35 years ago today

[Scooter]

And so it began - from the CDC's Morbidity and Mortality Weekly Report, 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. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.

Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes, leukopenia, and CMV viruria. The serum complement-fixation CMV titer in October 1980 was 256; in may 1981 it was 32.* The patient's condition deteriorated despite courses of treatment with trimethoprim-sulfamethoxazole (TMP/SMX), pentamidine, and acyclovir. He died May 3, and postmortem examination showed residual P. carinii and CMV pneumonia, but no evidence of neoplasia.

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, CMV viruria, and documented seroconversion to CMV, i.e., an acute-phase titer of 16 and a convalescent-phase titer of 28* in anticomplement immunofluorescence tests. Other features of his illness included leukopenia and mucosal candidiasis. His pneumonia responded to a course of intravenous TMP/.SMX, 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 that responded to Amphotericin B treatment. He was hospitalized in February 1981 for P. carinii pneumonia that responded to TMP/SMX. His esophageal candidiasis recurred after the pneumonia was diagnosed, and he was again given Amphotericin B. The CMV complement-fixation titer in March 1981 was 8. Material from an esophageal biopsy was positive for CMV.

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 being given intravenous TMP/SMX and corticosteroids and died in March. Postmortem examination showed no evidence of Hodgkins disease, but P. carinii and CMV were found in lung tissue.

Patient 5: A previously healthy 36-year-old man with 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, oral candidiasis, and CMV retinitis. A complement-fixation CMV titer in April 1981 was 128. The patient has been treated with 2 short courses of TMP/SMX that have been limited because of a sulfa-induced neutropenia. He is being treated for candidiasis with topical nystatin.

The diagnosis of Pneumocystis pneumonia was confirmed for all 5 patients antemortem by closed or open lung biopsy. The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses. Two of the 5 reported having frequent homosexual contacts with various partners. All 5 reported using inhalant drugs, and 1 reported parenteral drug abuse. Three patients had profoundly depressed in vitro proliferative responses to mitogens and antigens. Lymphocyte studies were not performed on the other 2 patients.

[Burning Petard]

Some things have changed since then, some have not. 35 years ago I was working for a bio-chemical company with a big pharm department. I was in the R&D group, working on ways to produce volumes of IL-2 for therapeutic research. When the HIV was identified we began working on producing various HIV proteins for all kinds of research and eventually a diagnostic test was commercialized.

I had many members of my extended family who worked in hospitals and other places for medical services. I think at that time basic sterile technique with patient exposure had become slack. This was the modern age. No need to slop carbolic acid or bleach or even soap and water, on everything--we now had pills and shots to cure anything thing. Until we didn't. Nurses refused to work in wards that had patients with Kaposi sarcoma. That changed rapidly. Soon everybody was wearing 'examination' gloves. Latex gloves were a hot item. Everybody was selling them and everybody was using them. The gloves themselves became a vector for illness--latex sensitivity. Today, I am suspicious of any situation where I see latex gloves. I want to see Nitrile or some kind of plastic Nevertheless, the surgeon who did the work on my wife recently still uses them in his followup exams in his office. I kept my mouth shut but noticed he did have boxes of Nitrile around and his assistants used them.

But "basic' sterile technique and sanitation that once was routine in hospital wards in the USofA are still not followed--too expensive, takes too much time. So we have regular outbreaks of infections within hospitals or 'rest homes' with infectious disease that is resistant to those wonderful pills and shots.

snailgate

[RayThom]

So when did they start calling it AIDS?

It put this company out of business.