Acquired Immune Deficiency Syndrome, or AIDS, is a deadly disease that has struck down some 2,000 people in the four years since its discovery. NOVA examines how modern science has been unraveling the mystery of this baffling ailment.
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00:00In 1979, San Francisco was a city marked by change.
00:29A jury's lenient verdict for the murder of Mayor George Moscone and Supervisor Harvey
00:34Milk had aroused both social anger and political awareness.
00:38In the predominantly gay neighborhood known as the Castro, Milk had been a beacon of change
00:43as the city's first openly homosexual elected official.
00:48There were visible signs that homosexuality had come out of the closet, and in urban centers
00:52throughout the country, gay men celebrated their sexual liberation in private clubs and
00:57bathhouses.
01:00But another, less apparent change would soon reveal itself.
01:04For Bobby Reynolds, a third-generation San Franciscan, the change began innocuously,
01:10with the simple nuisance of getting sick while far from home.
01:15I first got sick back in December of 1979 when I was on vacation in Key West.
01:21And I stayed in bed for a couple of days.
01:24And then when we came home, my fever rose to about 105.
01:28So I went to the hospital, I met my doctor there, and then had an army of specialists
01:34come through and take blood and run tests and examine me.
01:41The doctor just kept shaking his head, I don't know what this is.
01:46About six months later, I said, these lymph glands are still swollen.
01:49And so I started getting some biopsies.
01:53And I remember laying in the front room one night and discovering that there were lymph
01:59glands under my armpit that hadn't been there before.
02:02And it just triggered something, and I started crying.
02:05I was afraid.
02:07My father had died from cancer not too many years before, and that was going through my
02:12mind, and I was scared.
02:15Bobby's fear and his doctor's bewilderment were not unfounded.
02:20He was sick with the disease so new it had no name, so deadly no patient would ever recover,
02:28so baffling it would be called the disease of the century.
02:33The disease was AIDS, and this is the story of how modern science has begun to unravel
02:39its mystery.
02:41The account begins in 1981 when the first ominous signs appeared.
02:46As physicians and patients struggled with an insidious new killer, medical detectives
02:51tracked down the who, what, when, and where of this deadly new epidemic.
02:59The hunt for why followed, and the chase intensified when two laboratories, one in France and one
03:04in the United States, closed in simultaneously on the lethal culprit.
03:10The race to beat the AIDS epidemic is far from over, but the first heat has been run.
03:17This chronicle reflects the confounding events that started it all.
03:26In Atlanta, Georgia, the job of fitting together the first obscure pieces of the puzzle fell
03:31to the Centers for Disease Control, the federal agency that monitors public health.
03:37The CDC is headquarters for an elite corps of epidemiologists, doctors who specialize
03:42in the branch of medicine that investigates the causes and control of epidemics.
03:47A widespread surveillance network helps the agency monitor outbreaks of new illnesses
03:52and patterns of known ailments.
03:55Every week, the CDC publishes the MMWR, Morbidity and Mortality Weekly Report, a compendium
04:02of data on recent deaths and diseases nationwide.
04:06The first clue that something was wrong appeared in May of 1981.
04:11A report was published of pneumocystis pneumonia in Los Angeles.
04:15Five cases, all in homosexual men.
04:20Pneumocystis is an extremely unusual lung infection.
04:23It was previously seen only in chemotherapy or transplant patients.
04:27In these individuals, drugs artificially suppress the immune system and the ability of the body
04:33to fight infection.
04:35Dr. James Curran worked in the Venereal Disease Control Division along with Dr. Harold Jaffe.
04:42They read the MMWR and were both puzzled by the report.
04:47Because we had worked with gay men in hepatitis vaccine trials, it kind of hit us like a brick.
04:55What could be going on in gay men causing a very rare disease?
05:00It struck all of us as very strange that this disease, a disease that we previously
05:06associated with patients who were getting cancer chemotherapy or organ transplants,
05:12would suddenly occur in apparently healthy people.
05:15Jim Curran was perplexed.
05:17There was no obvious way to account for the cases.
05:20Three days later, Harold Jaffe remembers, a second piece of the puzzle appeared.
05:24I can remember talking to Bob Bolin, who's a physician from San Francisco, who had just
05:30read the report on pneumocystis and saying how strange it seemed.
