Dr Michael Gottlieb Reflects on the Early Days of the AIDS Epidemic

In the June 5, 1981, issue of Morbidity and Mortality Weekly Report (MMWR), from the CDC, a brief 3-page report appeared describing 5 rare cases of Pneumocystis carinii pneumonia (PCP) among 5 homosexual men in Los Angeles. These cases were considered rare because at that time, PCP was typically only seen in individuals with immunocompromised status.

The 5 men all died from this mysterious illness, as did thousands of others, before its viral cause was identified as lymphadenopathy-associated virus and human T-cell lymphocyte virus type III, by the Pasteur Institute and the National Cancer Institute, respectively.

The American Journal of Managed Care^® spoke recently with Michael Gottlieb, MD, the lead author on that first MMWR. We discussed the fear that permeated the scientific community at that time, lessons to be learned from this era, and the possibility of a safe vaccine against HIV.

Stay tuned next week for our Q&A with Gottlieb, as we mark the 40th anniversary of that first MMWR to discuss what came to be known as HIV. Until then, here is a preview.

Transcript

Can you discuss how azidothymidine (AZT), a failed cancer treatment, became an investigative agent against a virus of which little was known at the time?

It involved the determination to find a treatment. First, there had to be the will to look for something, and then it involved a stroke of luck. That’s really the truth.

Marty St. Clair, a scientist at then Burroughs Wellcome in Research Triangle Park, North Carolina, had an interest in retroviruses and developed a plaque assay in petri dishes with mouse leukemia cells that replicated with reverse transcriptase, the same the enzyme that’s necessary for HIV replication.

If you’ll recall, in Françoise Barré-Sinoussi and Montagnier’s [Luc Montagnier] initial paper, they show the rise of reverse transcriptase in their culture medium. And she tested numerous compounds in the library of compounds owned by Burroughs Wellcome, and one of them was AZT.

And as she tells it—and she’s the best one to tell it—she came to the lab and looked at all the petri plates with agar and cells suspended in them. And there were a bunch of them where there was no lysis of the cells: the cells were surviving. And in all the rest of them, the leukemia virus had chewed up the cells. And she thought she’d made a mistake and not put the chemical in that particular set of petri plates. And her colleagues came in and verified that she had, in fact, done it all correctly. And AZT had protected the cells against destruction.