The tipping point: HIV/AIDS opened a new age of emerging infections

January 12th, 2015

The broad misconception that infectious diseases were fading as a medical concern with the development of antibiotics and vaccines was dashed in dramatic and tragic fashion in 1981 when the first cases of a new disease were reported among groups of gay men in New York, Los Angeles and San Francisco. The AIDS epidemic had begun.

It is estimated that more than 25 million people have died of HIV worldwide since those first cases were reported.

“HIV was a tipping point,” said Julie Gerberding, MD, MPH, former director of the Centers for Disease Control and Prevention. “Prior to HIV the dogma in the infectious disease world was that infectious diseases were going to be a thing of the past. We had vaccines, we had antibiotics and we were cautioned not to go into the profession – it’s a dead end street. Then HIV happened and there was an awakening that infections do emerge. Now we live with that knowledge every day, but there was a time when we didn’t understand this and that’s probably why it took us so long to recognize that in fact it was an infectious disease that we were experiencing in the city.”

Now President of Merck Vaccines, Gerberding was an intern at San Francisco General Hospital when the AIDS epidemic began.

“It is really hard to go back and try to think what it was like when we didn’t know what [AIDS] was,” she said recently in Fort Lauderdale at the 40th annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

“All of my patients were dying,” she said. “They had pneumocystis, streptococcal meningitis, they had lymphoma and they were dying and we didn’t know it was an infectious disease.”

Though that seems hard to believe now, the initial cases were clusters of injecting drug users and homosexual men with no known cause of impaired immunity who developed an opportunistic infection typically seen in the immune compromised called pneumocystis carinii pneumonia. In short order, an unexpected number of gay men began developing a previously rare skin cancer called Kaposi's sarcoma. It wasn’t until 1983 that it was determined that HIV -- a novel retrovirus that would ultimately be traced back to chimpanzees – was causing the infections.

“At the very beginning of HIV I was an intern and we up all night with these deadly viruses around us and we didn’t realize that we were potentially at risk ourselves,” Gerberding said. “It was also a very sad time. As people caught on to the fact that this was an infectious disease they became very frightened and many stopped providing care. It was not just our patients; it was our hair dressers, our neighbors, our faculty. Everybody in San Francisco was affected by AIDS.”

Finding herself at the epicenter of a global outbreak, Gerberding determined she must do something. “You really couldn’t train there and not step up,” she said.

For the rest of this story see the August 2013 issue of Hospital Infection Control & Prevention