05:35And then he said, incidentally, you know, we've heard about some cases of Kaposi's sarcoma
05:42in gay men.
05:44Do you think there's any relationship?
05:45Have you heard about that?
05:48The MMWR quickly published this peculiar new development.
05:53Kaposi's sarcoma was a rare form of skin cancer, usually seen only in elderly men.
05:59It was considered highly unusual to find these cases among young men.
06:04But the immune system, again, provided a clue, linking this rare cancer to the unusual pneumonia.
06:11It too was several hundred times more common in transplant patients, and it too was much
06:16more serious in somebody whose immune system was broken down.
06:21So there was a clue right from the beginning that this cancer was a cancer that depended
06:26on the immune system to stay in check.
06:28We had also received some reports from New York from Dr. Friedman Keene on the same type
06:34of patient in New York, young homosexual men with Kaposi's sarcoma.
06:40So at that point, we became very suspicious that there was a relationship between the
06:44diseases, that it was going on in more than one place, and that it perhaps could turn
06:49out to be something very important.
06:52With these clues, the epidemiologists put together the first pieces of the puzzle.
06:58Post-pneumonia, a highly unusual infection, and Kaposi's sarcoma, a rare form of skin
07:03cancer both occurring in young gay men.
07:06A shared pattern linked the two diseases.
07:10Immune deficiency.
07:12But medical science had no explanation for what was happening.
07:15Something had gone wrong.
07:22San Francisco, like Los Angeles and New York, was reporting some of the first cases of what
07:27would come to be known as AIDS.
07:30The grim reality of this new killer was beginning to confront physicians such as Dr. Paul Volberding.
07:36I had been in a lab for a couple years.
07:39I had missed the patient contact, and this job became available, taking care of general
07:45oncology patients at a county hospital.
07:49When I started, one of the people who had worked here patted me on the back and said,
07:55the next big disease is waiting for you.
07:57There's a patient with Kaposi's sarcoma.
08:01I hadn't heard of Kaposi's sarcoma.
08:03I'd made it through an entire medical training program and oncology fellowship without ever
08:08having seen a patient with that cancer.
08:11And I ignored the remark pretty much until I saw the patient the next day.
08:15It was a 22-year-old man with Kaposi's sarcoma.
08:19I had never seen a patient with KS before, and I was really shocked with what I saw.
08:24He had lesions all over his body, a striking disease, and he followed the course that we
08:30now are very familiar with, with multiple infections, progression of his Kaposi's,
08:36and he died within six months.
08:38It was really that kind of patient that made us very aware that this was going to be a
08:44terrible disease.
08:47Early in June of 1981, Jim Curran called a meeting.
08:51The CDC needed more information, but first they had to name and define the disease.
08:58They would eventually call the disease AIDS.
09:00Acquired, because it wasn't inherited.
09:03Immune deficiency, because it linked the two diseases.
09:07And syndrome, because the different symptoms were signs of one disease.
09:13AIDS would remain defined as the presence of either pneumocystis pneumonia or Kaposi's
09:17sarcoma in an otherwise healthy individual.
09:22After looking at hospital records going back five years, the epidemiologists were sure
09:28the disease was new.
09:29A phone survey that summer revealed the problem was larger than they thought.
09:34In addition to cases clustered in New York, Los Angeles, and San Francisco, they found
09:39additional patients scattered throughout the country.
09:42And always, the cases were in young gay men.
09:44I wondered if you could give me some of this information.
09:49For example, is this a patient who has any underlying disease?
09:52It struck us as unusual that so many were openly gay.
09:58How could people know that all of these people were gay, for example?
10:02So we dispatched ourselves to interview as many as 30 cases of AIDS within the first
10:08couple weeks.
10:09Jim Curran did not anticipate the emotional impact or personal response that would be
10:14triggered by meeting his first patient.
10:19I remember the first patient that I met.
10:21He was a highly educated, very intelligent, and extremely pleasant and open gay man.
10:27He had skin lesions of Kaposi's sarcoma, otherwise was quite healthy.
10:34He was a medical oddity.
10:37He took his clothes off, walked around the room, showed himself to all the doctors, and
10:44said, doctor, do you think this is serious?
10:48And you from the Centers for Disease Control, who have never seen a case of this before,
10:53what do you think?
10:55And I acted like a doctor and said, well, we hope not, as if I knew.
