Who was patient "ZERO?"
Good question. Patient "Zero" was a patient in Randy Shilts book. Not really the first patient. He was an early case who may have spread HIV to a number of others. Part of the LA-Orange County cluster investigated and reported by CDC in the early days.
Is the transmission of the virus from female to males rare?
Not rare. Less common than male to female in developed countries. Very common in Africa and resource poor countrues.
How much confidence did you have during the first few months of seeing the initial patients that the illness was not being passed through casual contact or proximity? THANKS, Paul
There was some worry in the first days, weeks and months and we did take some chances. But it quickly became clear that the transmission pattern was the same as type B hepatitis which is spread in well defined, non-casual ways. One good thing to happen from the HIV epidemic is universal precautions followed by all health workers.
How have public attitudes and opinions toward the disease affected your work over the decades, and how has that changed? Have there any setbacks or difficulties in research regarding treatment of the disease? Likewise, what improvements have there been as the stigma over the disease shfits?
Things were very difficult in the first few years. The public and press ignored the first several thousand cases and woke up after Rock Hudson. Then there was fear and rejection. Our President and world leaders did not speak about AIDS. Things have improved slowly but there is still stigma. I dont know too many patients who feel comfortable disclosing their status to family and employers for fear of repercussions.
It was rumored that AIDS had its origins in monkeys. Truth or Rumor? What is the story?
It's not just rumor but a fact that HIV originated in chimpanzees in Africa. There is elegant science from Prof. Beatrice Hahn at the University of Alabama that documents this. The virus SIC cpoz is the ancestor of HIV and proabably crossed over when hunters butchered chimps for food and were exposed to blood.
What do you believe will be the method by which HIV is cured and what is required to achieve it? Thanks.
There are two strategies for cure. One is eradication, which is difficult because the virus enters a state of latency in very long-lived cells where it is integrated into the chromosome of the host. The drugs we have today don't touch that reservoir. The other strategy is "functional" cure where the persons own immune system is improved to better keep the virus under wraps. Kind of link what happens with some cancer cures where the tumor is in remission under the influence of the immune system.
How close is gene therapy for this disease?
Hi there Dr. Gottleib. I recognized you and your work from the Frontline Television Series about HIV and AIDS. Currently, I am in the process of applying to medical schools and your experiences with HIV/AIDS have inspired me pursue a career in infectious diseases. My questions: 1. What emotions and thoughts crossed in your head as you began to realize how big a pandemic HIV/AIDS was? 2. Do you feel that cancer research has taken precedence over HIV/AIDS research? 3. What do you think are the major obstacles to annihilating HIV from the world? Thank you for taking the time to answer these questions. Sincerely, Andrew Sou
My first reaction was amazement that in medicine there was something new and dramatic. I felt very badly for the first patients who were very ill and we were not able to tell them what they had or what to do about it. I became angry later when society at large did not seem to care. At the start it never dawned on me that this was the start of a global pandemic that would kill tens of millions.
Can you predict that the day will come when an actual "cure" will be found for AIDS??
Sorry. My crystal ball is not working very well. In 2001 I predicted an HIV vaccine by 2010 and was reminded of that earlier this year by reporters. No more predictions.
How often should one be tested for HIV?
It all depends on what you are doing sexually. If you are having multiple partners, not practicing safer sex, having anonymous sex, or having sex with someone who is HIV+ you should get frequent tests, maybe twice a year. But a better idea is to reduce the number of partners and know your partners HIV status, and practice safer sex, ie condoms.
HIV is stigmatizing and people with HIV discriminated against. I increasingly see language at state/federal level refer to people living with HIV/AIDS as 'HIV infected'. Does an emphasis on viral load suppression as a way of decreasing 'infectiousness' increase stigma?
I don't particularly like the language HIV-infected. But getting the viral load undetectable is the new gold standard for success in treatment and I view it as a step toward people feeling better about themselves.
