AS MEDICAL SCIENCE presses forward to find a cure for HIV—and as we mark the thirtieth anniversary of the discovery of HIV as the cause of AIDS—it’s useful in the compressed timeframe known as “AIDS time” to recall one of the most pivotal moments of the now-33-year-long AIDS epidemic: the discovery of the microbe that has wreaked hell on humankind. Such a recollection can help us to appreciate how far we’ve come, and renew our hope and determination to press onward toward our ultimate goal: A world free of AIDS.
Aftermath of a Discovery
The air buzzed with anticipation in the first floor auditorium of the Hubert H. Humphrey Building in downtown Washington, D.C., early in the afternoon on Thursday, April 23, 1984. Every major television network and newspaper had reporters there. Cameras and notebooks were poised, waiting for the announcement that a frightened public and desperate gay community had been waiting for three years to hear. By then, 4,177 cases of AIDS had been diagnosed in the United States; 1,807 Americans had already died, most of them gay men.
On the platform sat a small group of men, each of them a leader of America’s scientific response to AIDS: Dr. Ed Brandt, Assistant Secretary for Health; Dr. Vincent DeVita, director of the National Cancer Institute (NCI); Dr. James B. Wyngaarden, director of the National Institutes of Health; Dr. Peter Fischinger, associate director of the NCI; and Dr. Robert C. Gallo, chief of the NCI’s Laboratory of Tumor Cell Biology.
But it was a diminutive woman with a Washington power-helmet hairdo and laryngitis that everyone was waiting to hear. Margaret M. Heckler, Secretary of Health and Human Services, that day delivered the most exciting news of all to that point in the AIDS epidemic. “First,” she said, “the probable cause of AIDS has been found—a variant of a known human cancer virus, called HTLV-III. Second, not only has the agent been identified, but a new process has been developed to mass-produce the virus. This discovery is crucial because it enables us for the first time to characterize the agent in detail and to understand its behavior. Thirdly, with discovery of both the virus and this new process, we now have a blood test for AIDS which we hope can be widely available within about six months.”
She explained that the blood test, which the federal government had just patented, finally allowed the opportunity to screen the nation’s blood supply to help prevent transfusion-related infections and “promptly and easily diagnose people infected by the virus, and perhaps develop ways to prevent the full syndrome from occurring.” Finally, said Heckler, “we also believe that the new process will enable us to develop a vaccine to prevent AIDS in the future.” She added, “We hope to have such a vaccine ready for testing in approximately two years.”
For three decades, AIDS advocates have conflated the Secretary’s words “hope to have” with a promise she simply never made. What’s more, “ready for testing” said nothing about efficacy. It was conceivable that, with the causative agent identified and available for wide study, a crash program for a vaccine might have been feasible. Certainly no one at the time could have predicted all the challenges that HIV would present in the years ahead. In fact, Heckler’s prediction was right on the mark in that French researcher Daniel Zagury actually did conduct the first vaccine field trials in 1986, in Zaire, known today as the Democratic Republic of the Congo—precisely two years after the press conference.
But the controversy produced by Heckler’s words about a vaccine was nothing compared with the one she then unleashed: “In particular, credit must go to our eminent Dr. Robert Gallo, chief of the National Cancer Institute Laboratory of Tumor Cell Biology, who directed the research that produced this discovery.” She also credited Dr. Brandt for leading the Public Health Service’s efforts; Dr. DeVita; Drs. James Mason and James Curran of the Centers for Disease Control (CDC) and their scientific teams; and the French scientists of the Pasteur Institute, who were the first to detect the previously unknown microbe under their electron microscope.