11:01It was through continued collaboration with NYU that I was able to see this man on several
11:09more occasions before he died, only to develop progressive cancer, lose progressive weight,
11:17lose all his hair from chemotherapy, develop pneumocystis pneumonia, brain infections,
11:26and finally die a miserable death several months later.
11:31And I think back on the time when I first saw the patient and talked to him.
11:37He was from my home state.
11:38Talked to him about his days at an Ivy League school, what it was like to be gay in Detroit,
11:45if you will, and how it was more or less his age was, I think, six months older than
11:53I was.
11:54And we were talking about, my, I'm a medical oddity.
11:59You're a doctor who studies medical oddities.
12:02What do we think of each other?
12:04And only to realize that it wasn't fair.
12:07I'm still studying it, and he's dead.
12:10The CDC identified nearly 100 cases in the United States during that first summer of
12:171981.
12:20What they did not realize at the time was that while they were investigating the AIDS
12:24phenomena in New York and California, similar cases were beginning to appear throughout
12:29Europe.
12:31In Paris, France, Dr. Willie Rosenbaum is a specialist in infectious diseases.
12:36He subscribes to the CDC's Morbidity and Mortality Weekly Report.
12:41The issue detailing the first cases of AIDS arrived at his office during the first week
12:46of June, 1981.
12:48The same day, or the day after, I saw a sick person in my office who immediately told me
12:58that he was a homosexual.
13:00He told me that he was suffering from diarrhea, a cough which had lasted for a few weeks,
13:07as well as a fever.
13:10I ordered tests, but did not find the cause of these symptoms.
13:17One month later, the patient came back.
13:20There were now many similarities between this patient and what was described by the CDC.
13:25The patient underwent specialized lung tests which confirmed the existence of pneumocystis.
13:31The first patient in France was diagnosed at the same time that AIDS appeared in the
13:35United States.
13:37Willie Rosenbaum and several colleagues formed the French Working Group, a task force of
13:42both clinicians and researchers.
13:45Like their counterparts, the French Working Group was the first in the world to have a
13:50a task force of both clinicians and researchers.
13:53Like their counterparts throughout the world, they began to speculate about the cause of
13:58this strange new disease.
14:00The French Working Group would eventually make a key contribution to AIDS research.
14:06For Bobby Reynolds, more than two years had passed, and his doctor still had no explanation
14:11for the chronically swollen lymph nodes that continued to trouble him.
14:15But an unsettling new development soon led to an even more disturbing diagnosis.
14:20I first heard about AIDS in the gay papers.
14:23They started reporting that men in other parts of the country had been diagnosed with the
14:29gay plague or gay cancer.
14:32And I read what it was saying about them, and none of what it said fit my life.
14:41And then, lo and behold, there was a purple spot on my foot.
14:46In March of 1982, and immediately I knew what it was, but I wouldn't let, I wouldn't let
14:55that sink into my consciousness.
14:59And so I wasn't officially diagnosed with AIDS until June of 1982.
15:05When you're diagnosed with AIDS, very often you lose your support system.
15:09You lose your families.
15:10You lose your job.
15:12You lose the basic needs.
15:18I've lost the majority of friends that I had before my diagnosis.
15:25His illness prevents him from working at the job he held for 18 years with a Bay Area utility
15:30company, although Bobby has been fortunate.
15:33His employer continues to provide both disability and health insurance.
15:37Bobby was also fortunate because he was one of the few AIDS patients who responded favorably
15:41to cancer chemotherapy.
15:44His skin cancer is now in full remission, and Bobby now devotes much of his free time
15:49to a volunteer organization that provides counseling and support services for people
15:54with AIDS.
15:55...Shanti Volunteer and Client Party, People with AIDS Party.
16:01So far, he has experienced no other life-threatening infection.
16:04But the sense of normalcy is haunted by the knowledge that his immune system is damaged.
16:11It's difficult, once you're diagnosed with AIDS, to remember that you can get common
16:16colds and you can get the flu, and it's not life-threatening, and it's not the end of
16:22the world.
16:23It's real hard to remember that sometimes, that, you know, you wake up at three o'clock
16:29in the morning and you're congenital, and you have a fever, and you have a cold, and
16:33you wake up in the morning and you're congested, and there's this lump on your chest.
16:37Is this it?
16:39You know, is this the start of it?
16:41Is it going to happen to me now?
16:43It's hard.
