The Opposing Thumb

An opinionated digit leafs through the biological literature
Media Roundup

“Thank you, for the others”

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HIV Photo Credit: Electron microscopy image by CDC/Dr. Edwin P. Ewing, Jr.

In 1981, the Centers for Disease Control’s Morbidity and Mortality Weekly Report published an unassuming article describing 5 homosexual men hospitalized in Los Angeles. It could have been a statistical blip- the group of young men had succumbed to a normally harmless microbe, Pneumocystis carinii (at the time of the report, 2 had already died). In retrospect, it was the first clear warning of a coming plague. Pneumocystis is the kind of bug we all carry around in our guts, skin, and in this particular case, lungs. In these young men, aged 29 to 36, it caused an aggressive, deadly pneumonia. The short clinical paper authored by Michael S. Gottlieb hints at the ultimate cause of disease:

“Three patients had profoundly depressed numbers of thymus-dependent lymphocyte cells and profoundly depressed in vitro proliferative responses to mitogens and antigens. Lymphocyte studies were not performed on the other 2 patients.”

The loss of thymus-dependent lymphocytes, or T-cells, would rapidly be recognized as the common denominator in a series of mysterious illnesses afflicting homosexual and bisexual men. These diseases themselves were not new to medicine. They were just very rare, often restricted to particular ethnic groups. Young Americans were being diagnosed with Kaposi’s Sarcoma, a form of cancer normally confined to older Mediterranean men. Many of the diseases were common in patients incapable of mounting normal immune responses. Until then, immunodeficient patients were known from a well defined set of conditions- either they had genetic problems and were born without a properly functioning immune system, developed immune tumors like leukemias or lymphomas or were immune suppressed for a variety of reasons (transplantation, autoimmune disease, chemotherapy, radiation exposure etc). Within two years of Gottlieb’s 1981 report, it was clear that a new infectious disease had emerged, Acquired Immune Deficiency Syndrome, or AIDS.

In the brief period between the initial spread of AIDS and the identification of its causative agent, the Human Immunedeficiency Virus (HIV), ignorance bred fear, and fear brought out the worst in many people. New York Magazine has recently posted online an article originally published in 1983:

After being diagnosed, one 24-year-old AIDS patient was driven from his family’s home and left to live on the street. Another was evicted by his lover and forced to sleep in hallways while he had a fever of 104 degrees. When one patient died, his family refused to claim his body. A patient named Arthur Felson was fortunate enough to have a friend who stuck by him. Then the friend saw an erroneous report on television that the illness could be spread by everyday household contact. Terror of the disease apparently drove the friend to commit suicide.

“I just couldn’t shake it out of him,” Felson says.

In many hospitals, AIDS patients were placed in isolation. Nurses entered the rooms wearing gowns and gloves. A number also wore surgical masks. At the Veterans Administration Medical Center on First Avenue, some of the staff were reluctant to bathe the AIDS patients. Others had to be prodded to change the beds. One patient at Bellevue Hospital heard a knock and opened his door to discover that somebody had left his food tray on the floor and then fled. A patient at another hospital was told by his doctor that he could leave and go home to die, but was unable to find a housekeeper who was willing to risk exposure to AIDS.

At Lenox Hill Hospital, a nurse named Deborah Curran noticed that some of the technicians avoided drawing blood from AIDS patients. “A lot of times, they say, ‘I can’t get it.’ A lot of times, they don’t even try, and then some doctor has to do it,” she says. Curran herself felt the fear of contagion for the first time in her five years as a nurse when she was asked to remove an intravenous tube from a young man with AIDS.

Françoise Barré-Sinoussi co-discovered the human immunodeficiency virus, HIV, with her colleague Luc Montaigner at the Pasteur Institute in Paris. Knowledge turned the tide on AIDS. Generalized fear of contact gave way to specific measures like the use of condoms or disposable needles, and testing for HIV removed the terrible uncertainty- evident in the NY Magazine article, where every fever or yeast infection generates months of anguish. Inefficient first generation drugs like AZT gave way to highly successful combination therapy in less than two decades. Barré-Sinoussi has never stopped fighting AIDS. A recent interview with Mosaic Science tracks her life’s work, from her scientific heyday in Paris to current work at the frontline of the epidemic in Africa. In it, Barré-Sinoussi describes a moving encounter:

In early 1984, soon after her discovery, the virologist was invited to give a talk at the General Hospital in San Francisco, the genesis of the AIDS crisis. News soon circulated among patients on the wards of the now famous French scientist being in their midst.

“The doctor there asked me whether I would see an [AIDS] patient that was in the emergency room and was dying,” she says, as we sit in her bright, white office in the Pasteur Institute – the very building in Paris where her discovery was made.

“He told me that the patient would like to see me. And I said okay. I went there and he was really ill, in terrible shape.” What did he say?

She swallows and folds her arms, as if hugging herself.

“It will stay in my mind for ever,” she says. “He had difficulty speaking, but I could see on his lips that he said, ‘Thank you.’”

Her jaw moves back and forth, grinding her teeth to keep control.

“I was so totally… I didn’t know what to say, and the doctor saw me and said, ‘Ask him why.’ And I did, I asked him why he thanked me and he said, ‘Not for me, for the others.’”

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