Three decades ago, the June 5, 1981, issue of Morbidity and Mortality Weekly Report (MMWR) reported on five previously healthy young gay men in Los Angeles diagnosed with pneumocystis carinii pneumonia (PCP), an infectious disease usually seen only in people with profoundly impaired immune function. As a specialist in infectious diseases and immunology, I had cared for several people with PCP whose immune systems had been weakened by cancer chemotherapy. I was puzzled about why otherwise healthy young men would acquire this infection. And why gay men? I was concerned, but mentally filed away the report as a curiosity.
One month later, the MMWR wrote about 26 cases in previously healthy gay men from Los Angeles, San Francisco and New York, who had developed PCP as well as an unusual form of cancer called Kaposi’s sarcoma. Their immune systems were severely compromised. This mysterious syndrome was acting like an infectious disease that probably was sexually transmitted. My colleagues and I never had seen anything like it. The idea that we could be dealing with a brand-new infectious microbe seemed like something for science fiction movies.
Little did we know what lay ahead.
Soon, cases appeared in many groups: injection-drug users, hemophiliacs and other recipients of blood and blood products, heterosexual men and women, and children born to infected mothers. The era of AIDS had begun.
I changed the direction of my career to study this disease — to the chagrin of my mentors and many colleagues — and began a 30-year journey through this extraordinary global health saga. The early years of AIDS were unquestionably the darkest of my career, characterized by frustration about how little I could do for my patients. At hospitals nationwide, patients were usually close to death when they were admitted. Their survival usually was measured in months; the care we provided was mostly palliative. Trained as a healer, I was healing no one.
In the first couple of years, few scientists were involved in AIDS research, and there was very little funding to study the disease. Initially, we did not know the infectious agent — if indeed there was one — so researchers had no precise direction in which to search.
The first major research breakthrough came in 1983 with the discovery of the human immunodeficiency virus, or HIV, and then in 1984, with proof that it caused AIDS. Our knowledge of HIV/AIDS rapidly grew with the development of a diagnostic test in 1985 that revealed the frightening scope of the pandemic. Our desperately ill patients were just the tip of the iceberg.
The first drug that slowed the progression of HIV/AIDS — zidovudine, initially called AZT — was licensed by the Food and Drug Administration in 1987. For those in the field, this was a major high point. Finally, we could treat the disease instead of just its complications. Soon, however, we learned that the benefits of AZT as a stand-alone treatment waned within months as HIV developed resistance to the drug. The disease relentlessly progressed. The realization that we were in for the long haul began to set in.
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