16:46During 1982, the CDC's investigation gathered momentum.
16:52They focused their efforts on searching for a cause of the still unexplainable outbreak.
16:57Right at the beginning, there were a lot of what I think were completely crazy theories
17:02that it was, you know, going to tanning salons or something like that.
17:07I think most people who were seriously thinking about it believed that it was either some
17:13sort of infectious agent, like a virus, or that it was some sort of environmental exposure,
17:20like a drug.
17:22Poppers were their first suspect.
17:24Drugs like amyl and isobutyl nitrite, often used by homosexual men to enhance sexual activity.
17:30They hoped to find a bad batch of the drugs that would explain the new illness, but preliminary
17:36tests failed to detect any contamination.
17:39The CDC pushed on.
17:41We thought the thing to do would be what's called a case control study, and that's a
17:46really classic technique in epidemiology.
17:50And you're just asking a simple question.
17:52You're saying, what's the difference between people who have a disease and people who are
17:57very similar to those affected but don't have the disease?
18:01The CDC analyzed data from nearly 200 subjects, comparing AIDS patients with matched controls.
18:08The most striking difference was sexual activity.
18:11AIDS patients had more than twice as many sexual partners as did controls.
18:16This pattern suggested AIDS might be sexually transmitted.
18:22By the summer of 1982, one year since the start of the AIDS outbreak, there were over
18:28350 cases, but still no answers.
18:33The CDC, with neither hospital nor patients, remained one step removed from the real front
18:38lines.
18:41In an intellectual way, I guess it's hard for all of us, but I think it's much more
18:45difficult for the physicians and nurses who see AIDS patients in hospitals all the time.
18:52They see these people who've been healthy.
18:54They come in with this terrible disease.
18:57They get to know them.
18:59They become friends with them, and then they die.
19:00And I can't think of any experience in medicine that could be worse than that.
19:07Paul Volberding's clinic at San Francisco General Hospital now treats more than half
19:12of all the AIDS patients in that city, including Bobby Reynolds.
19:18The bond between doctor and patient has grown during the years since Bobby was first diagnosed,
19:24and his prognosis is favorable while his cancer remains in remission.
19:29Some patients do very well.
19:30Some patients with Kaposi's sarcoma who haven't had infections can expect to live
19:36a reasonably long lifespan, and we hope that some of them will go on living for a long
19:42period of time.
19:44Your response to the chemotherapy has been really gratifying for me, seeing how some
19:49of the other patients don't respond to it.
19:51It's been a struggle for two years.
19:54The typical AIDS patient dies within 18 months of diagnosis, and few live beyond three years,
20:00so Bobby is monitored closely for signs of infection.
20:04You have to look in your mouth.
20:05Watch out for the gum.
20:06Oh, watch out.
20:09Say ah.
20:11Okay.
20:12Well, great.
20:13I don't see any evidence of thrush.
20:16I see some gum, not much else.
20:19Good.
20:20They both remain alert for any signs of his skin cancer.
20:23Correct me if I'm wrong.
20:24You've never had Kaposi's in your mouth.
20:26Oh, I did.
20:27You did?
20:28Yeah, that was one of the first places they found it.
20:30Okay.
20:31I don't see anything in there now, so it's another evidence that the chemotherapy is
20:35making the Kaposi's go away.
20:38Usually, though, the Kaposi's itself progresses despite therapy often, and because of the
20:45underlying immune deficiency, the people with AIDS remain susceptible to a whole range
20:50of infections that we see.
20:52Take some good, deep breaths with your mouth open.
20:55Unfortunately, the disease has not yet been one that we've been able to reverse.
21:01Once the immune deficiency is there, nothing we do really changes that.
21:07What happens to the immune system of a person with AIDS?
21:11In healthy individuals, white blood cells circulating in the bloodstream search out
21:16and destroy foreign invaders.
21:18Here, white blood cells attack a virus-infected cell and render it harmless.
21:28Two important types of white blood cells are B cells, which originate in the bone marrow,
21:32and T cells, named after the thymus.
21:35Each microorganism that invades the body has unique chemical markers on its surface.
21:42The shape of that marker works like a lock.
21:45Each B cell carries a particular key or antibody on its surface.
21:50When a B cell discovers an invader with a lock that matches its key, it sets off an
21:55alarm to warn the troops.
21:58T cells also join the assault.
