There When AIDS Began: An Interview With Michael Gottlieb, M.D.
June 2, 2011
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If you look at the first published report of the disease we now know all too well as AIDS, you'll see this name listed as the primary author: M.S. Gottlieb, M.D. For 30 years, Michael Gottlieb has been at the forefront of HIV/AIDS medicine, advocacy and research -- and through it all, he hasn't lost a drop of his passion or his empathy. In this interview, Dr. Gottlieb sits down with friend and long-term HIV survivor Nelson Vergel to look back over the past 30 years and to ponder the years to come.
Nelson Vergel: I'm honored to have Dr. Michael Gottlieb in this interview. He's agreed to speak to us about the 30-year anniversary of the first report that he made to the CDC [U.S. Centers for Disease Control and Prevention] on the first cases of AIDS.
Dr. Gottlieb, obviously, has been treating HIV since the beginning. He has his own medical practice in Los Angeles. He's one of my heroes. I'm honored to have him here, speaking to us about the first report that he made, and about his thoughts on the present and future of HIV research and access.
Thank you for joining us, Dr. Gottlieb.
Michael Gottlieb: Thank you, Nelson. It's really a pleasure to be here.
Nelson Vergel: Tell us a little bit about what your practice is right now in Los Angeles.
Michael Gottlieb: Right now, I have a private practice, largely in HIV medicine here in Los Angeles, at Synergy Hematology and Oncology. I have two associates, Phillip Musikanth and Alex del Rosario. Between us, we probably care for about a thousand people with HIV.
Nelson Vergel: Let's flash back to 1981 for a moment. I would love to hear details about the day you actually found out about this strange immune disease that you didn't have a name for. Can you tell us a little bit about how that happened?
Michael Gottlieb: Sure, Nelson. It happened innocently enough in the course of a teaching exercise with my post-doctoral fellow at the UCLA Medical Center. I was an assistant professor of medicine, trying to teach the residents and fellows something about immunology.
I asked this particular fellow to go on the ward and ask the intern or resident if we could see a patient, just for teaching purposes -- in other words, if they had any patient with an illness that had immunologic features we would be interested in seeing, purely for the exercise of discussing the patient and learning something about immunology. From my perspective, it was an opportunity to teach the trainee something about immunology.
So the trainee, the fellow who was studying allergy and immunology, went onto the ward and was allowed to see this first patient named Michael, who was a 31-year-old, gay man who had been admitted through the emergency room with weight loss and fever. The patient also had candidiasis [thrush] and, within a week, developed pneumocystis pneumonia.
The intern correctly recognized that the patient must be immune deficient, and that was the reason that he pointed the patient out to us. So that was our very first patient with what came to be called AIDS.
Nelson Vergel: How did you and your team determine the cause of this person's immune deficiency?
Michael Gottlieb: Well, we scratched our heads as to what he might have. His white cell count was low. He had candida, as I've mentioned. And he had pneumocystis pneumonia. It was just such a striking, dramatic illness, and he was so critically ill. It was a distinctly unusual thing for someone previously healthy to walk into a hospital so significantly ill. It just didn't fit any recognized disease or syndrome that we were aware of.
We were fortunate in having access to T-cell testing technology. We determined that he lacked CD4 cells. There had never been a condition described before -- or, for that matter, after -- in which CD4 cells were so conspicuously absent.
Within a few weeks, Joel Weisman and other doctors referred us more patients who fit the mold. They all had pneumocystis pneumonia. We tested their T cells, and they were all CD4 deficient.
That's when we wrote up the report to the CDC that was published in the MMWR, Morbidity and Mortality Weekly Report, on June 5, 1981, and which turned out to be the first report of AIDS as a new disease in the scientific literature.
Nelson Vergel: How long did it take to find out that it was actually a viral illness?
Michael Gottlieb: We speculated in our paper, which was published in The New England Journal of Medicine in December , that this was a potentially transmissible immune deficiency, and we had proposed a viral cause. However, it took two years for the virus to be discovered by Françoise Barré-Sinoussi, Luc Montagnier, and Jean-Claude Chermann at the Pasteur Institute. They described LAV, lymphadenopathy-associated virus, which we now know as HIV-1.
What they did was culture material from the lymph node of a gay man with swollen glands. They cultured his lymph node with human T cells as a culture medium, based on the observation that CD4 cells go missing in people with HIV. The CD4 cells were able to nurture the virus, and they were able to isolate it. They won the Nobel Prize for that a couple of years ago.
Nelson Vergel: Back then, we didn't have a viral load test yet.
Michael Gottlieb: That was a dramatic development in the mid-1990s, the viral load test, which allows for the measurement of the amount of virus in the blood. And that's when we realized that that became a very important benchmark for success in therapy. Now, these days, I'd say that an undetectable viral load is the gold standard of success in therapy, irrespective of what happens with the CD4 count.
This article was provided by TheBody.
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