HIV and sexually transmitted disease.

Abstract

In June 1981, the Morbidity and Mortality Weekly Report carried a report of five deaths due to overwhelming Pneumocystts cannii pneumonia in Los Angeles, California. P. carinii has been recognised for many years as a human opportunist infection, infrequently causing lifethreatening pneumonia in patients with naturally occurring or iatrogenic immunosuppression. Since the development of immunosuppressive regimens for overcoming transplantation rejection, Pneumocystis has been seen in patients with compromised cellular immunity. All of the five patients reported had been homosexual men with no prior illness or history of congenital immunodeficiency, and none had taken known immunosuppressive drugs. In December 1981, three reports in the New England Journal of Medicine described the medical presentation and laboratory characterisation of a further 20 homosexual men who had died of unexplained immunodeficiency. In every case, previously healthy young men (mean age 35 years) had developed overwhelming opportunist infections associated with profound cellular immunodeficiency, or Kaposi's sarcoma, a tumour previously associated with immunosuppression. All the patients had an absolute decrease in the number and proportion of CD4+ve T-lymphocytes, and a specific loss of T-cell immunity. The syndrome was initially termed 'gay-related immune deficiency' (GRID), but by the end of 1982, cases of this acquired immunodeficiency had been reported in intravenous drug users, female sexual partners of index cases, children of affected women and in heterosexual men and women from Haiti resident in the US. As this disease was clearly not linked exclusively to homosexuality, the term acquired immune deficiency syndrome (AIDS) was adopted. Following the description of AIDS in the US, the disease was described in homosexual men and in intravenous drug users throughout Europe, South Africa and Australia by the end of 1982. Subsequently, in 1984, it was reported that heterosexual cases of AIDS were occurring in large numbers in West, Central and Eastern Africa, involving minimally the Correspondence to Prof