40 years after discovering HIV, doctors recall challenges – 05/19/2023 – Health

40 years ago, Science magazine published the discovery of a virus. It was an infectious agent found in the lymph nodes of a patient treated at the Pitié-Salpêtrière hospital in Paris, with signs and symptoms often associated with AIDS.

The article was headed by French researchers Luc Montagnier and Françoise Barré-Sinoussi, who were later awarded the Nobel Prize in Medicine for their revelation, and signed by ten other scientists.

In the text, the group stated that the new virus, baptized in 1986 as HIV (human immunodeficiency virus), could be involved in the development of the syndrome, at the time a great mystery.

“The press called it cancer-gay”, recalls infectologist Zarifa Khouri. In 1983, she was a resident at Hospital Emílio Ribas, in São Paulo, and treated some of the first AIDS patients in the country.

“The first case I saw was a boy who was a hairdresser and had frequented gay saunas in the United States. He was admitted with diarrhea and the teachers diagnosed typhoid fever, but it didn’t work because in adults typhoid fever causes a blocked intestine”, he recalls.

Nobody knew what the man had. After a few days, purple spots appeared on his heel and forehead, and the team recalled that reports about the disease reported that patients often developed a type of cancer called Kaposi’s sarcoma.

The team wondered: could it be Aids? But there was still no test to confirm it and no antiretrovirals to prevent the virus from multiplying in the body. So the case continued to get worse. Pneumonia developed and the man died in the ICU with respiratory failure.

“What we managed to do was treat opportunistic infections and these patients were dying. It was a death sentence. When they found out they were HIV-positive, they dropped out of college, dropped everything”, says Khouri.

Nobody understood how the disease was transmitted, and the doctors themselves were afraid to lay their hands on patients. Contact with visitors was made through an opening in the wall and the question “How long do I have to live?” it was frequent.

“Sometimes, we would go out for coffee across the street and we would come across patients throwing themselves out of the window, committing suicide”, says the doctor.

In the case of women diagnosed with the virus, the recommendation was tubal ligation, since there was no control of transmission between mother and baby.

“One day, I was in the emergency room and a young couple, 14, 15 years old, came to talk. They were injecting drug users, very common at that time, and asked not to tell anyone that they had HIV because otherwise the two would be lynched in the favela where they lived. The discrimination was very, very great”, recalls the doctor through tears.

Cocktail offer and challenges

The scenario began to change in 1991, when the world had 10 million people infected, according to the WHO (World Health Organization), and Brazil had 11,805 cases.

It was in that year that the Ministry of Health began distributing antiretrovirals free of charge. The following year, the combination of AZT and Videx inaugurated the country’s first anti-AIDS cocktail and, from then on, the inclusion of new drugs increased the patients’ life expectancy and quality.

“With the cocktail, the person no longer had a defined life span”, compares Khouri. Even so, the first medicines caused diarrhea and the loss of fat on the face showed who had the disease.

Other changes were the control of transmission between mother and baby and, more recently, the prophylactic use of antiretrovirals before and after exposure to the virus. “Our biggest challenge today is to get the prevention right to reduce the number of infections”, evaluates the doctor.

José Valdez Madruga, coordinator of the scientific committee on HIV/AIDS at the SBI (Brazilian Society of Infectious Diseases), mentions another obstacle: the permanence of stigma. “We see families that throw children out of their homes and companies that lay off employees because of HIV.”

“The world has changed a lot in these 40 years, but we still see people with late diagnosis and serious illness simply because of the fear of taking the HIV test”, he reports. “This leads to increased mortality and also to sequelae of diseases resulting from immunosuppression.”

According to Unaids (United Nations Program on HIV / AIDS), in 2021, 38.4 million people in the world were living with HIV. That year, the last one with available data, there were 650,000 deaths.

Since the emergence of the first cases, 84.2 million people in the world have been infected with HIV and 40.1 million have died from AIDS-related illnesses.

In that entire period, there were only five reports of cures, all involving transplantation of stem cells from donors with a mutation in the CCR5 gene that prevents HIV from entering cells.

“In this decade, we hope that medicines continue to improve, with an increase in the interval between doses and fewer adverse effects, and above all we dream of a cure”, confesses Madruga.

“I hope to witness this moment, to see the cure announced”, says Khouri.