SFGH Grand Rounds Explores Disease That First Defined AIDS

Doctors and other health care professionals packed into San Francisco General Hospital’s Carr Auditorium for the June 7 medical grand rounds, commemorating the 30th anniversary of the first AIDS report to the US Centers of Disease Control (CDC) and Prevention.

Laurence Huang, MD

Laurence Huang, MD

Affiliated with UCSF since 1873, San Francisco General Hospital (SFGH) was the first to open its doors to HIV/AIDS patients and continues to set the standard internationally for treatment and research.

The standing-room-only lecture was given by Laurence Huang, MD, professor of medicine and chief of the SFGH HIV/AIDS Chest Clinic, who spoke on the past, present and future of pneumocystis carinii pneumonia (PCP), a severe illness found in people with HIV.

“Laurence Huang is the go-to person for every new critical case of PCP in this hospital,” said Diane Havlir, MD, chief of the UCSF Division of HIV/AIDS at SFGH, in her introductory remarks. “Thirty years ago, the AIDS epidemic appeared on the doorstep of San Francisco and this hospital. PCP is one of the hallmarks of AIDS and looking at the disease through the lens of PCP illustrates some of our greatest successes. But it still exists and people still come in with it today.”

Before the 1980’s, less than 100 cases of PCP were reported annually in the United States, and limited to immunosupressed patients, such as cancer patients, or patients taking immunosuppressants for an organ transplant. But that changed on June 5, 1981, when the CDC published a report in the Morbidity and Mortality Weekly Report (MMWR) on five previously healthy homosexual men with PCP in Los Angeles. The report, Pneumocystis Carinii Pneumonia, signaled the start of HIV epidemic in the United States. PCP is the AIDS-defining disease most often reported at the initial AIDS diagnosis.

In the early years of AIDS, PCP was a major cause of death in people living with AIDS. At its peak, from 1990 to 1993, there were greater than 20,000 cases per year of PCP reported to the CDC as AIDS-defining diagnoses and countless more cases occurred in individuals after their diagnosis of AIDS, said Huang.

Today, with standard treatments such as Trimethoprim-sulfamethoxazole, the incidence of patients with PCP has been greatly reduced in the United States, Western Europe, and areas of the world where combination antiretroviral therapy is widely available. HIV incidence has also decreased by more than 25 percent in 33 countries across the world, said Huang. But challenges remain in areas such as sub-Saharan Africa, parts of Eastern Europe and Asia where access to retroviral therapy and PCP prophylaxis is limited.

In the last 30 years, approximately 25 million people across the world have died due to AIDS related illnesses and 33.3 million people are currently living with HIV. Two thirds of the global population living with HIV/AIDS resides in sub-Saharan Africa.