By Kate Volkman Jay Levy, MD, pioneer AIDS and cancer researcher, remembers the day in 1981 when a former student introduced him to a patient suffering from Kaposi's sarcoma, a rare form of cancer that indicates AIDS. "We had been looking for a human virus that causes cancer," he recalled. Instead, Levy ended up co-discovering HIV. Levy and his colleagues, world-renowned AIDS researchers and physicians, came together June 5 to mark the 26th anniversary of the first reported cases of AIDS. The group, on the front lines since the start of the epidemic, shared their experiences at a luncheon hosted by the AIDS Research Institute (ARI) at UCSF and the UCSF Office of Planned Giving for Bay Area estate planning professionals. Levy's former student, oncologist Paul Volberding, MD, now director of the Center for AIDS Research at UCSF, recalled the early response while working at the UCSF-affiliated San Francisco General Hospital. "Right away, we started using community organizations to communicate about the disease," he said. "It wasn't just about patient care; it was about providing comfort. People in the U.S. have since forgotten the pain we experienced then." But Steve Morin, PhD, director of the Center for AIDS Prevention Studies, remembers. "I have a picture of me and my friends at a Christmas dinner back in the '80s. There were 12 of us, and I'm the only one left." John Greenspan, BDS, PhD, director of the ARI, reminded the group that more than 65 million people worldwide have been infected by HIV/AIDS, 25 million have died and 45 million are currently living with the disease. To combat those astounding numbers, physicians and researchers at UCSF are pursuing multiple paths. "The AIDS program at UCSF is consistently ranked No. 1 by U.S. News & World Report in its annual survey of medical schools," he noted. "We cover every aspect of HIV/AIDS," said Levy. "Ask us about any subject, and we've got an expert. We're the largest institution working on HIV/AIDS outside the National Institutes of Health." Impact in Africa Nancy Padian, PhD, ARI director of international research, focuses on Africa, where 12 million children are orphans as a result of AIDS. "One-quarter to one-third of the entire population of Zimbabwe is infected," she said. "No one there is untouched by AIDS. No one hasn't dealt with death or sickness, or suffered the devastating consequences of this disease." Treatments have evolved remarkably to the point that now an HIV-infected person can take one pill a day, a regimen that combines three potent medicines. President George W. Bush recently proposed to double the funding for the President's Emergency Plan for AIDS Relief, which brings life saving antiretroviral treatment to developing countries. And there are long-term survivors of HIV/AIDS - people who have lived with the disease for more than a decade.
"But these are not long-term solutions," said Levy. For every person who starts antiretroviral treatment, six more will become infected. "The solution is to boost our immunity to the virus and to develop a vaccine." That's exactly what Levy is working toward in his research now.
Padian is working toward prevention in women, both in Africa and in San Francisco's Mission District. She's studying why women are more vulnerable to HIV/AIDS, and is finding reasons ranging from biological to cultural to gender disparities and inequalities. Padian is researching condoms for women, microbicides, which are a topical application of antiretroviral drugs, and whether protecting the cervix will guard against HIV. She's also studying whether giving adolescent women in Africa economic independence will protect against the disease.
HIV and Aging
Malcolm John, MD, studies disparities among men of color in the United States, where 40 percent of HIV-infected persons are African Americans. As director of 360: The Positive Care Center at UCSF, he's also studying HIV and aging. John says that 70 percent of the HIV-infected population in San Francisco is over the age of 40.
John is finding that as long-term survivors get older, they develop problems at a rate considered disproportionate to their peers. "One of our patients developed heart failure," he said. "When all standard health tests that would reveal the cause of his heart failure came back negative, we wondered if he could have HIV cardiomyopathy. This is usually seen in people with advanced HIV/AIDS, but this patient had never even required treatment for his HIV. His cardiologist, noting that the patient had been infected with HIV/AIDS since the late '80s, wondered whether the patient's cardiomyopathy was related to the duration of his HIV infection alone. Despite his long-term survival, chronic HIV infection was impacting his overall health."
Other problems for aging HIV-infected patients include coronary artery disease, bone loss, certain cancers, liver disease and memory-cognitive loss. John said that 360 is developing a collaborative group of physicians and researchers to study the link between HIV and aging in these areas.
Morin concurred that "HIV is still a major issue among gay men. In San Francisco, more than 40 percent of gay men over the age of 40 are infected with HIV."
Recognizing the audience at the anniversary luncheon as estate planning professionals, Morin said, "I think gay men and women are highly motivated to do something to honor their adult lives and the lives of their friends and families in the gay community. Giving to the AIDS Research Institute would be tremendously meaningful for them, and wonderfully helpful to us."
AIDS Research Institute
Center for AIDS Prevention Studies (CAPS)
UCSF-GIVI Center for AIDS Research (CFAR)
360: The Positive Care Center at UCSF
25 Years of AIDS: June 5, 1981 - June 5, 2006
UCSF Today, June 5, 2006
UCSF Today, June 5, 2006