The dramatic saga of the acquired immunodeficiency syndrome (AIDS) features an early sense of helplessness and frustration in the face of a mysterious new disease, courage on the part of the afflicted, and the gradual accrual of groundbreaking scientific advances that have brought hope to a formerly desperate situation. This progress began with a series of detailed epidemiologic studies, which were followed by the discovery of the human immunodeficiency virus (HIV) as the causative agent of AIDS, and has culminated in highly effective treatment regimens that have transformed HIV from a near-certain death sentence to a manageable disease (see timeline). Looking ahead, and considering the spectacular scientific advances that have been made over nearly four decades, it is conceivable that with optimal implementation of available prevention strategies and treatments, the end of HIV/AIDS as a global pandemic will be attainable.
This extraordinary journey began in 1981 with the initial reports of the first recognized case of AIDS in the United States. During the early years of the outbreak, the disease did not have an agreed-upon name and the causative agent of the new syndrome had not yet been identified. As a result, there were no specific medications available to treat patients with the syndrome, and their life expectancy was measured in months. Coinfections and neoplasms associated with the unknown disease resulted in high mortality.1 Health care providers could offer little to the multitude of patients flooding into clinics and occupying a disproportionate fraction of hospital beds in large cities such as New York, San Francisco, and Los Angeles.
The Institute of Medicine (IOM – now the National Academy of Medicine, or NAM) of the National Academy of Sciences, which is now celebrating its 50th anniversary, played a key role in the early response to AIDS, notably with the establishment in 1986 of the Committee on a National Strategy for AIDS, which published the seminal publication Confronting AIDS: Directions for Public Health, Health Care, and Research. This volume served as a road map and rallying call for policymakers, scientists, and others to address the growing pandemic in all its complexities. Over the ensuing years, the IOM/NAM has continued to provide leadership and expertise on HIV/AIDS.