HOW FOUR DOCTORS SPENT THE LAST
QUARTER-CENTURY:
Watching, terrified, as a trickle of
patients became a flood // Battling, bravely, against
activist outrage and social stigmas // Searching,
without pause, for answers // Advancing, inexorably, toward
a cure.
25 Years of AIDS [page 4]
 By
Michael Hirson
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BRUCE WALKER //
1981: Intern, the Massachusetts General Hospital
2006: Professor of Medicine at Harvard Medical School and Director of the Partners AIDS Research Center at the Massachusetts General Hospital
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My first encounter with AIDS came in 1981. A patient arrived at the
emergency room with three simultaneous life-threatening diseases, something
none of us had ever seen. As an intern, this was an eerie, memorable
moment, the first time the people I considered the smartest in the
world—the physicians training us—were stumped too. Similar
cases followed, and we realized we were seeing something entirely new.
I wanted a career in which I could use my skills as both a researcher
and a physician, so I chose infectious disease as my specialty and
focused on AIDS.
Mass General was early to set up a dedicated clinic for AIDS, which made the
hospital a very fertile place to study the disease. You could apply what you
saw in patients to basic research in the lab. Our patients have taught us a great
deal about how the body fights back against AIDS.
In 1994 a man came to the Mass General outpatient clinic.
He told me he was a hemophiliac who had been infected with HIV more
than a decade earlier. “But I’ve never had any symptoms,
never been treated with AIDS medicines, and I feel great,” he
said. “Am I still going to die?”
We could document that he had been infected but found
no virus in his bloodstream. We began to try to understand how this
man and a small number of others, now known as “elite controllers,” were
achieving this remarkable outcome. They might hold the secret to how
the body’s immune defenses keep HIV in check. That would be almost
as good as a vaccine.
Part of the answer seems to be that elite controllers
produce a very large number of cells—known as T-helper cells—that
allow the body to recognize and attack HIV. We are now conducting clinical
trials in which we try to boost this response in patients already infected
with the virus. And we will soon begin seeking additional answers in
elite controllers’ genetic makeup that allow such incredible success
against the virus.
My experiences have convinced me that great advances
in biomedicine come when you link research to clinical care. This is
a lesson we’re taking to the heart of the AIDS epidemic in sub-Saharan
Africa, where almost no basic research has taken place. In 2003 we opened
a research and care facility in Durban, South Africa, with the Nelson
Mandela School of Medicine, where we are trying to understand the viruses
fueling the African epidemic and helping to create improved treatment
programs. In another program, residents can work at a hospital in rural
South Africa. It is a global epidemic, and it is exciting to be involved
where the need is so great. After 25 years, AIDS still takes a terrible
toll, but I have to believe that this is a solvable problem.
 Dossier
1. “In
Their Own Words: NIH Researchers Recall the Early Years
of AIDS” (http://aidshistory.nih.gov).
An online trove of oral histories, original documents
and time lines, recounting the efforts of NIH physicians,
scientists and officials to confront the AIDS crisis.
2. Virus Hunting:
AIDS, Cancer, and the Human Retrovirus: A Story of
Scientific Discovery, by Robert C. Gallo
[Basic Books, 1993]. No scientist was more enmeshed
in the politics of AIDS research than Gallo, who here
answers his critics in an exhaustive—though often
slow-going—account.
3. Shots in the
Dark: The Wayward Search for an AIDS Vaccine, by Jon Cohen [W.W. Norton, 2001]. A perceptive
critique of the bureaucratic wrangling, marketplace
failures and personal rivalries that have held back
development of an AIDS vaccine.
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