5 Decades of Notable Achievements in Treatment for HIV/AIDS

Treatment for HIV/AIDS has consistently seen progress each decade, since the virus first appeared, as new information about the virus has been discovered and implemented in medical practice. In honor of AIDS Awareness Month, this article will take a trip through the history of advances in HIV/AIDS treatment, starting with the 1980s and winding our way to the present day treatment options for the virus that remains incurable but can become undetectable..

1980s

What would become known as HIV/AIDS was first reported in the CDC's Morbidity and Mortality Weekly Report in 1981 asrare cases of Pneumocystis carinii pneumonia.¹ The men described in this case died, as well as many others diagnosed with the virus, before it was officially diagnosed as lymphadenopathy-associated virus and human T-cell lymphocyte virus type III. The virus was notable, as it was the first time a virus of this nature was seen in patients who were not immunocompromised.

When asked by The American Journal of Managed Care^®, lead author of the original report, Michael Gottlieb, MD, indicated that he had no idea what the implication of the report would be or its significance. “What we were seeing was very different from anything I was aware of. It was very different. It was striking. And it was a distinction from previously known stuff, without being very eloquent,” he said.¹

According to the American Psychological Association, funding for HIV/AIDS research and treatment was approved in 1983.² Research into the new virus began quickly, with the first commercial blood test approved by the FDA in 1984, which utilized different enzymes to determine if a patient’s blood contained HIV.³ It wasn’t until 1987 that the first antiretroviral drug to target HIV/AIDS, zidovudine (AZT), was approved by the FDA for use in patients living with the virus. This treatment was able to slow down the progress of the virus and could prevent transmissions in certain instances.⁴

This development came just months before the AIDS Memorial Quilt was first displayed on the National Mall in Washington, DC, with the names of nearly 2000 people who had died due to HIV/AIDS.⁴

Treatment for HIV has changed rapidly since its discovery in 1981 | Image credit: jarun011 - stock.adobe.com

1990s

After the first federal AIDS bill was signed in 1988, AIDS became the leading cause of death for all Americans aged 25 to 44 years in 1994. A major development in HIV/AIDS care followed in 1995 when the FDA approved the first protease inhibitor, which is among the first highly active antiviral therapies (HAARTs) to be approved for patients living with HIV.⁵

HAARTs became a new standard of care, with 3 protease inhibitors approved in succession in 1995 and 1996, along with the combination of lamivudine and AZT being approved for use in HIV, each medication targeting a different aspect of the virus.

Testing for HIV were also updated, with a 10-minute blood diagnostic test approved for use by the FDA in 1992.⁶ The test was able to help health professionals identify patients with HIV-1. The FDA also approved an oral HIV test in 1994, which was the first non blood test for HIV. A viral load test, a home testing and collection kit, and an HIV urine test were all FDA approved in 1996.

However, treatment resistance became a concern, with limited options for treatment and more people staying on treatment for longer periods of time.

2000s

The beginning of the decade featured the Joint United Nations Programme on HIV/AIDS, the World Health Organization, and other health groups throughout the world announcing that they would negotiate reduced prices for treatments for HIV/AIDS in developing countries. The CDC also announced its goal to cut HIV infections in half within 5 years in the US.

Testing for HIV was bolstered by an FDA approval for the first rapid HIV diagnostic test kit, which was able to test with 99.6% accuracy. The test, approved in 2002, was able to be stored at room temperature and could be used outside of labs or clinics.

A vaccine for HIV fell through in 2003, as it was not shown to improve prevention of HIV infection. The FDA was able to approve generic copackaged antiretroviral drug regimens to increase usage of the treatment. The FDA also approved the 100th antiretroviral drug in 2009. However, ultimately, there were no major differences in how HIV was treated or prevented in this decade.

2010s

The results of the iPrEx study were released in 2010, finding that a daily dose of HIV drugs reduced the risk of HIV infection by 44% in men who have sex with men who were not living with HIV. The results supported the continued research into pre-exposure prophylaxis (PrEP) as a means of reducing HIV infection.

This finding was followed by a similar finding in 2011, with a study finding that a daily oral dose of ART could reduce HIV infection in patients who engage in heterosexual sex.⁶ By 2012, the FDA had approved the use of the first PrEP medication, emtricitabine/tenofovir disoproxil fumarate. These approvals were among the reasons that HIV diagnoses in the US fell by 19% from 2005 to 2014, according to the CDC.⁶

The bombshell research of this decade was the news that a bone marrow transplant first conducted in 2007 had repeatable success for a patient in London, whose HIV infection had been undetectable for 3 years and who had been off ART for 18 months. The bone marrow came from a patient genetically immune to HIV. Although this is not a method of cure that can be done for all patients, it displays an avenue of further research.

2020s: The Present Day

Current research into HIV treatment centers on long-lasting therapies that can be taken less frequently, whether that be biweekly, monthly, or even bimonthly. An injectable forumlation of cabotegravir and rilpivirine was approved in 2021 to be administered once a month as an HIV treatment. The first long-acting injectable form of PrEP was also approved in 2021, which can be administered once every 2 months to help prevent HIV.

These new developments in HIV treatment demonstrate the ongoing evolution of HIV treatment in the US and across the world. With new treatments and methods of preventing HIV/AIDS discovered each decade, it is likely that a treatment with potential to cure the virus or enact long-term prevention could reduce the number of new HIV cases each year. Research into methods of treating and preventing HIV should continue to be the forefront of addressing the worldwide epidemic.

References

1. Shaw ML. A q&a with HIV/AIDS pioneer Dr Michael Gottlieb. AJMC. June 4, 2021. Accessed October 2, 2024. https://www.ajmc.com/view/a-q-a-with-hiv-aids-pioneer-dr-michael-gottlieb

2. 1980s HIV/AIDS timeline. American Psychological Association. 2017. Accessed October 2, 2024. https://www.apa.org/pi/aids/youth/eighties-timeline

3. The AIDS epidemic in the United States, 1981-early 1990s. CDC. Updated July 8, 2024. Accessed October 2, 2024. https://www.cdc.gov/museum/online/story-of-cdc/aids/index.html

4. History.com Editors. AIDS crisis timeline. History. Updated June 20, 2024. Accessed October 2, 2024. https://www.history.com/topics/1980s/hiv-aids-crisis-timeline

5. Levy M. Discovery of highly active antiretroviral therapy for HIV: a national historic chemical landmark. October 7, 2022. Accessed October 2, 2024. https://www.acs.org/education/whatischemistry/landmarks/highly-active-antiretroviral-therapy-hiv.html

6. A timeline of HIV and AIDS. HIV.gov. Updated 2023. Accessed October 2, 2024. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline