From Deadly Disease to Chronic Condition: How the Evolution of HIV Treatment Has Allowed People to Live Longer, Better Lives

This year marks the 45th anniversary of the Centers for Disease Control and Prevention's (CDC) first Morbidity and Mortality Weekly Report (MMWR) publication describing AIDS. As a way to mark this anniversary as well as discuss other aspects of the disease such as how far treatments have come, The American Journal of Managed Care’s Lead Editor Maggie Shaw and Contagion’s Assistant Managing Editor John Parkinson spoke with Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health, on a variety of topics around AIDS/HIV.

In the early 1980s, AIDS was emerging as a mysterious, deadly disease with no treatment. People were very afraid to contract AIDS, which at that time, had no treatment and was viewed by most as a death sentence. According to the National Institutes of Health (NIH), the average life expectancy for an individual with AIDS was 3 years after diagnosis in the 1980s.¹

It wasn’t until a treatment for cancer was developed that offered the first antiretroviral drug. AZT (azidothymidine, also known as zidovudine) was initially developed as a potential anti-cancer drug in 1964 by Jerome Horwitz, PhD, at the Michigan Cancer Foundation.^2-4 It was designed to interfere with cancer cell replication, but it didn't work well for that purpose and was largely shelved.^2,3

It got a second life in the mid-1980s when researchers, amid the growing AIDS crisis, began screening existing compounds for activity against HIV.² AZT showed promise in lab tests by 1985, and Burroughs Wellcome (with NIH collaboration) fast-tracked it through trials.^2,8 In March 1987, the FDA approved it, making it the first antiretroviral drug approved to treat HIV/AIDS.^2,5 The approval process took under 2 years, remarkably fast for the time, reflecting the urgency of the epidemic.⁵

Perry Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health explains that community activist groups such as ACT UP pushed government officials and scientists advocating for the development of treatments, which led first to AZT and eventually ART.

Benefits and Challenges of AZT

AZT was a turning point in AIDS/HIV epidemic. “AZT 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,” said Halkitis.

Still there were a lot of issues, including suppressed bone marrow function, anemia, and neutropenia severe enough that some patients needed blood transfusions.⁶ Other common side effects included nausea, headaches, muscle pain/weakness, and fatigue.⁶

The original regimen required taking pills every 4 hours, around the clock, including waking up in the middle of the night.^5,6 This was later relaxed as dosing was better understood, but early on it was grueling.

“People were on these doses that you had to take with food, without food, with water on an empty stomach at certain times of day, and that complication made it very difficult for people to adhere to the medications in a highly effective way,” Halkitis.

Additionally, HIV can quickly mutate, and when AZT was used as a monotherapy, resistant viral strains often emerged within months to a couple of years, causing the treatment to lose its effectiveness.² This was a major limitation until the mid-1990s, when combination therapy, using multiple antiretrovirals together became standard. This dramatically improved outcomes and is still the approach used today.

Lastly, AZT was extraordinarily expensive when it launched—around $10,000 a year per patient—making it one of the priciest prescription drugs in history at the time.^7,8 This sparked further activism, from ACT UP and others, protesting pricing and access barriers during a crisis where people were dying.^7,8

ART: The Next Generation of Treatment

With all these challenges, public health officials, pharmaceutical companies, and activists knew they needed newer therapies. Still, Halkitis credits AZT with being an important piece of the treatment puzzle and the foundation for future therapies.

“That medication eventually gave way to what became known in in the mid 90s as highly active antiretroviral therapy, which is what we call ART now. By definition, the combination of different classes of HIV medications, which could be developed in part because of AZT, that would attack the virus from 3 different locations.”

Specifically, he notes the development of protease inhibitors as a game changer.

“Protease inhibitors proved to be the most consequential pharmaceutical development in the maintenance and control of HIV. And look where we are today. Now we're using HIV medications to prevent HIV, not just to treat HIV.”

Long-Acting Injectables

In recent years, AIDS/HIV treatment has evolved again with the development of long-acting injectables. These therapies allow people with HIV to go months without having to take treatment.

Halkitis points out how modern therapies make adherence much easier. “There were people who were living with HIV who had other demands in their lives. They had addictions they were living with; they had children they were raising; they had poverty that was affecting their lives. And for those folks, adherence became a much bigger obstacle. That is why I'm so grateful that we've created systems that ease the delivery of medications to people right now; because it accounts for the complexity of people's lives.”

Viral Suppression Means Longer Life

For those who have been fortunate to live in a time when ART is readily available, it has meant a better quality of life and the ability to live much longer.

“It's so funny when I think about myself right now, and my medications every morning. One of them is my HIV med, and the rest of them are all like my old people meds—like my cholesterol and my blood pressure and my vitamins and my calcium…It's very, very bizarre, but the evolution was interesting, right? Because it's so simple…the delivery of HIV treatment.”

One of the projects Halkitis is considering is to study aging in people with HIV and looking at who are the best providers for care. He says we need to rethink care, and instead of having just infectious disease providers care for people with HIV, they should be seen by primary care providers as well.

“Primary care providers understand the multiple, other health issues that people are facing, that understand aging, that understand polypharmacy… sometimes in our world we react in ways that's embedded by the past instead of what's going on right now. So I think this is a call to rethink the delivery of care in a really meaningful way,” he said.

In the next episode of this series, Halkitis discusses how human behavior and public health have led to both the successes and failures around AIDS in the 1980s, COVID-19 in recent years, and the reemergence of diseases like measles today.

References
1. NIH Office of AIDS Research: 35 Years of Advancing HIV Research. NIH. Reviewed June 17, 2026. Accessed July 16, 2026.
https://oar.nih.gov/about/history/oar-35-years

2.Zidovudine. Wikipedia. Accessed July 14, 2026. https://en.wikipedia.org/wiki/Zidovudine

3.Jerome Horwitz. Wikipedia. Accessed July 14, 2026. https://en.wikipedia.org/wiki/Jerome_Horwitz

4.AIDS drug AZT inventor and famed cancer scientist Jerome Horwitz dies at 93. Wayne State University School of Medicine News. September 7, 2012. Accessed July 14, 2026.
https://today.wayne.edu/medicine/news/2012/09/07/aids-drug-azt-inventor-and-famed-cancer-scientist-jerome-horwitz-dies-at-93-28466

5.Fischl MA, Richman DD, Grieco MH, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med. 1987;317(4):185-191.

6.Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med. 1987;317(4):192-197.

7.ACT UP. Wikipedia. Accessed July 14, 2026. https://en.wikipedia.org/wiki/ACT_UP

8.How AIDS activists fought for patients' rights. History.com. Updated May 28, 2025. Accessed July 14, 2026.

https://www.history.com/articles/act-up-aids-patient-rights