40 years of progress in HIV/AIDS diagnostics
The last 40 years have been an incredible scientific journey in the battle against acquired immunodeficiency disease (AIDS) – first to identify the cause of this new and mysterious disease, then to develop effective treatments and contain what had become a deadly, global health threat.
So much has happened in such a short time that it’s easy to forget how far we’ve come in the treatment of HIV – and that diagnostics played a crucial role in the remarkable achievements against a disease once considered an inescapable death sentence.
Combatting the AIDS epidemic meant waging a war on two fronts: medical and cultural. Patients, their families, healthcare professionals and even celebrities joined forces to raise awareness and to fight the stigma associated with HIV infection.
In vitro diagnostics (IVDs) paved the way for a greater understanding of the disease by supporting clinicians in diagnosing HIV, reducing the spread of infection and contributing to the development of better treatments. This combination of widespread testing and new therapies made HIV much less scary.
We want to give you a glimpse of this transformative journey. Show you the courageous people behind the science, and those in the public eye fighting the stigma shrouding the AIDS community – together these people put their hearts and minds into tackling the AIDS epidemic and helped with our ability to cope with it.
A mysterious epidemic with unusual symptoms breaks out.
Initial cases were discovered in a group of injecting drug users and gay men with unusual symptoms of rare opportunistic infections mostly seen in people with a compromised immune system. A surprising number of the gay men developed a rare skin cancer called Kaposi's sarcoma (KS). This prompted the US Centers for Disease Control and Prevention (CDC) to form a task force to address the epidemic and coin the name Acquired Immunodeficiency Syndrome (AIDS).1
The first patient in the UK is identified, leading to an avalanche of diagnoses and deaths.
Jonathan Blake became ‘patient number one’ at Middlesex Hospital, one of the first people diagnosed with HTLV-3 (later known as HIV) in the UK. This was the start of an avalanche of diagnoses and deaths.
Two research groups simultaneously identify the new virus.
Two research groups, one led by Robert Gallo in the US and one by Luc Montagnier in France, published their discoveries separately in Science. Both groups had discovered the same retrovirus behind Human Immunodeficiency Virus (HIV).2
An American teenager is banned from school.
Before Ryan, most people thought AIDS was an illness affecting only the gay community. This stigma shifted as Ryan (and later other prominent HIV-positive people) began to openly advocate for more AIDS research and public education to address the epidemic.
The first HIV test is designed to screen blood products.
Once HIV was identified, companies began to develop tests that could detect the antibodies found in the blood after being infected. The first HIV antibody screening assays using Enzyme-Linked Immunosorbent Assay (ELISA) technology were licensed by the US Food and Drug Administration (FDA). Later in 1985, the insurance companies started using these tests to assess an individual's risk of developing AIDS. As it takes time for most individuals to develop antibodies to HIV, these tests only become positive 6 to 12 weeks post infection, leaving a window of uncertainty and delay.
Scientists, clinicians, leaders and advocates gather for the first time to find a way to control the threat.
Every single world region had diagnosed at least one case of AIDS by the end of 1985.3 To build scientific knowledge in the fight against HIV, the World Health Organization (WHO) and the US Department of Health hosted the first International AIDS Conference in Atlanta, US.
A princess shows compassion after an ad causes panic.
As more news about AIDS hit the media, this public information film/ad was released in the UK. Its tagline, Don’t die of ignorance, compounded fear and prejudice. In April 1987, at the opening of the UK's first purpose-built HIV/AIDS unit, Princess Diana shook the hand of an infected man without any safety precautions. With this simple gesture, she helped break the myth that HIV/AIDS could be transferred by touch, and showed that the disease was a condition needing compassion and understanding, not fear and ignorance.
Promising results proved disappointing.
The FDA approved an antiretroviral drug known as a reverse-transcriptase inhibitor. It works by slowing the replication of the virus. The drug had been fast-tracked for approval – people needed immediate help – and initial responses to the drug were positive. Lives were prolonged only slightly, however, as the virus mutated and grew resistant to the treatment.
The boy who changed the world's legacy.
Surprising his doctors, Ryan lived five years longer than predicted, but sadly died one month before his high school graduation on 8 April 1990. Shortly after his death, US Congress passed a major piece of AIDS legislation, the Ryan White CARE Act.
