United States: What Did We Learn From AIDS?

Two decades of struggling with HIV/AIDS have taught scientists arcane lessons about the molecules that cause illness and the molecules that can treat it as well as basic truths about the politics, economics, and psychology of health and disease.

Before HIV/AIDS, scientists naively assumed that vaccination, sanitation and antibiotics were making infections obsolete. Most considered retroviruses of academic interest only.

"The consensus was that retroviruses did not infect humans, that viruses did not cause cancer and that infectious diseases were a problem for the third world but not for us," said Dr. Robert Gallo, co-discoverer of HIV and director of the Institute of Human Virology at the University of Maryland Biotechnology Institute in Baltimore. "Those biases were shattered in just a few years."

In figuring out how HIV works, virologists learned valuable nuances of cell biology and that viral infections can be treated, according to Gallo.

Before HIV/AIDS, only a few primitive antiviral drugs existed, the thinking being that since viruses use the body's cellular machinery to reproduce, developing better drugs would be so difficult as to be almost hopeless and prohibitively expensive. The clear need for HIV/AIDS drugs overcame the doubts. The success of HIV antiretrovirals marked a milestone in antiviral treatment.

Today, immunologists have a greater understanding of T-lymphocytes, said Dr. Fred T. Valentine, a professor of medicine, infectious diseases and immunology at New York University. He added that complex links between cancer, immunity and infection have been cemented by findings in HIV-positive patients. Moreover, AIDS has re-educated scientists to the importance of vaccines.

Another lesson doctors learned was to take note of their patients' private lives and to ask intimate questions about sexual behavior and drug habits. AIDS taught physicians to be suspicious of their patients' blood, and it fomented a complete overhaul of standard protocols for blood drawing, blood transfusion, organ transplantation, surgery and dentistry.

AIDS also spawned a new approach to death. Medical ethicists agree that AIDS was a prime force in introducing living wills, health care proxies, do-not-resuscitate orders and hospice care into the common consciousness.

People living with AIDS formed, for the first time on record, a huge grassroots patients'-rights movement that has changed the process of drug approval and the structure of scientific meetings, which now routinely seek input from patients. PWAs who insisted on becoming collaborators in their own treatment altered the balance of power in doctors' offices. That philosophy has since carried over to other diseases.

The global nature of the epidemic has taught scientists to look past their laboratories to the world beyond. "AIDS has taught us both the power of science and its limitations," said Dr. Gerald Friedland, professor of medicine at Yale and director of the school's AIDS program. "It has given us incredible technologic successes. But fully implementing those successes still escapes us."

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