Editor's note:This year, Dr. Fauci was recognized with the Presidential Medal of Freedom for his leadership in international research against HIV/AIDS.
Heather Dron, MPH, HIV InSite: What were you doing when the epidemic started in the United States (the early 1980s)?
Anthony S. Fauci, MD: I was a clinical researcher at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), and I was studying the regulation of the human immune response.
What was the first indication that this might be a new epidemic?
|"It was at this point that I developed goose bumps realizing that, although we did not know what the etiologic agent was, it was almost certain that we were dealing with the beginning of a new epidemic whose scope we could not have imagined at that point."|
I remember reading the first report in the CDC's Morbidity and Mortality Weekly Report (MMWR) on June 5, 1981, of 5 patients from Los Angeles with Pneumocystis carinii pneumonia (PCP). I was struck by the curious nature of the fact that they were all gay and all previously healthy. I kept it in the back of my mind, but went on with my business. On July 4, 1981, the second MMWR report came out, describing 26 men, otherwise well, who had PCP and some with Kaposi sarcoma. Again, all were gay men. It was at this point that I developed goose bumps realizing that, although we did not know what the etiologic agent was, it was almost certain that we were dealing with the beginning of a new epidemic whose scope we could not have imagined at that point.
What attracted you to this field?
Clinically and from a research standpoint, I was trained in infectious diseases and immunology, and I had been studying the regulation of the immune system. Here was a disease that I realized at the time was almost certainly an infectious disease and it was attacking the immune system. It was almost as if I had been training for years to study this new disease. It was a natural fit.
Why did you persist in pursuing AIDS in spite of the early challenges?
I felt passionately that this would evolve into a major pandemic despite the fact that it was apparently epidemiologically restricted at the time. I actually wrote a commentary to this effect in the June 1, 1982, issue of the Annals of Internal Medicine.
What was it like in the beginning of the epidemic?
It was extraordinarily challenging and exciting, but very sad and discouraging. I began in Fall 1981 to admit patients with this strange disease to the NIH Clinical Center. Prior to AIDS, I studied patients with immune-mediated diseases such as Wegener's granulomatosis and other systemic vasculitides, and for the most part we made them well with innovative therapies. With AIDS, we were dealing with drastically ill patients, almost all of whom died during those early years.
List some major successes and/or missteps of HIV/AIDS advocacy and research efforts.
With regard to advocacy, the major successes were capturing the attention of the researchers and regulators and getting them to realize early on before there were any approved drugs for AIDS that AIDS was different and drugs needed to be made available under creative mechanisms such as "Parallel Track" to those who had no other access to drugs that were restricted to clinical trials and that would have any chance of helping them. There were really few missteps by advocacy efforts except for some rare ones that were more disruptive than productive.
With regard to research efforts, there were many successes such as the discovery of HIV, the development of a sensitive, specific, and simple diagnostic test, and most importantly, the development of a menu of highly effective antiretroviral drugs that have transformed in a positive way the lives of so many HIV-infected people throughout the world. The missteps might have been to move a bit too slowly in realizing the importance of prophylactic therapy for opportunistic infections.
What are the major issues facing HIV researchers and policy makers today?
|"The major defining research issue is the development of a safe and effective preventative HIV vaccine."|
The major defining research issue is the development of a safe and effective preventative HIV vaccine. The major policy issue is the need to markedly scale up domestic and global preventive measures and to provide universal access to antiretroviral drugs.
What is most important lesson you have learned over the 25 years that HIV researchers and policy leaders should keep in mind as we move forward?
Do not become complacent in the face of major research and public health advances. We are still in the middle of a catastrophic pandemic.
Do you think that HIV has fundamentally changed the way that we think about and research infectious disease?
|"If you invest substantial research and public health resources and you recruit the best and the brightest to address a problem, you can accomplish an enormous amount."|
Yes, the lessons that we have learned from HIV/AIDS are that if you invest substantial research and public health resources and you recruit the best and the brightest to address a problem, you can accomplish an enormous amount. We have done it for AIDS, and we should apply the same principles to our approach to tuberculosis, malaria, and other diseases of major global health impact.
What are some of the findings from HIV research that benefited research into other diseases?
The importance of targeted drug development and a great understanding of the complex mechanisms of the regulation of the human immune system.