Twenty-five years ago today, the Centers for Disease Control (CDC) published the first official document on the disease that later became known as AIDS. The Morbidity and Mortality Weekly Report described five cases of Pneumocystis carinii pneumonia, a type of pneumonia typically caused by a suppressed immune system. All five cases were young men in Los Angeles who were homosexual and previously healthy. By the time the report was published, two men had died.
A month later, UCSF's Paul Volberding, MD, saw his first case of AIDS on his very first day of work at San Francisco General Hospital. The patient was a 22-year-old man with a rare skin cancer, Kaposi's sarcoma, which causes lesions across the chest. By the end of 1981, nine people in San Francisco had died from this mysterious disease.
Over the next few years, cases in San Francisco increased rapidly and, by 1984, more than 800 cases (one per 1,000 people) had been reported. In these initial years, Volberding realized the need for a central location for HIV patients. In January 1983, he established the first HIV outpatient clinic in the country, Ward 86 at San Francisco General Hospital. The clinic is now called the Positive Health Program, and is directed by Diane Havlir, MD, UCSF professor of medicine.
HIV/AIDS in 2005
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"We didn't know what it was, but we became known as the place where we were interested in the disease. We weren't afraid of it," said Volberding, now professor of medicine at UCSF. "With only a handful of us, we began treating the sickest patients anyone had ever seen."
Throughout the 1980s, HIV spread exponentially, not only as a sexually transmitted disease, but through intravenous drug use and through blood transfusions, which predominantly affected hemophiliacs. In that decade, HIV was a relentless virus that spread quietly from needle to needle, contaminated thousands of blood banks and, of course, devastated a generation of gay men. What began as a medical curiosity in 1981 has become the most catastrophic pandemic of our time.
From the beginning, UCSF has been on the front lines of this battle. In September 1983, virologist Jay Levy, MD, was one of the first scientists to isolate and characterize the retrovirus HIV.
"In 1983, I had no idea of the impact this virus would have," said Levy, now UCSF professor of medicine. "Since it was hitting San Francisco so hard, we felt dedicated to finding a solution for people in this city."
Once the virus was identified, therapy was the next step. AZT hit the scene in 1987, and most people with HIV saw an improvement within a matter of weeks. But there were severe side effects and, since the drug had to be taken every four hours, people were not consistent with the regimen. Also, AZT was very expensive, and since most of the people with HIV were poor and unemployed, this generated intense activism that continues today.
Although the CDC reported that 1 million Americans were infected in 1991, by the mid-1990s, hope was on the horizon. In 1995, UCSF's Charles Craik, PhD, now professor in the School of Pharmacy, developed a drug called a protease inhibitor. A year later, scientists developed antiretroviral therapy, or the miraculous "triple cocktail," which was a combination of three HIV-suppressing drugs, each with less toxic quantities. And this year, drug companies have formulated a single, once-a-day pill, which is currently pending Food and Drug Administration approval.
With the development of antiretroviral therapy, the year 1996 was a turning point. With this therapy's drugs, people with HIV regained a functioning immune system. Suddenly, contracting the virus was no longer a death sentence, but a chronic and manageable disease.
"In the first 15 years, we didn't see anyone who didn't die. And now, with the antiretroviral drugs, that's history," said Volberding. "Now we approach treatment with the expectation of success, whereas, before 1996, we approached it with an expectation of failure."
In the last 10 years, UCSF has continued to be a leader in all aspects of the epidemic, from drug and vaccine research, to clinical treatment, to prevention and education programs on a global scale. On campus, Levy, Warner Greene, MD, PhD, professor of medicine, Steven Deeks, MD, associate professor of medicine, and Robert Grant, MD, associate professor of medicine, are at the forefront of understanding the nature of the virus, researching possible vaccines and drug resistance factors. Extensive UCSF programs in Africa are being led by Nancy Padian, PhD, professor of obstetrics, gynecology and reproductive sciences, David Bangsberg, MD, associate professor of medicine, William Holzemer, RN, PhD, professor and asociate dean in the School of Nursing, and Kimberly Paige-Shafer, PhD, associate adjunct professor of medicine, to name only a few.
The AIDS Research Institute (ARI) was established in 1996 by Haile Debas, MD, who was at that time the dean of the School of Medicine. This institute brings together hundreds of Bay Area scientists to provide a central location for collaboration and a coherent vision to the multidisciplinary programs of AIDS. Today, John Greenspan, PhD, professor in the School of Dentistry, directs the ARI and coordinates more than 50 programs studying the biological, epidemiological and socioeconomic factors of the epidemic.
"UCSF is in its third generation of care and research of HIV. There were the early pioneers who became committed to the epidemic out of personal conviction - they had friends and family who were dying," said Greenspan. "It was an opportunity to make a contribution. It's like war. Sometimes it brings out the best in people. People get committed."