22:01One type of T cell, the T helper cell, responds by sending chemical signals that stimulate
22:07other B cells to multiply into a full-scale army that hunts down similar invaders.
22:13When the infection is under control, other T cells, known as T suppressor cells, send
22:18signals that call off the troops.
22:21In a healthy individual, there are twice as many T helper cells as T suppressor cells.
22:27In people with AIDS, this ratio is reversed.
22:31In advanced cases, there are virtually no T helper cells left to turn on the immune
22:36system.
22:38Invading microbes take advantage of this opportunity and proliferate.
22:44These so-called opportunistic infections are what actually kill the AIDS patient.
22:49What scientists needed to learn was what was causing the disappearance of the T helper
22:54cells.
22:55Hi, this is Jim Curran, returning your call.
22:58Good.
22:59During 1982, the CDC studied each of the 700 cases then reported.
23:05The number had doubled in six months, strengthening their suspicion that AIDS was being spread
23:10from person to person by some unknown microbial agent.
23:16One of our major hypotheses has always been that it could be caused by a transmissible
23:21agent.
23:22We had to be aware of the implications of that.
23:25We had to follow up very closely any cases which might either prove or disprove that
23:30hypothesis.
23:32At first, AIDS had been limited to homosexuals, but new clues were uncovered when it spread
23:37beyond the gay community.
23:39First were intravenous drug abusers who shared blood-contaminated needles.
23:44Next came puzzling cases in recent Haitian immigrants.
23:48Then hemophiliacs joined the list, proving the CDC's hypothesis of a transmissible agent.
23:55To control their hereditary bleeding disease, many hemophiliacs use a product known as Factor
24:008.
24:01This fragile clotting agent is dried and heat-treated, but cannot be fully sterilized.
24:07Each dosage is concentrated from the blood of up to 20,000 donors.
24:12Exposed to nearly a million different blood samples each year, hemophiliacs were especially
24:17vulnerable to a disease carried in the blood.
24:20When these new cases of AIDS appeared, it raised the specter that some portion of the
24:25national blood supply might be contaminated with the AIDS agent.
24:31In fact, a very small percentage of blood was contaminated, and the first cases of transfusion
24:37related AIDS were identified later that year.
24:42Blood banks moved rapidly to discourage donations from those at high risk, while the medical
24:48detectives sifted through the evidence for more clues.
24:52By tracing the contaminated donations, they learned that AIDS had a dangerously long incubation
24:58period of one to five years.
25:02After it became quite clear that AIDS was caused by a transmissible agent, after cases
25:08were firmly diagnosed in persons with hemophilia, were recognized in persons who had received
25:14blood transfusions as their only possible risk factor, then the directions became quite
25:21clear.
25:22The first order of business scientifically was to find the agent.
25:28Dr. Robert Gallo had followed developments in the daily paper, but never expected to
25:32play a role in the AIDS story.
25:34As director of the Laboratory of Tumor Cell Biology at the National Cancer Institute in
25:39Bethesda, Maryland, he was involved in basic research which seemed unrelated to AIDS, but
25:44which would soon play a crucial role.
25:47In 1980, Dr. Gallo had discovered the first human cancer virus.
25:52HTLV-1, human T-cell leukemia virus, specifically homed in on the T-cells of the immune system,
25:59causing a rare but virulent cancer.
26:02Most viruses consist of an outer protein shell and an inner core of double-stranded DNA.
26:08But HTLV-1 was a retrovirus and contained only a single strand of RNA.
26:15In order to reproduce, retroviruses carry with them a special enzyme, reverse transcriptase,
26:21which copies or transcribes the RNA to create DNA.
26:29Researchers can identify a retrovirus using a sophisticated procedure that detects the
26:34presence of reverse transcriptase.
26:36By the summer of 1982, evidence began to accumulate, leading Dr. Gallo to suspect that a
26:42virus, and specifically a retrovirus, might be the cause of AIDS.
26:46There were two things that led us to believe strongly it was something in the viral category.
26:53The first is that something called Factor VIII, which is used in the treatment of hemophilia
26:59to supply the missing factor in this genetic disease, apparently could transmit AIDS.
27:04And Factor VIII is filtered so as to remove bacteria and fungi.
27:10Second, and perhaps most important to me, conceptually, it is much easier for me to
27:17think about a virus homing in on a particular kind of blood cell or lymphatic cell than
27:24a bacteria or fungus.
