Heather Dron, MPH, HIV InSite: What were you doing when the epidemic started in the United States (the early 1980s)? What was the first indication that this might be a new epidemic?
Diane V. Havlir, MD: I was a medical student at Duke University. I remember reading about the cases in the CDCs Morbidity and Mortality Weekly Report (MMWR). There were some patients being seen by the head of infectious diseases at the time, and I asked him if I could see the patients with him. I also went to the CDC for 2 months to work in the division being run by Dr. Jim Curran to track the emerging epidemic. At that time the focus was Haitians, homosexuals, heroin users, and hemophiliacs--"the 4 H's."
What attracted you to this field?
|"The question is how could I not pursue this as a career? There were so many unanswered questions, such a need to understand the disease, to determine how to treat it, how to develop strategies that kept our patients alive and healthy. That is my passion, which started long ago and which is the basis of my involvement today."|
I specifically chose to do my residency in internal medicine at the University of California San Francisco (UCSF) because of the AIDS epidemic. Dr. Paul Volberding was my first attending physician in the Inpatient Medical Service at San Francisco General Hospital, and our service was filled with young men, suffering with every possible manifestation of AIDS. The infectious diseases we saw were incredibly exotic, often difficult or impossible to treat. The patients and their partners were devastated by the grim outlook, but I remember vividly the compassion and courage of the patients and their loved ones.
Why did you persist in pursuing AIDS in spite of the early challenges?
The question is how could I not pursue this as a career? There were so many unanswered questions, such a need to understand the disease, to determine how to treat it, how to develop strategies that kept our patients alive and healthy. That is my passion, which started long ago and which is the basis of my involvement today. My current involvement at the global level in research and with the World Health Organization stems from the experience of learning what can be done to transform the approach to a disease and those suffering from it.
What was it like in the beginning of the epidemic?
In addition to my response to the previous question, I can say that, in the clinical arena, one case was as devastating as the next. As providers, we were often attending memorial services for our patients who had died, and died so young before they had a chance to realize their dreams.
List some major successes and/or missteps of HIV/AIDS advocacy and research efforts.
|"Combination antiretroviral therapy (ART) is one of the greatest success stories in the history of medicine."|
Combination antiretroviral therapy (ART) is one of the greatest success stories in the history of medicine. There was an urgency and push by all to develop and get these HIV agents to the persons living with the disease as quickly as possible. It took us some time to determine that successful therapy required combinations of medicines. I did some of the original studies of nevirapine, which showed that it was valuable but vulnerable. Valuable because of its potency against HIV, but vulnerable because HIV became rapidly resistant when it was given as a single drug, which is what we did early on. Important lessons that we have learned along the way in HIV therapeutics include the following:
|Antibiotics can prevent some major opportunistic infections, but antiretroviral therapy is the best prevention against AIDS complications.|
|Multidrug combinations are needed to sustain the success of antiretroviral therapy, and we can neither reduce the regimen to a maintenance level nor stop and start the drugs without jeopardizing the benefit of therapy.|
|HIV medications are not too complicated to be given to persons living in the poorest and most remote parts of the world, and universal access to ART should be our goal.|
|HIV not only affects the susceptibility to infections and cancers, but also appears to increase the risk of liver, heart, and kidney disease.|
What are the major issues facing HIV researchers and policy makers today?
|"We should not be afraid to tackle the toughest questions, the seemingly most impossible strategies."|
For treatment: Optimal timing of therapy initiation, and treatment of complications with HIV disease, including TB, malaria, hepatitis B and C, and HPV. We need to understand better why we cannot eradicate HIV. We also need to understand more about the early events of HIV.
For policy: 1) How to sustain and increase global funding for HIV care. 2) How to increase HIV testing and linkages to care.
The search for a vaccine remains a high priority. We have yet, though, to fully realize the benefits of universal access to antiretroviral therapy for both prevention and treatment.
What is the most important lesson you have learned over the past 25 years that HIV researchers and policy leaders should keep in mind as we move forward?
We should not be afraid to tackle the toughest questions, the seemingly most impossible strategies.