As AIDS Turns 30, Scientists Reminisce
JACKI LYDEN, host:
This is WEEKEND EDITION from NPR News. I'm Jacki Lyden.
Thirty years ago today, the Centers for Disease Control published a report on five mysterious cases of pneumonia - mysterious because they were caused by immune system deficiencies that were harbored in otherwise healthy gay men. The world later learned that this was the virus that causes AIDS.
Today, an HIV diagnosis is not the death sentence it once was, but there are still about 40,000 new cases annually in the U.S., and millions still suffer around the globe. A vaccine, promised in the 1980s, has yet to be found.
Donald Abrams and Paul Volberding were some of the first doctors to study this strange, new disease. Today, Donald Abrams is the chief of hematology-oncology at San Francisco General Hospital, and professor of medicine. And Paul Volberding is a professor of medicine, and co-director of the Center of AIDS Research at University of California, San Francisco. They join us now from the studios of KALW in San Francisco. Thanks for being with us.
Dr. DONALD ABRAMS (Chief, Hematology-Oncology, San Francisco General Hospital; Clinical Medicine, University of California, San Francisco): Great to be here.
Dr. PAUL VOLBERDING (Professor of Medicine, Co-Director, Center of AIDS Research, University of California San Francisco): A pleasure.
LYDEN: Donald Abrams, may I start with you? What pulled you into this fear of HIV-AIDS research? You were basically a resident when you started looking at this, right?
Dr. ABRAMS: Yeah, actually, I was a resident in 1979 when we started to see a lot of cases of gay men with swollen glands. And after doing a lot of blood tests, I couldn't figure out what caused their glands to be swollen. Their immune system looked like it was revved up.
So then, two years later, Paul brought to my attention - after I actually heard on the radio the first reports of an outbreak of cancer in gay men - that I should become interested in this problem, when I found myself working in retrovirology labs. So it was, for me, a case of being a bit in the right place at the right time.
LYDEN: Paul Volberding, you came at this from a slightly different angle. What was your first encounter with HIV-AIDS?
Dr. VOLBERDING: Donald and I actually both worked in retrovirus labs but I decided to leave the lab and take a clinical job at San Francisco General Hospital. And literally, on my first day on the job, while seeing patients on the wards, came across a 22-year-old man with Kaposi sarcoma, the cancer that later became so identified with AIDS. He was...
LYDEN: That causes the skin...
Dr. VOLBERDING: Yeah...
LYDEN: ...lesions and discoloration.
Dr. VOLBERDING: Exactly. But I hadn't ever seen a case of that in my training. And when I read about it, it was supposed to be a disease that was rare in young men. So it was a pretty remarkable moment.
LYDEN: What were your thoughts back then - either of you - dealing with a population - these men were gay, but they were also really young. You're dealing with healthy, young people, and something is descending that you don't understand - and they certainly couldn't have understood.
Dr. VOLBERDING: For me, it was a huge part of the excitement, if you will, but also the terrifying nature of this disease, that the people we were seeing were exactly our age. I was 31 at the time, and a lot of the early patients were in their 20s - late 20s, early 30s, and they had a truly horrible disease. And all of them died.
Dr. ABRAMS: For me, this was my community. I'm a gay man in San Francisco. I also was 31 at the time. These were my friends, and these were my colleagues. And it was impossible to leave work because when I got home, people called and said hey, can you come over and look at this spot; or can you feel this swollen gland; or, what's going on with my partner? And it was really intense. But we both lived through toxic shock syndrome and Legionnaires disease during our medical training, and I think we thought that...
Dr. VOLBERDING: This would go away ...
Dr. ABRAMS: Yeah, we'd solve it, and it would be the same. And little did we think that we'd still be talking about this 30 years from now as a devastating illness.
LYDEN: Donald Abrams, when did it dawn on you that this was a devastating pandemic?
Dr. ABRAMS: At the beginning, we knew all of the patients that we took care of in San Francisco, and we knew all the patients in San Francisco with the disease. But then, the numbers started to increase, increase, increase, even in those early years - and then, we didn't know their names. And then I said wow, this is big. I think - let's say - 1991, San Francisco was just devastated. I mean, men were walking around in the Castro as skeletons, suffering from the wasting syndrome.
I remember on a TV interview, telling the woman interviewing me that my grandmother complained that all of her friends were demented or dying. And I said yeah, Grandma, so are mine and I'm, you know, quite a bit younger than you are. But it was exhausting and - but we fought on.
Dr. VOLBERDING: Yeah, the story that I remember is of talking to a minister of a Lutheran church in the Castro. This is a gay neighborhood; it's a largely gay church. And he said that they had one assistant minister who did nothing but help with the dying patients, and that they lost 10 percent of their congregation every year to this disease.
Dr. ABRAMS: Well, and half of the gay newspaper was obituaries. And you know, now it's sort of empty.
LYDEN: When was there a sense that the tide had turned, and that you were actually on the attack against the disease?
Dr. VOLBERDING: Ninety-five, '96 is when the combinations of treatments really did begin to turn things around.
Dr. ABRAMS: So it was really 15 years into the disease before we really saw any evidence that we were turning the tide.
Dr. VOLBERDING: Right.
LYDEN: What would you say the obstacles are remaining - either of you?
Dr. ABRAMS: As someone who's not directly involved anymore in the field, I think the challenge is really, trying to promulgate the prevention message. And Africa's a problem, but Asia also has a huge problem. And you know, access to care and also packaging a prevention message that's acceptable to the populace that exists.
LYDEN: Today, what about the field? There's not a vaccine nor a cure, but conferences with optimistic titles like the Road to a Cure, the Road to a Vaccine. What's the field focusing on?
Dr. VOLBERDING: Well, the treatments that we have here, for Americans with access to care, are really quite good. They're much more convenient than they used to be; they're much less toxic than they used to be. But they still have drawbacks. And the hope now is that the thought that there might be the possibility of a cure, there's also still a lot of work to find a vaccine.
And having just returned from Africa, it's clear that as good as the treatments might be, if you have to take medicines every day for the rest of your life, there's no way that can be sustained in Africa. And so it's interesting to me that the most advanced technology - i.e., finding a cure - is really most needed in the most resource-limited settings.
LYDEN: Donald Abrams is the chief of hematology-oncology at San Francisco General Hospital, and a professor of medicine at UCSF. And Paul Volberding is a professor of medicine, and co-director of the Center of AIDS Research, at University of California, San Francisco. They joined us from the studios of KALW in San Francisco.
It has been wonderful to speak with both of you today as we look back 30 years ago, on the discovery of AIDS. Thank you.
Dr. ABRAMS: Thanks for the opportunity, yeah.
Dr. VOLBERDING: A pleasure.
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