HIV/AIDS: Lessons from a New Disease Pandemic

  • M. Essex
  • Yichen Lu

The acquired immunodeficiency syndrome (AIDS) was first recognized about 25 years ago (Gottlieb et al., 1981; Masur et al., 1981; Siegal et al., 1981). The best available evidence suggests that HIV newly infected the human species about 50–100 years ago (Korber et al., 2000). It did not originate in Asia. It apparently moved to people from sub-human primates in Africa (Keele et al., 2006; Kanki, 1997). Because of different clinical presentations in different populations of people, and a long incubation period, it was more difficult to diagnose than SARS or avian influenza.

As a new epidemic that originated in the era of modern medicine, it taught us many lessons about the difficulties that a new infectious disease can present. Already claiming at least 60–80 million victims, AIDS seems destined to continue as a pandemic for the foreseeable future. Drugs that control HIV replication and reverse disease progression have been developed, but none eliminate the virus from the body. Sexual transmission can be prevented by abstinence or condoms, but such measures, which prevent procreation, provide only limited value.

Approaches for making a vaccine using conventional techniques have failed. Most experts believe that an effective vaccine will be made eventually, but not for at least 10–20 years. We need to learn more about the immunobiology of acute HIV infection, and about potentially protective immunoepitopes, such as conformational intermediates of the virus envelope. Until a vaccine is available, there is little or no chance that HIV can be eliminated, or even drastically reduced in prevalence. AIDS has presented scientists, political leaders, and health policy experts with unprecedented challenges.


