This story is one in a series of first-person perspectives from those who are working on the frontlines to better understand, treat and prevent transmission of HIV and AIDS as well as COVID-19. You can read more about the 40 years of AIDS in SF and how it has shaped the COVID-19 response.
Our generations have benefitted over the past 100 years from major discoveries with antibiotics and vaccines, doubling life expectancy. It is therefore humbling, in less than four decades, to face another microbial infection that reflects what William McNeill has summarized in “Plagues and Peoples” as a conflict between microparasites and macroparasites on this planet.
In considering the challenges of AIDS and recently COVID-19, it is regrettable that both encountered U.S. administrations that tried to avoid reality by downplaying their importance.
In the case of AIDS, then President Ronald Reagan did not mention the word until five years into the epidemic. At the time, even the UCSF administration tried to suppress the issue to avoid the stigma of UCSF being known as an AIDS-serving university. In the case of COVID-19, then President Donald Trump prevented any major action against the virus. Fortunately, this time, the UCSF response was exemplary.
A major lesson from both viruses is that the federal government’s early actions towards epidemics is very important and we must be well prepared to provide rapidly the scientific facts and needed resources for fighting future pandemics.
A major lesson from both viruses is that the federal government’s early actions towards epidemics is very important…
In terms of treatment and prevention, AIDS was finally controlled by appropriate antiviral therapy that took 15 years to develop after the causative virus was discovered. For COVID-19, no effective anti-virus drug has yet been recognized, but after 15 years of research, we have effective vaccines.
With AIDS, a vaccine has been a major challenge because the virus integrates its genome into human cells and becomes a reservoir for producing often mutated progeny viruses. These infected cells must be targeted and eliminated not only in the body, but also in blood and genital fluids that are major vehicles of transmission. Thus the fields of oncology and infectious diseases overlap and could inform approaches to HIV prevention and treatment.
An important avenue still left unexplored is the immune response in highly exposed individuals who resist HIV infection. We have focused on a novel non-cytotoxic anti-HIV response of CD8 +cells. The persistence of HIV-infected cells contrasts with the cell destruction by the coronavirus. Nevertheless, effective antiviral therapy is still wanting for COVID-19. The challenges involve the need to target the virus within a cell while avoiding toxicity to normal cells.
In fighting both viruses we should have taken better advantage of rapid international communication that, unfortunately didn’t happen, leading to further HIV transmission and widespread transmission of the coronavirus. We must do a better job at harnessing truthful, timely and transparent communication for education, training, and health care. Good public education is also needed to prevent the stigma and counter misinformation that has influenced public responses to both viruses, including effects on politics.
Certainly, in the future, we will face other micro-parasites that challenge us, the macro-parasites, on Earth. This continual struggle requires well-informed individuals with diverse backgrounds who can bring new ideas to the forefront, such as technologies involved in RNA sequencing and gene editing, to move science forward to improve health.
Jay A. Levy is a physician, professor, and cancer researcher in the School of Medicine at UCSF. His lab was one of the first to isolate the virus eventually confirmed as the cause of AIDS.
40 Years of AIDS in SF
Learn about UCSF’s four decades of work in HIV and AIDS, and how it has informed our response to the COVID-19 pandemic.