The making of an era

You’re in: AIDS at 25 Coverage / 25 Years Later: Overview

In 1981, I was on a sabbatical year in the lab of Dr. Robert Gallo at the NIH. I’d been working on retroviruses, looking at the mechanisms by which they appeared to be causing cancer in animals. One of the things we noticed was that these viruses suppressed the immune system.

That year, after young gay men inexplicably started getting sick and dying, the scientific literature was filled with speculation. Theories on the syndrome centered on known infectious organisms and substance abuse, but none could explain the variety of conditions that seemed, suddenly, to be killing people. The situation was extreme, causing fear and blame on all sides. A few religious leaders were preaching that the disease represented God’s wrath against individuals who didn’t share their values, while the mainstream scientific community was being accused of discrimination and of ignoring the disease. Then Haitians began getting sick and dying as well—though none of the assumed risk factors could be associated with the majority—and they too were blamed for spreading the illness.

After a group of scientists at the Pasteur Institute in Paris reported that they had isolated a pathogenic retrovirus from the cells of individuals suffering from AIDS-related illnesses in 1983, Gallo’s lab announced that a retrovirus had been isolated from existing cases of AIDS. Though the two groups would spend years in counterproductive legal battles over the discovery of HIV-1 and rights to royalties, their reports advanced the field enormously by teaching others how to rapidly and efficiently grow HIV in tissue culture and led to the securing of the blood supply, HIV tests and the development of antiretroviral drugs that have helped save millions of lives. Gallo provided my lab at McGill University with the reagents that we needed to work on HIV, and ours became the first Canadian lab that focused on the virus.

The progress toward treatments, however, has been slow. The FDA correctly insisted that a drug be shown to be effective in properly randomized, placebo-controlled clinical trials before being approved for human use. Some anti-HIV drugs were discontinued in clinical trials because of toxic and sometimes life-threatening reactions. AZT was a first important breakthrough, but not one that immediately translated into the saving of lives (the first doses of AZT that were prescribed were far higher than those used today and were responsible for much of the toxicity associated with the early days of therapy).

By the mid 1990s, research was demonstrating the success of highly active antiretroviral therapies (HAART), which have since become the mainstay of the global effort to treat those infected with HIV. At the same time, it was becoming apparent to many of us that unless something changed, only those in wealthy countries were going to have access to these therapies. I became involved at the international level. First, I was elected to the Governing Council of the International AIDS Society, and later I was elected as president. I worked to move the International AIDS Conference to Durban, South Africa in 2000, so that the world’s scientists and activists would experience the intensity and gravity of what pandemic AIDS had wrought on that region.

As a result of the political forces unleashed at Durban, the priority has become the obvious and immediate need to deliver antiretroviral drugs to infected individuals in developing countries. As we’ve worked to ensure that the scientific progress of the past 25 years becomes available worldwide, most pharmaceutical companies have succumbed to greater public and political pressures, permitting generic drug manufacturers to produce and sell less costly versions of patented antiretrovirals. Concerted worldwide efforts by globally recognized personalities like Bono and charities like the Bill and Melinda Gates Foundation—as well as huge investments by governments and NGOs—are now underway to assist with the purchase and distribution of antiretroviral drugs. As many as two million people in Africa are currently receiving antiretroviral drugs as a result of these initiatives, in contrast to the fewer than 7,000 Africans estimated to be receiving HAART in 2000.

A quarter-century into the era of the AIDS epidemic, the global culture is finally starting to grapple with the disease as a nefarious and complex social and scientific problem. Despite enormous progress, however, the epidemic continues to take a major toll. Over four million people each year are newly infected by the virus; millions still die each year of HIV/AIDS, and the disease has caused widespread economic devastation in many countries. This summer, the XVI International Conference on AIDS is taking place in Toronto. Durban was successful because scientists—not politicians—decided to exert social and political influence in combating HIV/AIDS. Now, as the passion and commitment of the scientific community has initiated a series of crucial reassessments, we have to respond to the theme of the conference: Time to Deliver. It’s a call that acknowledges the fact that enormous progress has been achieved since the first case reports on AIDS in 1981—and it demands that we not falter from achieving so much more.

Dr. Mark A. Wainberg is the co-chair of this summer’s XVI International AIDS Conference in Toronto. He is professor of medicine and of microbiology and director of the McGill University AIDS Centre in Montréal. He has published over 300 research articles in the field of HIV/AIDS since 1984, and he was president of the International AIDS Society from 1998 to 2000.

Originally published August 9, 2006


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