Human Immunodeficiency Virus Type Avian Influenza Acquire Immune Deficiency Syndrome Acquire Immune Deficiency Syndrome Patient Disease Pandemic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Barre-Sinoussi, F., Chermann, J. C., Rey, F., Nugeyre, M. T., Chamaret, S., Gruest, J., Dauguet, C., Axler-Blin, C., Vezinet-Brun, F., Rouzioux, C., Rozenbaum, W., & Montagnier, L. (1983). Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science, 220(4599), 868–871.PubMedCrossRefGoogle Scholar
  2. Brenner, B. G., Oliveira, M., Doualla-Bell, F., Moisi, D. D., Ntemgwa, M., Frankel, F., Essex, M., & Wainberg, M. A. (2006). HIV-1 subtype C viruses rapidly develop K65R resistance to tenofovir in cell culture. AIDS, 20(9), F9–13.PubMedCrossRefGoogle Scholar
  3. Clumeck, N., Mascart-Lemone, F., de Maubeuge, J., Brenez, D., & Marcelis, L. (1983). Acquired immune deficiency syndrome in Black Africans. Lancet, 1(8325), 642.Google Scholar
  4. Curran, J. W., Lawrence, D. N., Jaffe, H., Kaplan, J. E., Zyla, L. D., Chamberland, M., Weinstein, R., Lui, K. J., Schonberger, L. B., & Spira, T. J. (1984). Acquired immunodeficiency syndrome (AIDS) associated with transfusions. The New England Journal of Medicine, 310(2), 69–75.PubMedGoogle Scholar
  5. Daniel, M. D., Letvin, N. L., King, N. W., Kannagi, M., Sehgal, P. K., Hunt, R. D., Kanki, P. J., Essex, M., & Desrosiers, R. C. (1985). Isolation of T-cell tropic HTLV-III-like retrovirus from macaques. Science, 228(4704), 1201–1204.PubMedCrossRefGoogle Scholar
  6. Doualla-Bell, F., Avalos, A., Gaolathe, T., Mine, M., Gaseitsiwe, S., Ndwapi, N., Novitsky, V., Brenner, B., Oliveira, M., Moisi, D., Moffat, H., Thior, I., Essex, M., & Wainberg, M. A. (2006). Impact of human immunodeficiency virus type 1 subtype C on drug resistance mutations in patients from Botswana failing a nelfinavir-containing regimen. Antimicrobial Agents and Chemotherapy, 50(6), 2210–2213.PubMedCrossRefGoogle Scholar
  7. Duesberg, P. (1988). HIV is not the cause of AIDS. Science, 241(4865), 514, 517.PubMedCrossRefGoogle Scholar
  8. Eshleman, S. H., Hoover, D. R., Chen, S., Hudelson, S. E., Guay, L. A., Mwatha, A., Fiscus, S. A., Mmiro, F., Musoke, P., Jackson, J. B., Kumwenda, N., & Taha, T., (2005). Nevirapine (NVP) resistance in women with HIV-1 subtype C, compared with subtypes A and D, after the administration of single-dose NVP. The Journal of Infectious Diseases, 192(1), 30–36.PubMedCrossRefGoogle Scholar
  9. Essex, M., & Mboup, S. (2002). Regional variations in the epidemic. In M. Essex, S. Mboup, P. Kanki, R. Marlink, & S. Tlou (Eds.), AIDS in Africa, 2nd ed. (pp. 629–638). New York: Kluwer Academic/Plenum.Google Scholar
  10. Essex, M., Hardy, W. D., Jr., Cotter, S. M., Jakowski, R. M., & Sliski, A. (1975). Naturally occurring persistent feline oncornavirus infections in the absence of disease. Infection and Immunology, 11(3), 470–475.Google Scholar
  11. Essex, M., McLane, M. F., Lee, T. H., Falk, L., Howe, C. W., Mullins, J. I., Cabradilla, C., & Francis, D. P. (1983a). Antibodies to cell membrane antigens associated with human T-cell leukemia virus in patients with AIDS. Science, 220(4599), 859–862.PubMedCrossRefGoogle Scholar
  12. Essex, M., McLane, M. F., Lee, T. H., Tachibana, N., Mullins, J. I., Kreiss, J., Kasper, C. K., Poon, M.-C., Landay, A., Stein, S. F., Francis, D. P., Cabradilla, C., Lawrence, D. N., & Evatt, B. L. (1983b). Antibodies to human T-cell leukemia virus membrane antigens (HTLV-MA) in hemophiliacs. Science, 221(4615), 1061–1064.PubMedCrossRefGoogle Scholar
  13. Essex, M. E., McLane, M. F., Tachibana, N., Francis, D. P., & Lee, T. H. (1984). Seroepidemiology of human T-cell leukemia virus in relation to immunosuppression and the acquired immunodeficiency syndrome. In R. C. Gallo, M. Essex, & L. Gross (Eds.), Human T-Cell Leukemia/Lymphoma Viruses (pp. 355–362). Cold Spring Harbor: Cold Spring Harbor Laboratory.Google Scholar
  14. Francis, D. P., Curran, J. W., & Essex, M. (1983). Epidemic acquired immune deficiency syndrome: epidemiologic evidence for a transmissible agent. Journal of the National Cancer Institute, 71(1), 1–4.PubMedGoogle Scholar
  15. Gallo, R. C., Sarin, P. S., Gelmann, E. P., Robert-Guroff, M., Richardson, E., Kalyanaraman, V. S., Mann, D., Sidhu, G. D., Stahl, R. E., Zolla-Pazner, S., Leibowitch, J., & Popovic, M. (1983). Isolation of human T-cell leukemia virus in acquired immune deficiency syndrome (AIDS). Science, 220(4599), 865–867.PubMedCrossRefGoogle Scholar
  16. Gao, F., Robertson, D. L., Morrison, S. G., Hui, H., Craig, S., Decker, J., Fultz, P. N., Girard, M., Shaw, G. M., Hahn, B. H., & Sharp, P. M. (1996). The heterosexual human immunodeficiency virus type 1 epidemic in Thailand is caused by an intersubtype (A/E) recombinant of African origin. The Journal of Virology, 70(10), 7013–7029.Google Scholar
  17. Gelmann, E. P., Popovic, M., Blayney, D., Masur, H., Sidhu, G., Stahl, R. E., & Gallo, R. C. (1983). Proviral DNA of a retrovirus, human T-cell leukemia virus, in two patients with AIDS. Science, 220(4599), 862–865.PubMedCrossRefGoogle Scholar
