On June 5, 1981, the Centers for Disease Control and Prevention (CDC) published an alarming report about a mysterious illness in five young, gay men in Los Angeles. Each of these once-healthy men had come down with the same rare lung infection. This infection, and others they developed, strongly implied that their immune systems were severely weakened. Two of the patients died.
This was the first official report on acquired immune deficiency syndrome, or AIDS. Over the next decade, it spread widely around the country and the world.
The AIDS epidemic has taken many lives, both within the United States and abroad. But fortunately, doctors and researchers have written a new chapter. One where people with human immunodeficiency virus (HIV)—the cause of AIDS—can be treated and live long, full lives.
Paul Edward Sax, MD, is a Mass General Brigham infectious diseases doctor. He’s also the clinical director of Brigham and Women’s Hospital’s Division of Infectious Diseases, and for 20 years, was the principal investigator of the Brigham and Women’s AIDS Clinical Trials Research Unit. His HIV research continues to push the limits of what’s possible for patients with HIV or AIDS.
Dr. Sax reflects on the progress medicine has made in HIV treatment and shares his vision for the future.
“By 1992, when I became an infectious disease specialist, HIV had become the leading cause of death among young adults in the United States,” says Dr. Sax. In fact, in 1992 alone, around 33,590 Americans died from AIDS.
The year 1996 marked a major change in AIDS treatment. Thanks to dedicated funding from the government, as well as close collaborations with the people living with HIV and the pharmaceutical industry, major advances in HIV treatment heralded a steep drop in deaths due to AIDS.
“At the Vancouver International AIDS Conference that year, we learned about combination antiretroviral therapy (ART), which helped control the virus and allow the immune system to recover,” says Dr. Sax. “It was like turning on a light in a dark room.”
This was exciting news for clinicians and patients in countries like the U.S. and Canada. But the story wasn’t quite the same around the world. For example, in sub-Saharan Africa, about 25.3 million people had HIV. But few of them had access to treatment.
“Globally, there was an explosion of cases of AIDS and no available treatments,” says Dr. Sax. “The 2000 International AIDS Conference in Durban, South Africa, served as a wake-up call that these people needed treatments just as much as people in richer countries.”
There are now more people receiving ART in South Africa than in any other country in the world.
Watch Dr. Sax’s video to learn more about the history of HIV treatment.
HIV continues to be a leading cause of death worldwide. But the prognosis is vastly improved: Because of ART, along with widespread education, there has been a 68% decrease in AIDS-related deaths since 2004.
“This kind of progress is extraordinary,” says Dr. Sax. “People with HIV can lead lives that are as long and healthy as those of people without HIV. I never could have imagined this kind of progress when I first started in this field. And because HIV treatment makes people non-contagious to others, people on therapy cannot pass the virus to their loved ones.”
Antiretroviral therapy continues to be the best treatment for HIV today. And thanks to strong a strong global commitment to providing treatment, more people have access to treatment than ever before.
Despite the success of ART, HIV remains incurable for almost everyone: If treatment is stopped, the virus comes surging back. While five people have been cured with special bone marrow transplants, these risky treatments were only undertaken because the patients had cancer that needed them. As a result, while HIV is still very much with us, researchers continue to learn and discover more effective ways to treat and manage HIV.
Another major goal of the HIV research agenda continues to be an HIV vaccine. “It was predicted to come in 1984-1985, but frustratingly we still don’t have one,” says Dr. Sax. “I’m hopeful that some of the vaccine-related research that was done during COVID-19 will help us create an HIV vaccine.”
The outlook for patients with HIV today is vastly better than it was in the ‘80s and ‘90s. But Dr. Sax sees a future where even more is possible.
“It’s very exciting to see how far we’ve come in HIV research,” he says. “I feel privileged to be part of it. And I’m looking forward to seeing the progress we make in the near future.”