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The Evolution of Public Health Research: HIV/AIDS

Posted by Jaydeb Mukherjee on Aug 4, 2016 7:00:00 AM

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No one reading this blog was alive when John Snow created his famed cholera map of Soho, or when Robert Koch discovered M. tuberculosis. Many of us weren’t alive, much less paying attention to scientific studies, when the Framingham Heart Study was published to link cigarettes to lung cancer. But there’s one epidemic that everyone should be familiar with. One that was extensively covered in the media, that aspiring children dreamed of curing, that has inspired so many award-winning movies, that was declared a threat to national security.

AIDS.

Some of you might remember the start of the AIDS epidemic, when, in 1981, the rare diseases Pneumonocystis carinii pneumonia (PCP) and Kaposi’s Sarcoma (KS) started surging within the US subpopulation of homosexual men – unfortunately concurrent to their fight for civil rights in the country. Very quickly, the media coverage helped KS earn the nickname of “gay cancer”, and Newsweek helped put a face to the disease with Bobbi Campbell, a San Francisco nurse who referred to himself as the “KS Poster Boy”. This coverage engendered public support and sympathy, and helped start up support organizations for homosexuals with the disease in both New York and California. In turn, public support fueled governmental action, and in 1982 legislation was introduced into Congress that would eventually lead to several million dollars of funding to both the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).

HIV_AIDS.jpgIt was soon accepted that there was some odd condition lying behind both PCP and KS – Acquired Immune Deficiency Syndrome (AIDS). You might even remember when the “AIDS invasion” was referred to as “the 4H disease”, after the four groups considered to be at risk for the illness: homosexuals, heroin addicts, haemophiliacs, and Haitians.

But it wasn’t long before the disease proved itself not limited to such niche subpopulations. In December of 1982, the CDC first reported one infant infected by a blood transfusion, followed by several more. Shortly thereafter, several instances of immunodeficiency were reported in female sexual partners of men with either confirmed AIDS or early signs and risky behavior. This began bringing to light that not just the 4-Hs, but anyone, by either blood exposure or unprotected sexual intercourse, could potentially be infected by the deadly affliction. Later the following year, one of the CDC’s Morbidity and Mortality Weekly Reports clearly delineated these channels of transmission as those responsible for AIDS, while ruling out lesser interactions like casual contact, environmental factors, or sharing food, drink, or air.

This whole time, it was unclear what was causing the mysterious epidemic. However, in the spring of 1983, a group of researchers at the Pasteur Institute in France published their findings: a type of human T-cell leukemia virus (HLTV) infecting the blood of a patient with precursor signs of AIDS, that they named Lymphadenopathy Associated Virus (LAV). While they were the first to isolate and identify the virus as a possible culprit – which earned two of them the Nobel Prize of Medicine 25 years later – they could not establish a definite link between the virus and the disease. Only a year later, however, the National Institutes of Health announced in a press conference that they had isolated the retrovirus, HLTV-III, as the definitive cause of AIDS. Two years later, the International Committee on Taxonomy of Viruses established that these two retroviruses were one and the same, and declared that its official name should henceforth be Human Immunodeficiency Virus – HIV.

Walk_to_End_HIV.jpgShortly after the initial discovery of the virus, the first dedicated AIDS ward in the United States was opened by San Francisco General Hospital, filling up in a matter of days. One of the most important features of their approach to the disease here was not strictly medical, but humanitarian in nature - the disease carried a stigma with it, especially due to its association with various marginalized groups who were frequently blamed for their illness. Even if an individual didn't belong to one of these groups, the fear of being associated with one of them or receiving similar victim-blaming would easily deter them from seeking even testing, much less further medical attention. In order to alleviate such worries as much as possible, the San Francisco Model of Care prioritized compassion from the very beginning, and the effort has proven efficacious - while the national occurrence of HIV+ individuals unaware of their affliction is around 20%, the estimated rate in California is down to 11%.

Over the past three decades, the Ward has continued to improve its care in various ways, including their push in 2010 to start administering antiretroviral (ARV) drugs not just when patients have low CD4 cell counts, but as soon as they are identified with the viral infection. As explained by Dr. Susan Buchbinder, Director of HIV Research at the San Francisco Department of Public Health, "We now know that HIV is a chronic inflammatory disease... Just being infected – even if the patient has a high CD4 count – damages organs. Getting people treated is key to keeping them healthier."

It helped further that the HIV Prevention Trials Network (HPTN) proved in study 052 that treating still-healthy HIV+ individuals with ARV drugs decreased the chance of transmission to uninfected sexual partners by a shocking 93% (by the final result). Fisher BioServices played an instrumental role in this study, helping to coordinate the study's logistics with the Clinical Research Products Management Center, sending the ARV drugs and other clinical supplies to 13 clinical sites in 9 different countries, facilitating the treatment of an initial 1,763 sero-discordant couples. The interim review of the study in 2011 had reported a 96% decrease in transmission, and accordingly was named that year's Breakthrough of the Year by the magazine Science, for the implications in future care and epidemiological policy surrounding the disease.

While the AIDS epidemic is still ongoing, global public health efforts surrounding the disease have shown how important it is to take societal and cultural factors into account in treating diseases, particularly one in which a primary mean of transmission is sexual.

Fisher BioServices supports clinical trials in numerous ways, including acquiring and distributing clinical agents and the design and assembly of biospecimen collection kits. Download your free copy of our Cooling Valley Fever: Unique Kits for a Unique Clinical Trial case study to learn more about the challenges of designing complex kits and distributing them to clinical sites, and how customized solutions can support clinical trials.

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