27:26In addition, Dr. Gallo was familiar with the latest research on the behavior of the
27:30retrovirus in animals.
27:32In particular, he was influenced by discussions with his friend and colleague, Dr. Max Essex,
27:37at the Harvard School of Public Health.
27:40Dr. Essex had been among the first scientists to show that leukemia in cats was caused by
27:45a transmissible virus.
27:47Feline leukemia, well known in household pets, is a T-cell malignancy and is caused by a
27:52retrovirus.
27:54Dr. Essex had also discovered that the same retrovirus which caused leukemia in some cats
27:59caused an immune deficiency and opportunistic infections in others.
28:04The immune disorder he'd found in cats was strikingly similar to the human disease known
28:08as AIDS.
28:10He chatted with his friend, Bob Gallo.
28:12They began to speculate.
28:14Could the human leukemia virus, which Dr. Gallo discovered, have a similar dual personality?
28:20Could a retrovirus be the cause of AIDS?
28:23So that was the hypothesis from day one.
28:26A lot of things happen in science by serendipity.
28:28Many have happened to me with good fortune by serendipity.
28:31This was not an example of serendipity.
28:34This was the hypothesis that we both had from the very beginning.
28:38So we began testing this hypothesis by the same technology that led to the isolation
28:44of HTLV-1.
28:45Looking for a retrovirus, they first isolated T-cells from the blood of patients with AIDS.
28:50Then they grew the cells in culture for several weeks so that any virus present would increase
28:55to detectable levels.
28:57Finally, preparations began to test for reverse transcriptase, the telltale sign of a retrovirus.
29:04But a preliminary examination of the culture yielded an unexpected setback.
29:08The T-cells had failed to grow.
29:10There was nothing to test.
29:13The entire procedure would have to be repeated from the beginning.
29:17But then a second batch yielded similar results.
29:20Working long into the night, they tried again and again to coax the cells to grow.
29:25Frustration turned to bewilderment.
29:27On the surface, it seemed that one of the leading T-cell laboratories in the world
29:32had lost its touch for growing the vital cells.
29:38That same year, physicians began to realize that the AIDS problem was more extensive than
29:43the CDC definition allowed.
29:50Dr. Donald Abrams, assistant director of San Francisco General's AIDS clinic,
29:54specializes in treating lymphadenopathy syndrome.
30:05Patients with lymphadenopathy syndrome have chronically swollen lymph nodes and persistent
30:09fever.
30:10It was a condition that sometimes precedes AIDS and so is commonly referred to as pre-AIDS
30:16or ARC, AIDS-related complex.
30:19Dr. Abrams was seeing 10 times as many ARC patients as AIDS patients.
30:24We've seen a number of men who don't have CDC-defined AIDS.
30:30But they have something going wrong that we know is probably related to the overall AIDS
30:35picture.
30:36So ARC, or AIDS-related complex, is a group of symptoms which define a group of patients
30:42who have something that's suspicious about their immune system, suggestive that it's
30:48related to AIDS.
30:50And we don't know really what's going to happen.
30:52The future is a question mark.
30:53These patients are in a gray zone.
30:56Some of them get a little bit better.
30:58Some of them go on to get AIDS.
30:59A lot of them stay just the same.
31:01And even though they don't have AIDS, they're not well.
31:05They do have disease.
31:08In Paris, Dr. Willie Rosenbaum was also seeing not only AIDS patients but also ARC or pre-AIDS
31:14patients as well.
31:17He had heard that the American search for an AIDS virus had been disappointing.
31:21This sparked a new idea.
31:24Notre idée à nous a été de dire peut-être que le virus disparaît.
31:29Our idea was to say that perhaps the virus would disappear at the time the disease would
31:34express itself.
31:38For that reason, we thought of looking for the virus in patients in a pre-AIDS situation.
31:44Dr. Rosenbaum had a surgeon remove one of the swollen glands from a pre-AIDS patient.
31:54A colleague in the French working group suggested the lymph node be sent to the
31:58historic Pasteur Institute where Dr. Luc Montagnier was head of the cancer virology unit.
32:04He was conducting research looking for human retroviruses which might cause cancer
32:08and was considered one of France's top experts in the field.
32:14Yes, this was at the beginning of 1983.
