Forty-five years ago, the Centers for Disease Control and Prevention released its first report on what would become known as AIDS. The disease appeared in the early 1980s as a deadly illness with no known cure, leaving patients with an average life expectancy of just three years after diagnosis.
AZT, the first antiretroviral drug for HIV, received approval in 1987. Originally developed as an unsuccessful cancer treatment in 1964, the drug was repurposed during the AIDS crisis after studies revealed its ability to slow viral progression. The Food and Drug Administration approved it in under two years, reflecting the urgency of the epidemic.
From death sentence to lifeline
Perry Halkitis, dean of the Rutgers School of Public Health, described AZT as a major shift. “It provided a lifeline…it provided an entry point into thinking about the evolution of medications and the mechanism by which medications could work in controlling the virus,” he said. The benefits came with serious downsides, though.
Patients had to take pills every four hours around the clock. Side effects ranged from anemia to nausea and muscle pain, sometimes requiring blood transfusions. The virus also developed resistance quickly when AZT was used alone, making the drug less effective within months to a couple of years.
The price created another obstacle. At $10,000 per year, AZT was extraordinarily expensive when it launched. Activist groups like ACT UP staged protests over the cost, pushing for broader access as thousands continued dying from the disease.
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Halkitis said community pressure played a key role in speeding up research. Without activism, the drug might not have reached patients as fast.
How treatment evolved from pills to prevention
The mid-1990s brought combination therapy, which replaced AZT as the standard treatment. Halkitis called the change “the most important pharmaceutical advance in HIV control.”
The drugs attacked the virus from multiple angles, proving so effective that HIV medications now prevent infection in high-risk groups. Modern treatments have also simplified care.
Long-acting injectables have reduced the need for daily pills. Some patients now receive shots that last for months. Halkitis explained that the approach considers real-life challenges, noting that sticking to a schedule was harder for people dealing with poverty, addiction, or childcare responsibilities.