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There When AIDS Began: An Interview With Michael Gottlieb, M.D.

June 2, 2011

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Watching an Epidemic Unfold

Nelson Vergel: During those few years in which you basically were scrambling to find out what the causal pathogen was, what were you doing? Were patients coming to you every day from all over? Were you taking phone calls from around the country?

Michael Gottlieb: Well, we were sent quite a few patients in consultation. And we were trying to characterize the different syndromes associated with the virus. In other words, we had a sense from the numbers of people referred that cases of advanced AIDS represented just the tip of the iceberg of whatever we were dealing with, and that there was this large base of the iceberg -- people with oral thrush, just oral thrush and swollen glands, and people who simply fell ill with a viral illness, when we were trying to characterize those illnesses. We were trying to classify the varieties of what we now know as HIV disease. And we were trying to scramble to find money to do the research, which was difficult in those days.

Nelson Vergel: Yeah. Those were the days of Ronald Reagan.

Michael Gottlieb: They were. There just was not a lot of passion in that administration for helping people affected by HIV.

Nelson Vergel: I guess until Rock Hudson came out with his illness; and you were Rock Hudson's doctor, right?

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Michael Gottlieb: I was. Randy Shilts, in his book And the Band Played On, speaks about the sea change that was associated with Rock's illness. He says that the history of HIV in America can be divided into pre-Rock Hudson and post-Rock Hudson. Because after Rock Hudson, people finally got it that something bad was happening and that it was something that they ought to have an interest in.

Nelson Vergel: Although many people still associated HIV with a lifestyle, or with drug use, more than associated it to a viral illness. Even years after the discovery of the virus.

Michael Gottlieb: Absolutely. The association of HIV with the gay population is kind of an accident of nature and sociologic history. In other words, HIV did not start in the gay population and probably was in the United States well before we came upon it in 1981. And I think the virus got introduced [to the wider population] around the time of gay liberation in the '70s and '80s, when people were having sex with a lot of different partners. It was just unfortunate that the virus got into the population at that point in time, and got amplified there. In the early years of the '80s, many people became infected unknowingly.

I have to say that the perception that HIV/AIDS was a gay disease has hung on in the public mind. Of course, the reality is that a tiny percentage of the 33 million people worldwide who have HIV are homosexual. There's clear evidence, scientific evidence, that it did not start among gay people.

The continued stereotyping of the disease leads people to think that it's someone else's problem, that they are somehow isolated from HIV, or immune from contracting it; and it really contributes to public apathy, which is rampant these days. The 30th anniversary is just that; it does not mean that the HIV/AIDS epidemic in America is over. It's very much ongoing.


The Future of HIV Treatment, the Cure -- and Access to Both

Nelson Vergel: Did you think back then that, 30 years later, we would still be looking for the cure for HIV?

Michael Gottlieb: Really, I had a feeling back then that our description of AIDS as a new disease was going to be a big medical story. But I really couldn't have imagined that our first few patients would be the first recorded cases in this epidemic that's lasted 30 years, and still has no end in sight.

As you're probably aware, the Institute of Medicine estimates that by the year 2050 there will be 70 million people in the world living with HIV, up from the estimated 33 million today. That is, of course, unless we develop an HIV vaccine, which is a necessity. It has to be a number one priority.

Nelson Vergel: I agree. I totally agree. And even now, with so many drugs on the market, only 30 percent of people who need medications have access to them.

Michael Gottlieb: I'm very concerned about what's happening. The apathy on the part of the general public. The apathy by both federal and state politicians who have what we call "passion drift" with regard to adequately financing people's access to HIV medication.

There are situations in which there are waiting lists for state ADAP programs, AIDS Drug Assistance Programs. I think, as of last week, the number of people on ADAP waiting lists was almost 8,000. And states are reducing the number and types of drugs they're going to pay for. Some states have stiffened the financial eligibility requirements, capped enrollments, or removed some people who are already enrolled in ADAP programs. That's so self-defeating, to deny access to HIV medication.

Nelson Vergel: Especially now that we have some good data that shows that starting HIV-positive people on treatment earlier not only makes them less infectious to others, and can be one of the best tools to prevent the spread of HIV, but it's also better for their immune response in the long term.

Michael Gottlieb: Absolutely. It's a humanitarian thing to help people preserve their immune systems. But it's also a colossal miscalculation of public health policy not to give people medication to get their viral load undetectable, and then to reduce their risk of passing HIV onto others.

Nelson Vergel: Are you at all excited about what's happening with immune-based treatment, with the case of this Berlin patient that got cured of HIV? How do you see that case shaping the future of research?

Michael Gottlieb: I'm very excited about it. I think the Berlin patient is an important proof of principle. And the principle is that you can, in fact, eradicate HIV in someone who already is infected. Yes, it's just one case, but they did it.

The treatment in this patient's case was very radical, and it could have been fatal to him. Now scientists in a number of institutions are working on safer ways to achieve the same result. I'm very excited about the potential for finding a safe way to eradicate HIV.

Nelson Vergel: A safe and also cost-effective way that could be provided to everybody around the world. It's really sad that we have one pill a day, for instance, for HIV treatment [Atripla (efavirenz/tenofovir/FTC)], and yet most countries around the world don't have even access to that coformulation in 2011.

My concern as an activist is, if we do find a cure, it may take us more than 30 years to provide it to the entire world, given how long it has taken us to provide HIV medications to all who need it.

I'm also concerned about the cure being owned by pharmaceutical companies that may not want to release its patent. So I'm already foreseeing some critical fears when it comes to cure research. I think this needs to be discussed as we move deeper into the world of cure research.

Michael Gottlieb: Well, you've had a lot of experience, Nelson, and I admire you for taking the long view. On the other hand, we have this marvelous technology already for treating HIV infection and suppressing HIV infection.

As you point out, I think it is essential to extend the gains to the rest of the world. Fifteen thousand people die every day of AIDS, malaria and TB [tuberculosis] in Africa. And it's kind of "out of sight, out of mind" for most of the American public. I think it's important for AIDS activists here, like yourself, to continue to advocate on behalf of everybody affected by HIV in the world, not just our U.S. population.

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See Also
20 Years of Magic: How One Man's HIV Disclosure Inspired Others
More on the 30th Anniversary of AIDS

 

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