On supporting science journalism
If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.
Physicians we are often asked to describe the typical course of AIDS: the severe immune deficiency that enables normally benign organisms to flourish destructively in patients. Our answer is that people are asking the wrong question. Now that AIDS is known to be caused by a virus-the human immunodeficiency virus, or HIV-the focus should be on the full course of the viral infection, not solely on AIDS. HIV causes a predictable, progressive derangement of immune function, and AIDS is just one, late manifestation of that process.
An emphasis on HIV is important because it facilitates both treatment and prevention. Prompt diagnosis of HIV infection enables the patient to receive optimal medical care from the earliest moments of the disease. Such care can often prevent complications from developing or getting unnecessarily out of hand. For instance, the lethal opportunistic infection Pneumocystis carinii pneumonia (PCP), which has been a hallmark of AIDS, can now actually be prevented with medication given early in the course of HIV disease. (Opportunistic infections are ones that occur because the immune system has broken down.) In addition, the medicine Retrovir (also known as AZT), which has been shown to prolong life in patients with late-stage disease, holds promise as a therapy for patients in earlier stages of infection. Early diagnosis also eliminates the unwitting transmission of HIV and gives people the opportunity to consider changing their behavior before they pass the virus to others.
Although the continuing emphasis on AIDS alone is seriously misguided, it is somewhat understandable. When AIDS was first identified in 1981, it was a mysterious syndrome: a cluster of rare diseases that had suddenly become alarmingly common in homosexual men. In order to identify similar cases of AIDS, and thereby help to uncover the cause and means of transmission, the U.S. Centers for Disease Control (CDC) adopted a strict epidemiological-surveillance definition. People were said to have AIDS if they contracted Kaposi's sarcoma (a rare cancer) or if they developed any of a few rare opportunistic infections, most notably PCP.