A Jewish physician who was among the first to identify AIDS in 1981 believes that a cure is a long way off.
Speaking at Emory University’s Center for AIDS Research on Thursday, May 18, Michael Gottlieb said treatment and prevention have improved vastly the past 20 years, but much remains to be done to eliminate the effects of the human immunodeficiency virus, which causes the illness.
“Can we eradicate it (known as a sterilizing cure), or create what we call a functional cure, which is a suppression so that a person’s immune system will keep HIV in check without the need for medication?” asked Gottlieb, an associate clinical professor at the David Geffen School of Medicine in Los Angeles.
“Though it may not be politically correct to say so, the likelihood of eradication is actually pretty small, at least in the short term,” he said. “If I were betting, I’d say the prospects are fairly dim. I hope to be surprised.”
Calling a cure for AIDS “a luxury,” Gottlieb said it’s important to focus on the advances made. “Not that we’ve totally conquered HIV, but there’s been remarkable progress. We have therapy now that is very effective. Basic science in action has had a huge impact on people’s lives. Patients were dying in the early years of the epidemic, and it’s incredibly satisfying to see people surviving today with good quality of life.”
Gottlieb was 33 in January 1981 when, as a junior assistant professor at UCLA Medical Center, he noticed that five of his patients, all of them homosexual men, had pneumocystis pneumonia.
“It was very unusual to see a patient who was previously healthy to have this opportunistic infection, which by definition takes advantage of a lack of host response,” he said. “I can remember those first patients of mine probably better than patients I saw last week. I remember the faces and life stories because their illnesses were so dramatic. It was very frustrating, of course, not having anything to offer them.”
The causes of the disease were eventually narrowed down to sexual transmission, the sharing of needles and sexual transmission among intravenous drug users, and blood product transmission.
“The characterization of AIDS as a ‘gay disease’ was made early on. It was quickly disproven, but people didn’t want to think it was possibly their problem as heterosexual adults, so they preferred to keep calling it that, and we’ve suffered from that ever since,” Gottlieb said.
He added that, over the years, we have become numbed by the statistics. “Back then, we started with five victims. Today we have roughly 33 million people infected with HIV worldwide, and 25 million-plus have already died.”
However, a person diagnosed today in the United States who can obtain medication is projected to have a nearly normal life expectancy, a huge change from the dire situation in the 1980s and early ’90s.
“But it’s not available to everyone infected with HIV,” Gottlieb said. “It’s critical that we don’t forget people around the world who live with it or are spreading it sexually from one person to another. It would not be spread if they had treatment as prevention; a fraction of those with HIV are on hard therapy.”
Gottlieb said the bar for a sterilizing cure is very high, “and there are lots of gaps in our knowledge and unanswered questions. We’re reaching outside the country to obtain anything that might be helpful, such as Interferon, immune boosters, homeopathic remedies and anti-inflammatories.”
Methods that could serve as functional cures have been proposed, such as gene therapy in the form of a vaccine that could enhance T-cell receptors and induce new immune responses to HIV.
“My conclusion,” Gottlieb said, “is a combination of approaches is likely necessary.”