Other key celebrity announcements followed, and other famous people infected with HIV included actor Rock Hudson, tennis player Arthur Ashe, singer Freddie Mercury, writer Isaac Asimov, French philosopher Michel Foucault, designer Tina Chow, Russian dancer Rudolf Nureyev, and Portuguese singer António Variações – illustrating that AIDS is a disease that knows no national boundaries.
Diagnosis in hours.
A diagnostic test kit using polymerase chain reaction (PCR) technology was developed to help healthcare professionals detect within a few hours the presence of HIV using the virus’s DNA.4 This more sensitive test means diagnosis of patients in earlier stages of infection is possible. Moreover, immediate diagnosis leads to treatment starting right away, and gives the
Still not the cure.
This second type of antiretroviral medicine suppresses the virus by blocking an HIV enzyme known as protease. Without protease activity, no copies of the virus can be made, interrupting the HIV life cycle. Protease inhibitors are still used today in combination with other antiretrovirals.
Not everyone's HIV is the same.
Quantitative diagnostic testing determines the amount of HIV virus circulating in the body. By measuring viral load, doctors can gauge treatment response. Our understanding of how the virus worked then changed - we learned it did not stay dormant, but quickly replicated to build strength, which meant asymptomatic patients could still be infectious. This is why initiatives like the
Meet an HIV-positive Muppet.
In 2002, Kami, the first HIV-positive Muppet, was introduced to South Africa’s Takalani Sesame (one of Sesame Workshop’s many international projects modelled after Sesame Street). While normalising the face of HIV and AIDS, Kami provides a life-affirming remedy to the AIDS stigma. She helps children understand how it is and isn’t transmitted. By touching and interacting with those who are HIV-positive, Kami shows that normal interactions are nothing to be afraid of. It’s a very important message in South Africa, where denial and cultural misunderstanding have been blamed for the country’s alarming infection and death rates throughout the 2000s. Kami later starred in a UNICEF public-service announcement about AIDS and HIV education, appearing with Oprah Winfrey, Laura Bush, and Desmond Tutu.
A new approach to blocking HIV.
A new approach to preventing the virus from replicating was developed. By blocking HIV from entering healthy cells where it makes the copies of itself, viral load can be reduced enough to suspend the chain of infection.
Taboo in Africa, a discussion about HIV in Africa is initiated.
AIDS became the most important and dedicated cause of Nelson Mandela’s foundation. He launched a charity, to which he gave his Robben Island prison number, 46664, to raise awareness and funds through huge international concerts.
Mandela’s admission in 2005 that his son died from AIDS helped create awareness and initiate a discussion of the taboo in Africa. He went on to set up the World AIDS Trust with former US President Bill Clinton.
Each type of the virus needs its own treatment.
There are two types of the virus, HIV-1 and HIV-2. Most HIV positive people have HIV-1. It is more virulent, more easily transmitted and the cause of most HIV infections globally, about 95%. HIV-2 is less transmittable, has a slower prognosis and is largely confined to West Africa.
Physicians need to know the difference between the two forms as they are unique virus strains that require specific treatments. To help navigate this complexity, Roche launched a qualitative diagnostic test that differentiates between HIV-1 and HIV -2 infections in 2017.
Sometimes small things completely change the approach to big problems.
This new technology, the size and shape of a credit card, provides a simple way to collect blood samples and protect them from contamination despite heat and humidity. The samples are used to assess how much of the virus is in the blood - the viral load. This viral load testing measures whether treatment is working and guides clinical decisions to decrease transmission. The innovation behind the card is that it doesn’t require refrigeration. Its launch has meant increased access to HIV testing for patients living in remote areas such as rural Africa because a sample can easily be transported to labs in larger centres for reliable qualitative testing.
We’ve made incredible progress over the last 40 years in tackling the HIV epidemic. The annual number of people dying from AIDS-related causes worldwide is steadily decreasing from a peak of 2.2 million in 2005 to an estimated 1.8 million in 2010.5 With early diagnosis and appropriate treatment, there’s now the possibility of normal, healthy lifespans for people living with HIV.
However, more open discussions are needed in popular culture throughout the world to educate on prevention and help people understand what it’s like to live with HIV. UNAIDS believes that, over the past two decades, as many as 65 million people have contracted HIV and at least 25 million have died. It’s also believed that there are more than 35 million people living with HIV/AIDS worldwide4 .This means there is still a lot of work needed to help
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