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HIV and the Blood Supply: An Analysis of Crisis Decisionmaking
In conjunction with the first cases among hemophiliacs, CDC Director William Foege asked public health officials to inform physicians caring for patients with hemophilia about the three cases of PCP among patients with hemophilia. He wrote to inform state and territorial health officers, industry representatives, the Assistant Secretary for Health, the FDA Commissioner, the Director of NIH, and all CDC regional offices that the CDC was conducting surveillance of the new disease and gathering additional information to determine the significance of the incidence reports. In addition, he asked physicians to immediately report cases of opportunistic infections or suspected acquired immune deficiency through state health departments to the CDC (Foege 1982a).
At the July 16, 1982, PHS meeting, a Committee on Opportunistic Infections in Patients with Hemophilia was established to exchange information about the cases, to characterize their similarity to other risk groups, and to conduct surveillance of both hemophilia cases and antihemophilic factor (AHF) concentrate (Public Health Service July 1982). The committee held its second meeting on July 27, 1982; representatives from the PHS, CDC, FDA, NHF, ABRA and NIH attended. The committee, chaired by Dr. Foege, adopted the term "acquired immunodeficiency syndrome" (AIDS), and decided to focus on two goals: to determine if the underlying immunodeficiency seen in hemophiliacs had the same etiology as in other groups with acquired immunodeficiency, and to determine if certain blood products were risk factors for AIDS (Foege 1982b) (see further discussion below).
By September 1982, 593 cases of AIDS had been reported to the CDC. Of these cases, 445 of the patients were homosexual men, 77 were IV drug users, 36 were Haitians, 3 were hemophiliacs, and 32 had no defined risk; 41 percent had died (CDC, MMWR, September, 24, 1982). In an editorial note, the CDC defined AIDS as:
… a disease, at least moderately predictive of a defect in cell-mediated immunity, occurring in persons with no known cause for diminished resistance to that disease. Such diseases include Kaposi's Sarcoma (KS), Pneumocystis Carinii Pneumonia (PCP), and other serious opportunistic infections. … This case definition does not include the full spectrum of AIDS manifestations, which range[s] from absence of symptoms, to specific diseases that are insufficiently predictive of cellular immune deficiency to be included in incidence monitoring [CDC, MMWR, September 24, 1982].
The reference to an "absence of symptoms" suggests that as early as the autumn of 1982 researchers were beginning to establish that the new disease might have had an asymptomatic incubation period.