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Recalling the first reports of world noticing AIDS

THE BALTIMORE SUN

The article -- a page and a half of small type, in a publication of the Centers for Disease Control -- drew no special attention to itself when it appeared 20 years ago. It briefly described the serious illness of five young men in Los Angeles.

All five were identified as homosexuals. They had been diagnosed with a type of pneumonia usually associated with the elderly, or patients whose immune systems were weakened. Two of the five men had already died.

That was the June 5, 1981, issue of the CDC's Morbidity and Mortality Weekly Report. Its unheralded publication marks the first sighting of the disease now known as AIDS -- a disease now so much in view, we might mistake for something known for centuries.

A month after the first article, another issue of the Morbidity and Mortality Weekly Report described hitherto rare cancers in another 26 gay men. A third report, published that August, tentatively wove together some of the threads: the clustering of those diseases among gays suggested "a common underlying factor."

That factor was HIV, the virus that researchers discovered in 1983.

Today, to mark the 20th anniversary of that first, landmark sighting, the CDC is releasing a far longer, more detailed report describing its state of knowledge of the disease. On this page are excerpts from those first, long ago articles published by CDC, including the CDC's "editorial notes," heralding a disease so new that it lacked a name.

-- Robert Ruby

Glossary:

Pneumocystis carinii pnuemonia: A pneumonia that affects individuals whose immune systems have been weakened, typically by malnutrition or cancer. Abbreviated PCP.

Kaposi's Sarcoma: A cancerous tumor that affects especially the skin and mucous membranes. Formerly limited to elderly men. Abbreviated KS.

June 5,1981

In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died ... ..

Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia ... after a 2-month history of fever ... .The patient's condition deteriorated despite courses of treatment with [a battery of drugs]. He died May 3 ... .

Patient 2: A previously healthy 30-year-old man developed P. carinii pneumonia in April 1981 after a 5-month history of fever each day and of elevated liver-function tests ... .Other features of his illness included leukopenia and mucosal candidiasis. His pneumonia responded to a course of intravenous [drugs], but, as of the latest reports, he continues to have a fever each day.

Patient 3: A 30-year-old man was well until January 1981 when he developed esophageal and oral candidiasis ... .He was hospitalized in February 1981 for P. carinii pneumonia that responded to oral [drug treatment]. His esophageal candidiasis recurred after the pneumonia was diagnosed ... .

Patient 4: A 29-year-old man developed P. carinii pneumonia in February 1981. He had had Hodgkins disease 3 years earlier, but had been successfully treated with radiation therapy alone. He did not improve after [drug therarpy] and died in March ... .

Patient 5: A previously healthy 36-year-old man with a clinically diagnosed CMV infection in September 1980 was seen in April 1981 because of a 4-month history of fever, dyspnea, and cough. On admission he was found to have P. carinii pneumonia ... .

The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses. The 5 did not have comparable histories of sexually transmitted disease. Four had serologic evidence of past hepatitis B infection but had no evidence of current hepatitis B surface antigen. Two of the 5 reported having frequent homosexual contacts with various partners ... ..

Editorial Note: Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients . The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual. The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population ... .

All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis ... .

July 4, 1981

During the post 30 months, Kaposi's sarcoma (KS), an uncommonly reported malignacy in the United States, has been diagnosed in 26 homosexual man (20 in New York City; 6 in California). The 26 patients range in age from 26-51 years ... . Eight of these patients died -- all 8 within 24 months after KS was diagnosed ... ..

Skin or mucous membrane lesions, often dark blue to violet plaques or nodules. were present in most of the patients on their initial physician visit. However, these lesions were not always present and often were considered benign by the patient and his physician.

A review of the New York University Coordinated Cancer Registry for KS in man under age 50 revealed no cases from 1970-1979 at Bellevue Hospital and 3 cases in this age group at the Now York University Hospital from 1961-1979 ... ..

Although it is not certain that the increase in KS and PC pneumonia is restricted to homosexual men, the vast majority of recent cases have been reported from this group. Physicians should be alert for Keposi's sarcoma, PC pneumonia, and other opportunistic infections associated with immunosuppression in homosexual men.

August 28, 1981

Twenty-six cases of Kaposi's sarcoma (KS) and 15 cases of Pneumacystis carinii pneumonia (PCP) among previously healthy homosexual men were recently reported. Since July 3, 1981, CDC has received reports of an additional 70 cases of these 2 conditions in persons without known underlying disease ... .

The majority of the reported cases of KS and/or PCP have occurred in white men. Patients ranged in age from 15-52 years; over 95 percent were men 25-49 years of age. Ninety-four percent of the men for whom sexual preference was known were homosexual or bisexual. Forty percent of the reported cases were fatal.

Of the 82 cases for which the month of diagnosis is known. 75 (91 percent) have occurred since January I 980, with 55 (67 percent) diagnosed from January through July 1981. Although physicians from several states have reported cases of KS and PCP among previously healthy homosexual men, the majority of cases have been reported from New York and California.

Editorial Note: KS is a rare, malignant [growth] seen predominantly in elderly men in this country. In elderly men the disease is manifested by skin lesions and a chronic clinical course; it is rarely fatal. In contrast, the persons currently reported to have KS are young to middle-aged men, and 20 percent of the cases have been fatal ... ..

The occurrence of Pneumocystis cerinii pneumonia in patients who are not immunosuppressed due to known underlying disease or therapy is also highly unusual. Although 7 of the 61 patients with PCP also had KS, in many instances pneumonia preceded the tumor. Although most of the patients with PCP reported recent respiratory symptoms. some gave a history of weeks to months of systematic symptoms including weight loss and general malaise, similar to the [early sympton] described by patients who developed ... KS. Several of the patients with PCP had other serious infections ... .

The apparent clustering of both Pneumocystis carinii pneumonia and KS among homosexual men suggests a common underlying factor. Both diseases have been associated with host immunosuppression and studies in progress are showing immunosuppression in some of these cases. The extent or cause of immune suppression is not known.

Physicians should be aware of the possible occurrence of these diseases and other opportunistic infections, particularly among men with symptoms suggestive of these disorders or their [warning symptoms], since therapy is specific and verification of the diagnosis requires biopsy.

Several state and local health departments and CDC are conducting active surveillance for KS, PCP, and opportunistic infections in persons without known predisposing underlying disease. A national case-control study will be implemented shortly.

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