  18. Gottlieb, M. S., Schroff, R., Schanker, H. M., Weisman, J. D., Fan, P. T., Wolf, R. A., & Saxon, A. (1981). Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. The New England Journal of Medicine, 305(24), 1425–1431.PubMedGoogle Scholar
  19. Kanki, P. (1997). Epidemiology and natural history of human immunodeficiency virus type 2. In V.T. DeVita, Jr., S. Hellman, S. A. Rosenberg, J. Curran, M. Essex, & A. S. Fauci (Eds.), AIDS: Etiology, Diagnosis, Treatment and Prevention, 4th ed. (pp. 127–135). Philadelphia: Lippincott.Google Scholar
  20. Kanki, P. J., McLane, M. F., King, N. W., Jr., Letvin, N. L., Hunt, R. D., Sehgal, P., Daniel, M. D., Desrosiers, R. C., & Essex, M. (1985). Serologic identification and characterization of a macaque T-lymphotropic retrovirus closely related to HTLV-III. Science, 228(4704), 1199–1201.PubMedCrossRefGoogle Scholar
  21. Kanki, P. J., Travers, K., Mboup, S., Hsieh, C.-C., Marlink, R. G., Guèye-NDiaye, A., Siby, T., Thior, I., Hernandez Avila, M., Sankalé, J.-L., NDoye, I., & Essex, M. E. (1994). Slower heterosexual spread of HIV-2 than HIV-1. Lancet 343, 943–946.PubMedCrossRefGoogle Scholar
  22. Keele, B. F., Van Heuverswyn, F., Li, Y., Bailes, E., Takehisa, J., Santiago, M. L., Bibollet-Ruche, F., Chen, Y., Wain, L. V., Liegeois, F., Loul, S., Ngole, E. M., Bienvenue, Y., Delaporte, E., Brookfield, J. F., Sharp, P. M., Shaw, G. M., Peeters, M. & Hahn, B. H. (2006). Chimpanzee reservoirs of pandemic and nonpandemic HIV-1. Science, 313(5786), 523–526.PubMedCrossRefGoogle Scholar
  23. Korber, B., Muldoon, M., Theiler, J., Gao, F., Gupta, R., Lapedes, A., Hahn, B. H., Wolinsky, S., & Bhattacharya, T., (2000). Timing the ancestor of the HIV-1 pandemic strains. Science, 288(5472), 1789–1796.PubMedCrossRefGoogle Scholar
  24. Marlink, R., Kanki, P., Thior, I., Travers, K., Eisen, G., Siby, T., Traore, I., Hsieh, C.- C., Dia, M. C., Gueye, E.-H., Hellinger, J., Guèye-Ndiaye, A., Sankalé, J.-L., Ndoye, I., Mboup, S., & Essex, M. (1994). Reduced rate of disease development after HIV-2 infection as compared to HIV-1. Science 265, 1587–1590.PubMedCrossRefGoogle Scholar
  25. Masur, H., Michelis, M. A., Greene, J. B., Onorato, I., Stouwe, R. A., Holzman, R. S., Wormser, G., Brettman, L., Lange, M., Murray, H. W., & Cunningham-Rundles, S. (1981). An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. The New England Journal of Medicine, 305(24), 1431–1438.PubMedCrossRefGoogle Scholar
  26. Piyasirisilp, S., McCutchan, F. E., Carr, J. K., Sanders-Buell, E., Liu, W., Chen, J., Wagner, R., Wolf, H., Shao, Y., Lai, S., Beyrer, C., & Yu, X. F. (2000). A recent outbreak of human immunodeficiency virus type 1 infection in southern China was initiated by two highly homogeneous, geographically separated strains, circulating recombinant form AE and a novel BC recombinant. The Journal of Virology, 74(23), 11286–11295.CrossRefGoogle Scholar
  27. Poiesz, B. J., Ruscetti, F. W., Gazdar, A. F., Bunn, P. A., Minna, J. D., & Gallo, R. C. (1980). Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma. Proceedings of the National Academy of Sciences USA, 77(12), 7415–7419.CrossRefGoogle Scholar
  28. Qiu, Z., Xing, H., Wei, M., Duan, Y., Zhao, Q., Xu, J., & Shao, Y. (2005). Characterization of five nearly full-length genomes of early HIV type 1 strains in Ruili city: implications for the genesis of CRF07_BC and CRF08_BC circulating in China. AIDS Research and Human Retroviruses, 21(12), 1051–1056.PubMedCrossRefGoogle Scholar
  29. Renjifo, B., Gilbert, P., Chaplin, B., Vannberg, F., Mwakagile, D., Msamanga, G., Hunter, D., Fawzi, W., & Essex, M. (1999). Emerging recombinant human immunodeficiency viruses: uneven representation of the envelope V3 region. AIDS, 13(13), 1613–1621.PubMedCrossRefGoogle Scholar
  30. Rogers, M. F., Morens, D. M., Stewart, J. A., Kaminski, R. M., Spira, T. J., Feorino, P. M., Larsen, S. A., Francis, D. P., Wilson, M., & Kaufman, L. (1983). National case–control study of Kaposi’s sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part 2. Laboratory results. Annals of Internal Medicine, 99(2), 151–158.PubMedGoogle Scholar
  31. Siegal, F. P., Lopez, C., Hammer, G. S., Brown, A. E., Kornfeld, S. J., Gold, J., Hassett, J., Hirschman, S. Z., Cunningham-Rundles, C., Adelsberg, B. R., Parham, D. M., Siegal, M., Cunningham-Rundles, S., & Armstrong, D. (1981). Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. The New England Journal of Medicine, 305(24), 1439–1444.PubMedGoogle Scholar
  32. Su, L., Graf, M., Zhang, Y., von Briesen, H., Xing, H., Kostler, J., Melzl, H., Wolf, H., Shao, Y., & Wagner, R. (2000). Characterization of a virtually full-length human immunodeficiency virus type 1 genome of a prevalent intersubtype (C/B’) recombinant strain in China. The Journal of Virology, 74, 11367–11376.CrossRefGoogle Scholar
  33. UNAIDS. (2006). Report on the Global AIDS Epidemic. Geneva: UNAIDS, Available online at Accessed on 9 February 2007.
  34. UNAIDS. (2007). AIDS Epidemic Update: December 2007. Available Online at Accessed on 28 January 2008.

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • M. Essex
    • 1
  • Yichen Lu
    • 1
  1. 1.Department of Immunology and Infectious DiseasesHarvard School of Public HealthBostonUSA

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