Though 25 years have passed since he saw his first patient with
AIDS, Dr. Michael Gottlieb, an assistant clinical professor of
medicine at the David Geffen School of Medicine at UCLA, said he
remembers that patient in more detail than the patients he saw
yesterday.
Gottlieb, who was a 33-year-old assistant professor of
immunology at UCLA in 1981, had been working at UCLA for only six
months and was looking for patients with immunological problems
because he had “nothing better to do.”
What he found was a 31-year-old man he described as “thin,
gaunt, with bleached-blond, closely cropped hair and an early punk
look.” The patient had been admitted to the UCLA Medical
Center after suffering a fever and dramatic weight loss. A week
later, he had developed a rare type of pneumonia, previously found
only in people with severely suppressed immune systems.
After running several laboratory tests, including a new research
test to examine T-cells, a type of white blood cell which functions
as part of the body’s immune response, and seeing four other
patients with similar symptoms, Gottlieb knew he had found
something big.
On June 5, 1981, he published a short article in the Center for
Disease Control’s Morbidity and Mortality Weekly Report, and
became the discoverer of a new disease.
Twenty-five years and millions of patients later, this disease
is known as AIDS and is a leading cause of death worldwide.
“We had no idea that we were on the cusp of a global
epidemic where 65 million people would be infected with the same
virus that caused the illness in our first five patients,”
Gottlieb said.
At first, Gottlieb and his fellow researchers thought the
disease would be a limited, brief outbreak. But after the CDC
report was published, it was clear that they had only seen a
handful of the patients who had cropped up nationwide.
“The phones started ringing from doctors all over the U.S.
asking about their own cases,” he said. “It had been
smoldering for several years already, we just brought it to
attention.”
Working within the branch of immunology, Gottlieb and the
division were accustomed to dealing with rare diseases that
affected only small percentages of the population.
“Nobody realized the full implications at the
beginning,” said Dr. Andrew Saxon, chief of the Clinical
Immunology and Allergy Division at the UCLA Medical Center then and
now. It was only after talking with an epidemiologist about the
potential for dramatic spreading of the disease through sexual
transmission that Saxon realized the mass public health
implications.
“If I had been brilliant, we all could have helped alert
the world. People realized it was important, but we didn’t
know it’d change the shape of Africa,” Saxon said.
“We said, “˜Wow,’ but maybe not loud
enough.”
Originally, Gottlieb had named the disease GRID, or gay-related
immunodeficiency disorder, because his earliest patients with AIDS
were gay.
But “quickly that proved to be inaccurate, because AIDS
was described in transfusion recipients, intravenous drug users,
prisoners, babies and hemophiliacs,” Gottlieb said.
Within a year, the CDC changed the name to AIDS.
“It was important that they chose that, because it
didn’t stigmatize any group,” Gottlieb said.
Myths continued to circulate, however, and the “tag has
been difficult to remove,” despite evidence that AIDS has
been unleashed beyond specific groups of individuals, such as gays
and intravenous drug users, he said.
Currently, UNAIDS, the Joint United Nations Programme on
HIV/AIDS created to develop a global response to the disease,
maintains that the AIDS epidemic has a disproportionate impact on
women. According to the 2006 Report on the Global AIDS Epidemic, in
some areas of sub-Saharan Africa, HIV infects two to three women
for every man.
Following the original discovery, researchers from other fields
quickly got involved.
“I had certainly no idea at the time that this would
devastate the world; I don’t think anybody did,” said
Dr. Yvonne Bryson, chief of the Pediatric Infectious Diseases
Division at the UCLA Medical Center, who remembers being asked by
Gottlieb to see his first three patients. “Nor did I have an
idea that it would affect women and children, which is who it
mainly affects now.”
Since then, Bryson has worked on treating infants and using
antiviral drugs, and helped to reduce the transmission of AIDS
between mothers and infants by 70 percent in 1995.
She said she was optimistic about finding a successful
preventative vaccine.
“That’s the way to stop the epidemic ““ … to
vaccinate infants and children,” she said. “We are
probably some years away, but we’re making
headway.”
Gottlieb, too, continued to treat patients with AIDS and conduct
clinical research at UCLA. He published more than 50 papers and
received one of the earliest grants for AIDS research given by the
National Institutes of Health.
But the AIDS epidemic proved to be a touchy social issue.
Gottlieb was one of the few scientists who was willing to speak
openly to the media in the early stages of the epidemic, but he did
so at a price. His frequent media appearances garnered disapproval
from colleagues and superiors, and he found it increasingly
difficult to “stay on the cutting edge of AIDS, socially as
well as academically.”
He found himself “not just the eye of an epidemic, but in
the center of intense media attention” in 1985, after movie
star Rock Hudson’s diagnosis, which Gottlieb said was an
important milestone for increasing public knowledge about AIDS.
In 1987, he was denied tenure and went into private
practice.
Since then, he has continued to treat patients and work directly
with pharmaceutical companies to develop clinical trials of new
antiviral drugs. He also serves as a clinical faculty member at the
UCLA Medical Center.
“I’m committed to staying in the field,” said
Gottlieb, who is confident there will be a cure for the disease.
“It’s just a matter of time.”
“AIDS is a sad, but also a fascinating story. It’s
an evolving story and it reads like a suspense novel. It’s a
page-turner,” he said. “I’m proud to have been
there at the beginning.”