First case reports: 1981

The first identification of a pattern of illness related to immune suppression came in 1981. It was discovered that a rare cancer, Kaposi's sarcoma, was appearing amongst gay men in New York, Los Angeles and San Francisco and in June 1981 a short report was published in the weekly news bulletin of the Centers For Disease Control. The original report can be read at http://www.cdc.gov/hiv/pubs/mmwr/mmwr05jun81.pdf

A number of doctors had been aware of extraordinary levels of immunosuppression and sexually transmitted infections amongst sexually active gay men in New York and San Francisco for several years, and also of the widespread emergence of persistently swollen lymph glands (PGL-Persistent Generalised Lymphadenopathy) amongst gay men.

Many of these doctors were concerned that very high levels of sexual activity amongst urban gay men could eventually lead to chronic ill-health. During the late 1970s epidemic hepatitis B began to become a serious health problem amongst gay men, as did bowel infections such as giardiasis and amoebiasis. The first, mysterious cases of a rare skin cancer, later identified as Kaposi's sarcoma, began to appear amongst gay men in 1979 and 1980, but it was not until 1981 that a clear pattern emerged.

Reconstructing the first cases of HIV in North America has been hindered by genuine concerns about patient confidentiality. Much of the published literature provides nothing more than a general background. One paper that was published in 1984 entitled AIDS Trends in the United States 1978-1982 by Curran, Haverkos and Selik divided the earliest cases of AIDS into four 'risk groups'. These were; gay and bisexual men (with the first cases appearing in the first quarter of 1978), intravenous drug users, Haitians (first cases appearing in the first quarter of 1980) and haemophiliacs (first cases appearing in the last quarter of 1981).

According to this paper, 4 cases of AIDS were diagnosed in the USA in 1978 and a further 8 in 1979. Eleven of the 12 cases were among gay men, 8 who lived in New York, 2 in California, 1 in Illinois and one whose place of residence was not specified.

Additional reports in the medical literature concerning the suspected AIDS cases in 1979 in the report above suggest that at least 5 of the 8 cases were genuine AIDS cases which resulted in death in 1979 or 1980. The four cases from 1978 may be more problematic in that it is likely that two of them may represent cases of classical KS.