Gallo said at the press conference, “There have never been any fights or controversies between us and a group in France. I came back from a meeting astounded to see this kind of discussion. The laboratory at the Pasteur Institute and my laboratory have been friends for about fifteen years. We, in fact, are collaborating.”*
Then came Randy Shilts’ 1987 book And the Band Played On, the best-known book about AIDS ever published, though it covered only the first six years of the epidemic and is well known to have fudged the facts for dramatic impact. Among other erroneous reporting, Shilts’ book perpetuated the discredited allegation that Gallo “stole” the French scientists’ virus and claimed to have discovered it himself. Stemming in part from Shilts’ distorted account of the history, in the late 1980s Gallo became the center of a firestorm of accusations, allegations, and investigations that distracted him from work that he was uniquely qualified to pursue.
It’s not overstating the case to say that Gallo was the right man at the right historic moment. Without his landmark discoveries in the 1970s at the level of basic research—the first human retrovirus, when the scientific community claimed there was no such thing, and his 1976 discovery of Interleukin-2, which allowed him to culture and grow the virus in the high quantity needed to study it—treatments that saved countless lives could have taken many more years to develop than they did. It was this knowledge base that allowed Gallo to make what is considered the most crucial scientific discovery in connection with a newly identified microbe: proving that it’s the cause of a particular disease. Whereas the French scientists simply found something new, Gallo proved not only that it was a retrovirus but that it was the cause of AIDS.
High-stakes international politics have robbed Gallo twice of the Nobel Prize for his crucial discovery. Meanwhile, the French scientists have received the Nobel and floated unscathed above a scandal promulgated in the name of science that had nothing to do with science and everything to do with envy and greed. As Nikolas Kontaratos demonstrates with voluminous evidence in Dissecting a Discovery: The Real Story of How the Race to Uncover the Cause of AIDS Turned Scientists against Disease, Politics against Science, Nation against Nation, the real issue had nothing to do with scientific discovery, but with French government lawyers’ lust for a bigger share of the profits that the U.S. government would reap from the HIV blood test that Gallo had developed.
Proving that a newly discovered retrovirus was the culprit behind the growing AIDS epidemic was the first major milestone in unlocking the mysteries of the deadly plague. Developing a blood test to detect infection was the second, made possible only by knowing what exactly to look for. Only after those foundations had been laid could medical science begin to investigate ways to treat those infected with HIV and move toward developing drug therapies, preventive and therapeutic vaccines, and ultimately a cure.
HIV/AIDS in the U.S. Today
The CDC today estimates that 1.1 million Americans age thirteen years and older are living with HIV—including nearly one in five who don’t know they’re infected. About 50,000 more people are infected each year. Since the epidemic began in 1981, an estimated 1,155,792 people in the U.S. have been diagnosed with AIDS. Of the approximately 636,000 Americans killed by AIDS, the CDC estimates that 302,148 have been gay and bisexual men—or “men who have sex with men” (MSM) as the CDC generically categorizes us.
Gay men continue to bear the greatest burden of HIV infection. Although MSM represent only an estimated four percent of the male population in the United States, we account for 78 percent of new HIV infections among males—and 63 percent of all HIV infections. The number of new HIV infections is greatest among thirteen to 24-year-old MSM, particularly young African-American men, who accounted for 55 percent of all new HIV infections among young MSM overall.**
Looking Ahead to a Cure
For an informed perspective on the various efforts underway to find a cure for HIV infection, I went to the source of those early major milestones in the epidemic, Dr. Robert Gallo. Today, at nearly 79 years old, Gallo still directs the Baltimore-based Institute of Human Virology that he founded in 1996, one of the world’s foremost sponsors of clinical and laboratory research on HIV and other infectious diseases.
I asked Gallo whether a so-called “functional” cure will be enough to keep HIV sufficiently in check that people with the virus can perhaps go months between medical treatments—or if a “sterilizing” cure, a complete and provable eradication of all traces of the virus, is considered a viable goal. “It’s very important to define our terms,” Gallo replied. “A functional cure generally means people are living a reasonably normal life, maybe a completely normal life. They still carry some evidence of the virus, very low, not doing any damage. But they still take their drug. This can be regarded as a ‘cure’—cure in quotes.” With antiretroviral drugs now able to manage HIV infection, Gallo said “we already have a functional cure.” But is it really a cure when we still have to take expensive, toxic drugs? Gallo replied with a question: “Can we reach a state where you don’t need drugs, where there is no damage from residual virus? The answer is unknown.”
