Infectious Disease · 1981
First report of AIDS (Pneumocystis pneumonia cluster)
Pneumocystis carinii pneumonia was, in 1981, a disease of the immunocompromised: organ transplant recipients on azathioprine, patients on high-dose corticosteroids, children with congenital immune deficiencies. Seeing it in five previously healthy young men in Los Angeles, all gay, all without any identifiable reason for immune suppression, was alarming enough that Michael Gottlieb, an immunologist at UCLA, sent a case report to the CDC rather than publishing it in the usual way. He wanted the agency's epidemiologists to know quickly.
The CDC's MMWR published the report on June 5, 1981. All five men had profound cellular immune deficiency; three had also developed other opportunistic infections. Two had died before the report appeared. Gottlieb noted the striking depletion of CD4-positive T-lymphocytes, a finding that at the time lacked any clear explanation. The MMWR report carried an editorial note observing that the cluster suggested a common exposure.
A second report followed within weeks, describing Kaposi's sarcoma, usually a rare and indolent tumor, appearing aggressively in 26 young gay men in New York and California. Together, the two clusters pointed to a transmissible agent capable of destroying cellular immunity. James Curran at the CDC organized the task force that began systematic epidemiological surveillance. The formal term AIDS, for Acquired Immune Deficiency Syndrome, was adopted in 1982 after cases had appeared in intravenous drug users, hemophiliacs receiving clotting factor concentrates, and Haitian immigrants, establishing that transmission was not limited to sexual contact within any one group.
The causative virus was identified in 1983. Luc Montagnier and Francoise Barre-Sinoussi at the Pasteur Institute in Paris isolated a retrovirus from lymph node tissue of a patient with lymphadenopathy, publishing in Science in May 1983. Robert Gallo's group at the National Cancer Institute published a series of papers in the same journal the following year, providing strong evidence that the same virus caused AIDS and reporting a method for growing it in culture, which enabled antibody testing. Montagnier and Barre-Sinoussi received the Nobel Prize in 2008.
The virus, eventually named HIV, spread from the initial clusters into a global epidemic. By the early 1990s, more than a million Americans were infected and AIDS was the leading cause of death in men aged 25 to 44 in the United States. The 1981 MMWR report set the case surveillance framework in motion and gave clinicians the first conceptual handle on what they were seeing. More than 40 million people have died of AIDS-related illness globally since the epidemic began, and approximately 38 million people were living with HIV as of the early 2020s.
Key People
- Michael Gottlieb — UCLA immunologist who identified and reported the first cluster of cases
- James Curran — CDC epidemiologist who led the early investigation and response
- Luc Montagnier — Pasteur Institute virologist who co-discovered HIV as the causative agent
- Francoise Barre-Sinoussi — Pasteur Institute virologist who isolated HIV from lymph node tissue in 1983
MMWR Morb Mortal Wkly Rep, 1981
Related landmarks
- 1984 · Marshall & Warren: Helicobacter pylori causes peptic ulcer disease (Infectious Disease)
- 1987 · AZT (Zidovudine) Trial for AIDS (Infectious Disease)
- 1987 · Haemophilus influenzae type b (Hib) conjugate vaccine (Infectious Disease)
- 1996 · Highly Active Antiretroviral Therapy (HAART) and the Vancouver protease-inhibitor combination era (Infectious Disease)