Forty-five years ago, the CDC published its first report on what would later be identified as AIDS. In the early 1980s, the disease carried a life expectancy of just three years after diagnosis. There was no treatment, no clear understanding of transmission, and no hope for those infected. Fear dominated the era.
The first significant advance arrived in 1987 with the approval of AZT, a drug originally developed as a failed cancer treatment. It wasn’t a cure, but it offered a starting point.
From Shelved Drug to Lifeline
AZT, or zidovudine, was synthesized in 1964 by chemist Jerome Horwitz, who had intended it to combat cancer. When it failed, the compound was set aside. Decades later, as the AIDS crisis worsened, scientists revisited old drugs in search of anything that might slow the virus. AZT showed potential in lab tests, and by 1985, clinical trials began.
The FDA approved it in record time—less than two years—reflecting the urgency of the epidemic. For the first time, people with HIV had a chance to survive. But the drug came with serious drawbacks.
Patients had to take pills every four hours, around the clock, often on rigid schedules that disrupted daily life. Side effects included anemia, muscle pain, nausea, and exhaustion severe enough to require blood transfusions. The virus also developed resistance quickly. When used alone, AZT lost effectiveness within months as mutations emerged.
Cost posed another obstacle. At $10,000 annually per patient, it was one of the most expensive drugs ever. Activist groups like ACT UP organized protests, demanding lower prices and broader access.
The Shift to Combination Therapy
AZT’s limitations led scientists to rethink treatment strategies. By the mid-1990s, combination therapy—using multiple drugs to attack the virus from different angles—became the standard. This method, now known as antiretroviral therapy (ART), turned HIV from a fatal diagnosis into a manageable chronic condition.
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Perry Halkitis, dean of the Rutgers School of Public Health, called AZT the foundation for this progress. “That medication eventually led to what we now call ART,” he said.
Today, ART is so effective that people with HIV who maintain viral suppression can expect lifespans similar to those without the virus. The drugs also serve a preventive role, with pre-exposure prophylaxis (PrEP) cutting transmission risk by more than 90%.
Adherence has improved but remains a challenge. Early regimens required strict schedules, which were difficult for people dealing with poverty, addiction, or caregiving responsibilities. Modern treatments have eased that burden. Long-acting injectables, for instance, allow patients to go months between doses. “We’ve built systems that consider the realities of people’s lives,” Halkitis said. “That’s an important step forward.”
Disparities in access persist. Care availability differs by location, income, and insurance coverage. As people with HIV live longer, new questions arise about managing their health. Halkitis is studying whether primary care providers should take a larger role in treatment. “Primary care doctors understand aging, medication interactions, and other health concerns,” he said. “We need to rethink how we deliver care.”
For those who lived through the early years of the epidemic, the changes are dramatic. Halkitis, who takes HIV medication daily, now jokes about his “old people meds”—cholesterol pills and vitamins alongside his antiretrovirals. “It’s strange,” he said. “But it also shows how much progress we’ve made.”
The tools to end the epidemic exist. New infections continue, particularly among marginalized communities. Whether these tools reach everyone who needs them remains uncertain.
Recent advances in medical technology have also improved monitoring and treatment outcomes for chronic conditions like HIV.