 1991, Freddie Mercury died of Aids, just a day after admitting he had Aids. US basketball player Magic Johnson had told the world that he was HIV positive just a few weeks earlier, helping to dispel the stereotype that HIV could only affect gay men.
This was a time of gay activism with high profile individuals such as Elton John, who set up his Aids foundation in 1992, demanding more money for treatment and research.
The 1990s saw a host of scientific breakthroughs, including the first trials of an HIV vaccine. But the real game changer was the development of the first combination treatment – highly active antiretroviral therapy (ART) – which eventually led to a 60 to 80 per cent decline in the death rate.
By the end of 1999, the WHO announced that Aids was the fourth biggest cause of death worldwide and the number one killer in Africa. An estimated 33 million people were living with HIV globally – 23 million of whom were in Africa.
Accessible treatment
The 2000s were a time of hope for people in poorer countries: in 2001 drug companies abandoned their opposition to the generic production of antiretrovirals, making life-saving treatments much cheaper.
And in 2002 the Global Fund to Fight HIV/Aids, Malaria and Tuberculosis was set up, which has since distributed nearly $40 billion in the fight against the three diseases.
The following year President George Bush announced the creation of the President’s Emergency Plan For AIDS Relief , initially a $15 billion, five-year plan to combat AIDS, primarily in countries with a high number of HIV infections.
Aids “cure”
The first talk of a an HIV “cure” was in 2007 when Timothy Brown – dubbed the Berlin patient – underwent a bone marrow transplant to treat leukaemia. More than 10 years later he remains free of the disease.
While the Berlin and London patients are the only people known to have been “cured” of the disease, today patients can be functionally cured – that is, the level of virus in their blood is so low that it is undetectable and they cannot pass it on.
In a 2012 study, 14 French people living with HIV started taking ART within 10 weeks of infection. After three years they stopped taking their treatment and for the next seven years had negligible levels of the virus.
In 2013 a baby born to an HIV positive mother was given treatment four hours after birth and nine months later was declared functionally cured.
Last year a Chinese researcher shocked the world when he announced he had altered embryos for seven couples during fertility treatment to protect them against contracting HIV, leading to the birth of two twin girls with engineered DNA.
Prep
One of the most exciting breakthroughs in recent years has been the development of pre-exposure prophylaxis (Prep), which was approved by US authorities in 2012.
A major step in efforts to stem the spread of the virus, Prep has been shown to lower the chance of a person becoming infected with HIV during sex by more than 90 per cent when medication is taken daily.
It can reduce the risk of contracting HIV from needle use by roughly 70 per cent.
Towards eradication
Today, an estimated 36.7 million are living with HIV. But while Africa has the highest burden, it is Eastern Europe which is fighting a rising tide of infections.
Deaths in the region have climbed by 38 per cent in the past decade, almost as much as they have fallen elsewhere, with Russia at the epicentre of the crisis.
In the UK, just over 101,000 people are living with the virus. Health Secretary Matt Hancock pledged at the end of last year that there would be no new infections in England by 2030 – and in his State of the Union address US president Donald Trump made the same promise.
Most experts believe that both targets are within reach.