32:18Françoise Brun, who was a former student of mine, called me asking me if I would be
32:26interested to work on a lymph node taken from a patient with pre-AIDS and looking for a
32:33retrovirus.
32:34And I said yes.
32:38Working on the node himself, Dr. Montagnier isolated the T-cells from the patient's lymph
32:43tissue and placed them in culture fluid.
32:45They incubated the cells for several days and then set out to test for reverse transcriptase,
32:51the indicator of a retrovirus.
32:54He began these tests at an earlier stage than Dr. Gallo, who had grown his cultures for
32:58several weeks.
33:00A preliminary check showed the T-cells were still growing, so the researchers prepared
33:05to test for signs of reverse transcriptase, which would indicate the presence of a retrovirus.
33:09Only 22 days after receiving the tissue sample, they found significant reverse transcriptase
33:15activity, a positive sign that a retrovirus was present.
33:21When I first found this reverse transcriptase activity, I was not very much excited at
33:27first, because we knew there were already some known human retroviruses.
33:32And our first feeling was to compare, to think this was a retrovirus of the HTV-1 type.
33:39So I asked my colleague, Dr. Gallo at NCI, to send me some reagents to show if the virus
33:50that we have isolated was really HTV-1 or not.
33:55Dr. Gallo's lab quickly sent off the reagents, biochemicals which would react with the virus,
34:01to tell them if they had found HTLV-1 or not.
34:05And this was the beginning of the excitement, because it turned out that the virus we had
34:12was not HTLV-1.
34:13It was another type of human retrovirus.
34:17With an electron microscope, they were able to take a somewhat fuzzy picture of the virus
34:22budding out from the cell wall.
34:24They would name it lymphadenopathy-associated virus, or LAV.
34:30I keep a record of all my experiments.
34:33And this notebook was specially devoted to the research on human retroviruses.
34:39It started in 1977.
34:42And for each experiment, I put a mark after the results.
34:47If they are good, I put plus plus.
34:50And nothing if they are not, there are no positive results.
34:54And of course, you would guess that in the experiments for LAV, I put plus plus.
34:58And also, I added enfin, which means in French, at last, because I was looking for four years
35:06for a human retrovirus before I found this one.
35:11But this virus caused Dr. Montagnier and his colleagues problems they had not anticipated.
35:18To keep it alive, they had to keep putting it into fresh T-cells.
35:22And with each successive culture, the virus weakened.
35:25The virus weakened.
35:27The elusive retrovirus was fading away.
35:31And they were unable to perform further tests which would describe or characterize the virus
35:35in full detail.
35:37Nonetheless, they were excited by their discovery.
35:40They prepared an article on their new human retrovirus, which appeared several months
35:45later in the prestigious journal Science.
35:48It was the first published report suggesting a retrovirus might be the cause of AIDS.
35:55At the time of the report from the group at the Pasteur Institute, the virus was not put
36:00into a permanently growing cell line.
36:02It was not characterized in any detail.
36:05And they did not provide data that linked the virus to the disease.
36:10Around November of 1982, during the period that they made their report, we had similar
36:17observations.
36:18But we did not publish the identification of that virus at the time.
36:24This jumble of numbers in a laboratory notebook is the only written record of their findings.
36:29The D14 notation shows they were seeing positive reverse transcriptase activity, and a second
36:34test indicated it was not HTLV-1.
36:38Gallo, like Montagnier, had found a new retrovirus associated with AIDS.
36:42Yet he did not publish.
36:44Why?
36:45We had these electron microscopic observations, and we didn't publish it because I was
36:49concerned about the following problem.
36:51What if we published five cases, five pictures, five different people, and they turned out
36:56to be five different retroviruses?
37:00We would have misled the field.
37:01That was our dilemma.
37:02We saw pictures of what we believed to be new retroviruses, but we failed and we couldn't
37:08characterize them.
37:09Why?
37:09Because we couldn't grow the cells very long, neither could they in Paris.
37:13So no one could characterize these viruses properly.
37:16Not them, certainly, and not us.
37:19So we put the virus that we were seeing in patients with AIDS in the freezer, hoping
37:25for a better day.
37:27We struggled with this problem longer than I wish we had.
37:32Accustomed to the methodical pace of basic research, Dr. Gallo felt mounting pressure
37:37as the epidemic grew.