Gallo was skeptical of the claim that the so-called “Berlin patient,” Timothy Brown, was totally cured of HIV. “We know many animals, monkeys,” he said, “that we thought were totally free until they died or the monkey was sacrificed. If you looked at the intestinal tract and the brain, you would find virus sequences. So they weren’t totally virus-free.” Even if Brown had a true sterilizing cure, he added, the radical and expensive procedures used to treat his lymphoma and reconstruct his immune system are “not relevant to the vast majority of the world.”
Gallo said the ultimate solution, a real sterilizing cure, would be to get genes into a sufficient number of T-cells—the white blood cells that HIV infects—that enzymes can be directed to cut out the HIV genes that have become part of the T-cells’ own genetic makeup. “That would give rise to new cells without the virus,” he said. One potential gene therapy now being explored would involve knocking out the CCR5 receptor, the T-cell’s portal that allows HIV to enter it. Closing the door would keep out the virus and let the body eventually eliminate it.
While these approaches are being studied, the current rage in HIV cure-related research is called “purging” or “shock and kill.” Basically, it involves using existing HIV medications to “smoke out” the latent virus lying dormant in reservoirs within the body, particularly the brain and gut. Because of these reservoirs, the latent virus revives itself quickly after people stop taking their antiretroviral drugs. In theory, reactivating the latent virus and the cells it has infected will allow the drugs to kill it and then block new infection of other T-cells.
Gallo offers two objections to this approach. First, he said, “no one has ever proved that once you activate the virus, the cells die.” Second, “what’s the evidence that you completely protect the other cells by using anti-HIV therapy?” He said the purging concept is not based on proven, sound principles. “I’m not a prophet,” he told me. “But from what my thinking will tell me, it’s not likely to work and could make it worse.”
Gallo may not be a prophet, but the renowned microbiologist’s comments were certainly prescient in light of news that emerged at the end of October. A study published in the journal Cell showed that the reservoir of latent HIV could be sixty times larger than previously thought. Not only that, the latent virus is by no means defective—as previously believed—but fully capable of swinging right back into action once it is awakened. “These results indicate an increased barrier to cure,” said senior study author Robert Siliciano, of the Johns Hopkins University School of Medicine. “Although cure of HIV infection may be achievable in special situations, the elimination of the latent reservoir is a major problem, and it is unclear how long it will take to find a way to do this.”
Siliciano’s wife and Hopkins research partner biochemist Janet D. Siliciano was rather more optimistic in an interview with The Los Angeles Times. “I don’t think it’s discouraging,” she said. “Our approach has always been to try to understand the latent reservoir. Everything that we’re doing just gives us more information about the reservoir, and about the mechanisms of latency. I think the more we learn about what works and doesn’t work helps us go forward.”
One of the important lessons from the hiv/aids epidemic—a reminder, really—is that scientific knowledge is cumulative in nature. Dr. Gallo’s highly specialized knowledge and skills at the beginning of the epidemic enabled him to make the essential connection between HIV and the once mysterious, deadly disease called AIDS. Likewise, the work of scientists such as the Silicianos serves to fill important gaps in the knowledge of HIV. Of course, we lament that we still do not have a cure for HIV. But a fair-minded assessment at this important anniversary must acknowledge the extraordinary progress that has been made toward understanding, containing, and eventually ending the reign of terror of one of humanity’s deadliest enemies.
* Executive Court Reporters. Press Conference: Secretary Margaret Heckler, April 23, 1984. Jon Cohen AIDS Research Collection at the U. of Michigan.
** Centers for Disease Control and Prevention. “HIV among Gay, Bisexual, and Other Men Who Have Sex With Men” (fact sheet).
John-Manuel Andriote has been an HIV/AIDS journalist since 1986, has been living with HIV since 2005, and is the author of Victory Deferred: How AIDS Changed Gay Life in America.
