Can AIDS be Cured?

published on December 17, 2014 in The Newyorker

One morning in the winter of 1981, my wife came home after her on-call shift at the U.C.L.A. Medical Center and told me about a baffling new case. Queenie was an eighteen-year-old prostitute, his hair dyed the color of brass. He had arrived at the emergency room with a high fever and a cough, and appeared to have a routine kind of pneumonia, readily treated with antibiotics. But the medical team retrieved a microbe from his lungs called Pneumocystis carinii. The microbe was known for causing a rare fungal pneumonia that had been seen in severely malnourished children and in adults undergoing organ transplants or chemotherapy.

Several specialists at the hospital were enlisted to make sense of the infection. Queenie had a critically low platelet count, which made him susceptible to hemorrhage, and I was called in to examine him. He was lying on his side and breathing with difficulty. His sheets were soaked with sweat. A herpes infection had so severely blistered his flesh that surgeons had cut away necrotic segments of his thighs. I couldn’t explain his falling platelet numbers. His lungs began to fail, and he was placed on a ventilator. Soon afterward, Queenie died, of respiratory failure.

His was one of several cases of the same rare pneumonia seen by physicians on both coasts. Michael Gottlieb, a U.C.L.A. immunologist, studied the blood of some of these patients and made the key observation that they had lost almost all their helper T cells, which protect against infections and cancers. In June, 1981, the Centers for Disease Control published Gottlieb’s cases in its Morbidity and Mortality Weekly Report, and, in July, Dr. Alvin Friedman-Kien, of New York University, reported that twenty-six gay men in New York and California had received diagnoses of Kaposi sarcoma, a cancer of the lymphatic channels and blood vessels. This, too, was strange: Kaposi sarcoma typically affected elderly men of Eastern European Jewish and Mediterranean ancestry.

I tended to our Kaposi-sarcoma patients. I was the most junior person on staff and had no expertise in the tumor, but none of the senior faculty wanted the job. My first patient, a middle-aged fireman nicknamed Bud, lived a closeted life in West Los Angeles. Not long before he checked in to the hospital, he had started to find growths on his legs that looked like ripe cherries. Then they appeared on his torso, on his face, and in his mouth. Despite strong doses of chemotherapy, the standard treatment for advanced Kaposi sarcoma, his tumors grew, disfiguring him and killing him in less than a year. By 1982, men with highly aggressive kinds of lymphoma had started to arrive at the hospital. They, too, failed to improve with chemotherapy. Patients were dying from an array of diseases that had overcome ravaged immune systems. All my patients had one disorder in common, which the C.D.C., that year, had named acquired-immunodeficiency syndrome, or AIDS. Scientists did not yet know what caused it.

JEROME GROOPMAN
The Newyorker
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Can AIDS be Cured?

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