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This month in pharma...

Exploring the industry's most important dates, we recall June 1981: the first official recording of AIDS
Calendar - June 2011

It was on June 5, 1981, that doctors at US Centers for Disease Control (CDC), the federal agency to protect public health and safety, submitted a report concerning five cases of the lung infection Pneumocystis carinii pneumonia in previously healthy homosexual men in Los Angeles, California, without a clinically apparent underlying immunodeficiency in any of them.

It is a paper now seen as the first official recorded case of acquired immune deficiency syndrome, or AIDS, a condition that has gone on to have significant consequences around the globe, with about 33.3 million living worldwide with HIV/AIDS in 2009 and 1.8 million deaths a year from AIDS according to the charity Avert.

It took a long time for a true understanding of the disease to emerge, with initial suggestions, heightened by media portrayal of this still poorly researched illness, linking AIDS only to homosexual men. Some even attempted to classify AIDS as GRID, standing for gay-related immune deficiency.

Other groups were soon identified as being infected with the same condition however, with the CDC coining the 'four Hs' to describe the communities seemingly hit – homosexuals, Haitians, haemophiliacs and heroin users.

Despite this, the true cause and risk groups were still undetermined and, after further cases were diagnosed in wider populations, the term AIDS was properly defined at a meeting in Washington on July 27, 1982 – one of Time magazine's '80 Days That Changed the World'.

Myths were still abundant in people's perceptions of the disease however, with uncertainties over how it was transmitted leading to landlords evicting tenants and children being kept back from school.

It was not until 1984 that scientists concluded that the cause of AIDS was the human immunodeficiency virus, or HIV, after studies confirmed that two previously identified viruses LAV and HTLV-III were the same.

A year later, a test to identify HIV was licensed as the disease spread to sub-Saharan Africa and across Asia, with more than 38,000 cases of AIDS reported in 1986 across the world.

Research into treatment was also ongoing, and the first therapy for AIDS was approved in 1987 – the antiretroviral drug AZT or azidothymidine. Developed jointly by Burroughs-Wellcome Company (now GlaxoSmithKline) and scientists at the US National Cancer Institute (NCI), AZT was found to prolong life in patients living with AIDS and was approved 25 months after the first demonstration of its effectiveness against HIV – one of the shortest ever timeframes for drug development.

Later trials showed AZT to have little efficacy in patients going through the early stages of HIV development and a combination antiretroviral treatment was approved in 1996, with AZT to be used along with didanosine (developed by the NCI and licensed to Bayer)  and dideoxycytidine (developed by the NCI and licensed to Roche).

Treatments not cures
These were only treatments, not cures, however, and the rate of AIDS around the world continued to grow with around 22 million cases worldwide by 1997.

Death rates in developed countries began to drop in the late 1990s as the more effective combination therapies became more widespread and public health campaigns warned people of the real dangers of becoming infected.

And despite Brazil becoming the first developing country to guarantee free combination treatment in 1997, other nations in similar circumstances could not afford the necessary treatments and education.

Organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the President's Emergency Plan for AIDS Relief (PEPFAR) have been supporting access to treatments in developing countries though, with South Africa following Brazil's lead and providing free combination therapy in 2004.

In recent years, much research and development has focused on the potential of a vaccine for HIV/AIDS, with the International AIDS Vaccine Initiative (IAVI) estimating that a vaccine that is 50 per cent effective given to 30 per cent of the population could reduce the number of new HIV infections in the developing world by 24 per cent over 15 years.

No real success
Of the 30 vaccines trialled by 2010 however, none has shown real success and the search continues.

The most recent positive discovery in the battle against AIDS has been a vaginal gel containing tenofovir which, in 2010, was shown to reduce the number of HIV transmissions by 39 per cent in the CAPRISA 004 trial in Africa.

This relative success in phase II has still to be seen in further trials and, though the clamour may now be about the potential success of preventative drug and vaccine candidates, it should not be forgotten that of the millions of people living with AIDS worldwide, almost two-thirds still cannot access adequate treatment.

Tom MeekThe Author
Tom Meek
, assistant editor at PMGroup

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13th June 2011


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