I have heard that the US Military has blood samples from 1950's they retained from GI's that had HIV. Is there or has evidence been found that HIV/AIDS/ARC/GRIDS was in US before 1980's? I have a friend whom had active AIDS Complications (GRIDS Diagnosis due to PCP and with T-Cells below 100) in 1982. Person had been in literally World Class Athletic Shape in 1980, so seems person had to get HIV much prior to 1980 with HIV taking so long to become AIDS; especially when it was a low active HIV Infection. Blessings and Warmest Regards....
HIV was in the US blood supply (rare instances) as early as 1977. It may have been in North America as early as the late '60s. So the patients like your friend and my first patients may have been infected in the late '70s and it took 3-4 years to progress to an AIDS diagnosis and be noticed.
With 22.5 million people in sub-Saharan Africa HIV+, high prevalence rates among women and especially girls, high numbers of people unable to access ARVs, millions of orphans, and more, do you think it is realistic to speak of zero's? I have a very hard time with this theme. Susanna Grannis West Townshend, VT
Maybe not zero's, but we can achieve dramatic reduction in numbers. While a formidable problem, HIV in Africa should not be thought hopeless. Secretary of State Clinton spoke about an AIDS-free generation in November and that can be achieved through theknow-how that we already have. Prevention of mother to child transmission, voluntary male circumcision, and providing treatment, which reduces the risk of transmission. We just need to make it more available and this is threatened by proposed cuts to the US and other countries cuts to their committments to the Global Fund for AIDS, TB and Malaria. I hope that the Administration will reconsider.
Did you steal the research on HIV from the French?
No. All I did was report the first cases and describe the syndrome, not the isolation of the virus. Thanks for the opportunity to clear that up.
Dr. Gottlieb, How far away is the medical world to see a prevention/cure for HIV/AIDS? -Michael in San Francisco, CA
The best route to prevention is a vaccine and that research has been frustrating. That deserves a very high priority for funding and many scientists are working on it full time.
There are some promising approaches in the works.
Cure is more difficult. The Berlin patient appears cured but treatment was radical, life-threatening and expensive, not feasible for the masses. Patients should not think it is right around the corner. Suppression of the viral replication with ARV's taken religiously is the best approach despite its obviuous problems of side effects, cost, etc.
AIDS appeared about the time that the religious right was rising to prominence, and that group used the disease as proof of its hateful idea that homosexuality and gays are a threat to society. Back then I was very pessimistic about the future of gays in American society - I had expected all sorts of limits on their freedoms "for the sake of public health." Not only did that bleak future fail to materialize, gays and lesbians have actually made more gains toward full equality. Why do you think that happened? Did the religious right's rhetoric have the effect of galvanizing gay activists?
I agree that it did not materialize although it was scary for awhile in the late '80s with LaRouche and others proposing draconian measures. I think what did happen speaks to the strength of our system in protecting the rights of minorities.
It is a good thing that activists were able to move the research agenda forward working through legislators and by some civil disobedience as with ACT-UP. The community of activists played a huge role in producing the gains in
treatent we have today. And Elizabeth Glaser whose own kids were affected made progress happen for children with HIVand for prevention of mother to child transmission. Her foundation EGPAF carries on that work today in Africa and other resource poor settings.
If one wishes to get pregnant and one partner has AIDS, was is the risk of the disease being transferred to other partner?
This can be done. There are clinics who will "wash" the male's semen clean of HIV and then do in vitro fertilization.
I have several patients in my practice who did that and have healthy kids and an uninfected mom.
Dr. Gottlieb, seeing you on this chat is so exciting (coming from someone who read "And The Band Played On" from cover to cover and then immediately started over). Thanks for doing it. In the book, Shilts used startling imagery to convey the idea that AIDS was brought to the US during the bicentennial celebration in NYC in 1976. Is this still an accurate hypothesis, or has it been discredited?
I loved that book, but Randy did take some poetic license to make the story nmore dramatic. Maybe patient zero and the bicentennial are examples of this. I just don't think there is any data to support but did make a great story.
