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Posted: 12 May 2011
30 years in 30 weeks, 1982

Categories: comment, opinion piece

In 1982, reports of immunodeficiency in previously healthy individuals continued to roll in. The key question at that time  was to determine its  cause  and how it was spreading in the community. The first case reports of immunodeficiency came primarily  from gay men, but soon scientists realized that other cases were linked to this phenomenon as well – intravenous drug users, women, and children. This known linkage helped to identify blood and sexual intercourse as primary modes of transmission. In a paper published in 1982, Masur et al. describe women who were either drug users themselves, or sexual partners of drug users. The authors immediately realized the importance of this finding for the epidemiology of AIDS (as it was officially named by CDC in September of that year).  In a 1989 interview with the NIH about the history of the AIDS epidemic, Dr. Henry Masur described how he became involved in HIV research. Below are the excerpts from this interview, the full text can be found here:

Opportunistic Infection in Previously Healthy Women.  Initial Manifestations of a Community-Acquired Cellular Immunodeficiency

Annals of internal medicine 1982 ;97(4): 533-9.

Masur H; Michelis M A; Wormser G P; Lewin S; Gold J; Tapper M L; Giron J; Lerner C W; Armstrong D; Setia U; Sender J A; Siebken R S; Nicholas P; Arlen Z; Maayan S; Ernst J A; Siegal F P; Cunningham-Rundles S

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1981 < All years > 1983

I became involved with AIDS in a very indirect way […] I was interested both in immunosuppressed   patients and in tropical medicine. Pneumocystis was something that affected both immunosuppressed patients and patients in some developing countries, such as in orphanages following World War II […]

In 1979, after I had been in Brazil, I came back and was on the Cornell faculty when I attended the first patient who came into the emergency room with what turned out to be, after a long work-up, Pneumocystis pneumonia. It was clear to me, because I knew the literature very well, that it was very unusual for someone previously healthy to walk in with Pneumocystis. […]

It is interesting how life is serendipitous. One of the people whom I have mentioned was working on putting this data together. Her work was delayed by a pregnancy, so, as a result, she was slow completing her portion of the case report. […] By the time she got the data together, we had seen two more patients. […]

We presented one of the cases at intercity infectious disease rounds in New York, and several people came up to us and said they had similar cases. So, we went around and we collected a dozen cases. These cases were being seen at a variety of different hospitals. […]

We did not know about [Dr. Michael] Mike Gottlieb's cases in Los Angeles. So, at this point, it was clear to us that we had seen about a dozen men with Pneumocystis, but it not clear whether they were immunosuppressed because they had been infected with a virulent strain of Pneumocystis, which had somehow altered their immunity, or whether they had somehow become immunodeficient due to something else. It was not at all clear that this was a major public health problem. It seemed to be an unusual issue, and the major focus was whether or not there was some kind of an environmental exposure. We did not know that they were all gay or intravenous drug users. […] Not as many people knew about the gay culture then as they do now. […]

Just as I was leaving New York at the end of 1981, we started seeing women with the disease, although they were mostly drug users. That was published by my group in about mid-1982, but by the end of 1981, we were beginning to see it in women. Then, in 1982 and 1983, it was clear that there were two main groups infected: homosexuals and IV drug users. The assumption was that it was something transmissible through blood. Although there were people speculating about a virus, there were a lot of different theories as to what kind of thing might be transmissible. […] There were a number of people who felt strongly that it could be a virus, but until Dr. Gallo or the French, depending upon which you want to give the initial credit to, showed the strong correlation, viral etiology was just one of a number of different theories. […]

It really took a combination of basic science and clinical science to bring the patients in, to recognize the important patient-care-related problems, but also to do, very quickly, a lot of the groundwork in immunology and virology. It required the range of expertise that we have at NIH from basic immunology, basic retroviral studies, basic herpes virus studies, to very good autopsy studies. […] Progress was made as part of this integrated team.  To me, that was what made NIH an exciting, attractive place to work.

About the author: Dr. Masur is currently chief of the critical care medicine department at the NIH Clinical Center. He is a leading clinical researcher who continues to study better ways to treat HIV disease and its associated opportunistic infections.

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Posted by: alleslie, 13 May 2011 5:28 am

A few years back i attended the 25th anniversary meeting of the identification of HIV as causative agents of AIDS at the institute Pastuer and now we have the 30th anniversary of the first recognized AIDS cases. The standard media line for time of scientific breakthrough to meaningful therapy, be it cancer, gene therapy or vaccine seems to be about 5 years. Does the field have reason to make this make this statement for the 6th time, and if we do, do we have any right to expect anyone, be they scientists, public health professionals, policy makers or general public, to take us seriously?

On one hand such statements maybe seen to maintain the profile of HIV research but on the other risk diminishing the credibility of our current and future claims. The partial success of the RV144 vaccine and the astonishing efficacy of the "test and treat" discordant couple trail (96% of uninfected partners in a discordant couple protected if infected partner is on continous ARVs), suggests real reason for optimism, but it remains hard to know what to say when someone comes back with "yeah, but you said that last time..."