Hello Dr. Gottlieb. Thanks you for your work. Do you feel that if the Reagan Admin had not failed to fund and address the early days of this epidemic we would be in an even better place today? Do you tink teh stigma against HIV+ people throughout the world is as big if not a bigger hampering to progress in defeating this virus?
I do think that many of the 700,000 who died here and the 1.3 million in the US now living with HIV might have been spared if their had been a clear message coming from the highest levels of the federal government from the get-go. But Reagan's advisors were very conservative and not about to have anything to do with a disease that had a homosexual or drug use association. Stigma remains a major force today in every society where HIV is present. For a while we saw HIV+ characters on TV presented sypathetically but that and media coverage in general has faded here as there is a sense that the crisis is past.
Does the HIV virus mutate quickly (like a cold or influenza virus) or slowly? Is that one of the challenges in creating a vaccine against HIV/AIDS?
That is one problem but there are others such as the way HIV hides some of its vital structures from the immune system until after it infects a cell.
My boyfriend disclosed to me that he's HIV+ and he did so before we had sexual relations. How cautious should I be? We are both gay men... I don't stigmatize him, but I want our intimacy to be as normal and as safe as possible.
Disclosing is the right thing to do. The next question is whether he is on medicatiion and has an undetectable viral load, takes his medicine, and does not do drugs like crystal that could affect his adherence. Sex is safer if the viral load is undetectable but no one can guarantee that it is totally safe and that is why the use of condoms is still recommended.
Magic Johnson has announced he's cured of HIV/AIDS -- wonderful news! What can immunology and virology learn from his case, and those few others where patients appear to have made a full recovery?
I don't think he has announced anything of the sort. I saw him interviewed the other night on CNN where he said that he was taking medicine twice a day to suppress his HIV.
Dr. Gottlieb, While many people blame The Reagan Administration and homosexual stimga, isn't it true that early research was impeded in part by the medical community by the National Institutes of Health, a prominent institute in Paris and the medical agendas of the doctors who wanted to be credited with isolating the disease?
I don't think so. Scientists at NIH worked hard on AIDS from the get-go and the NIH under the incredible leadership of Dr. Anthony Fauci has produced many of the gains we have today in treatment and prevention.
Some whom had AIDS have regained high T-cell numbers; are the New T-cells the same, better or worse in fighting infections....
Good question. Actually doubt that they are functional and as diverse as T cells in people who are not HIV+. But today T cell number is less important than having the viral load undetectable. There are some patients with undetectable who have CD-4 counts less than 200. They do well clinically but we all would be more comfortable if their counts were higher and strategies to raise then are being studied.
Does medical marijuana have any use for AIDS patients?
Does not affect T cell counts or viral load in my experience. Some patients are helped with their neuropathy (nerve pain) from previous toxic meds or with sleep and anxiety.
When AIDS was identified and reserach worked backwards, did the earliest AIDS patients appear to be concentrated in Manhattan, LA, or from where?
Earliest patients were in large cities. NY, LA, SF, Houston and Miami.
Which do you think is more likely to be developed first: a cure for HIV infection or a vaccination to prevent it? I am a young gay man in Washington DC and despite the fact that I always use protection, I am petrified by the knowledge that HIV infection rates here are so high.
There is also the emerging area of PREP, pre-exposure prophylaxis, where a young man can take an antiviral to prevent establishment of HIV if he is exposed. Best advice is careful selection of partners and if the partner is HIV+ that he be undetectable and practicing safe sex. But ask an expert about PREP or keep following that story.
There are many theories ranging from cross-contamination of blood supply while searching for Polio vaccine to eating monkey. What do you believe is the origin of AIDS and do you see promising breakthroughs in CCR5 gene mutation being something that can be pilled for easy access to the poor?
I don't buy the polio story. Yes, exposure to the blood of chimps probably explains the crossover to the human species.
More widepread use of needles (re-used) in Africa may have played a role in transmission.