37:40It was now the summer of 1983, two years since the first reports, and nearly 1,500 cases
37:46had been reported to the CDC.
37:48Equally disturbing was the fact that cases continued to double every six months.
37:54Gay activists criticized the government's response to the health crisis and urged additional
37:59funding for research.
38:02Press coverage of the AIDS epidemic increased dramatically when it spread outside the homosexual
38:06community.
38:07This new development was accompanied by a quantum leap in the concern of the general
38:11public, almost amounting to panic.
38:14A firestorm of fear was fanned in the media.
38:17Harold Jaffe remembers the AIDS hysteria.
38:20That really was very frightening when that happened.
38:22When it looked like, you know, gay men were going to get thrown off buses in San Francisco
38:28or that Haitians were going to be thrown out of their apartments in New York.
38:31I think that was really a very scary time for all of us.
38:34The gay community organized.
38:36Marches were held throughout the country to dramatize the plight of people with AIDS and
38:40to demand funds for more research.
38:43During 1983, as pressure grew, the Public Health Service made AIDS its number one priority.
38:50Over $40 million were released for new research.
38:53Volunteer organizations were mobilized to provide counseling and support services for
38:57people with AIDS.
39:00Kevin McConville was an active member of Boston's AIDS Action Committee and one of the first
39:05people trained for their hospice support group.
39:07He volunteered to help an AIDS patient and was assigned to a 35-year-old man named Bill,
39:12who was in the latter stage of his illness.
39:16When I first met Bill, I was very nervous.
39:18First of all, I didn't know what to expect.
39:21The whole thing was very new to me on such a personal level.
39:25Some of the things that I did for Bill were cleaning his house, doing his grocery shopping,
39:30taking him to the doctor.
39:32Bill was one of the first people diagnosed in Boston.
39:36He was a real pioneer.
39:38Paranoia was running rampant.
39:40The media was doing a sensationalist number.
39:44People were running scared, including many health professionals.
39:47Good health care was much harder to get at the time because it was so little known.
39:54He was one of the people that you used to read about that had his meals left outside
39:58his room for hours at a time.
40:00Cleaning crew would never come in and clean his room.
40:03People would come in looking like they were ready for a moonwalk with gowns, masks, gloves,
40:08and hats.
40:12The isolation must have been horrible.
40:16He taught me about dignity, about the right kind of health care that people are entitled
40:23to.
40:24I can thank Bill in a lot of ways for being as courageous as he was because he wouldn't
40:30tolerate it.
40:30He refused to tolerate it.
40:31He had no self-respect and enough dignity to know that he was entitled to.
40:35And he fought for it.
40:38At San Francisco General Hospital, they were also struggling to provide appropriate health
40:42care.
40:43Dr. Paul Volberding.
40:45We found ourselves dealing with more and more people with AIDS and finding that the
40:50care was very specialized.
40:52The requirements for social support and medical care were really quite unique in that those
40:56needs were difficult to meet on conventional units.
41:00So we had the idea in early 83 that we might set up an AIDS care unit.
41:06Reaction at that time was uniformly negative, that this would be a leper colony, that patients
41:11wouldn't want to be there, that family and friends wouldn't visit, that the physicians
41:15wouldn't come there.
41:17We went ahead anyway and opened up the unit and it's been a complete success.
41:21The people who work there aren't afraid of AIDS, so they feel comfortable dealing with
41:25the patients.
41:26That's very important.
41:27As an oncologist, as a cancer specialist, I think I'm perhaps a bit better protected
41:34emotionally than some other specialists in taking care of people with AIDS.
41:38I know from talking to other people in our clinic who are infectious disease specialists
41:43who really go through their medical training being prepared to cure infections that my
41:49expectations are different.
41:52Most of my patients, even before AIDS, I don't really expect a cure.
41:57How are you today?
41:59Great.
41:59How are you doing?
42:00Doing real well.
42:01I expect to help them with their disease, help them be more comfortable, help them live
42:05as long as possible.
42:06Yeah, I'm doing much better.
42:08I feel better.
42:11We've been talking before about the Kaposi's and how that's changing.
42:16Have you noticed any change with the Kaposi's since you've been admitted with a pneumocyst
42:22pneumonia?
42:23Not really.
42:24It's, I have so many lesions, it's rather difficult to really keep track of them.
42:31There's no way, though, that this is an easy field.
42:34It's not easy taking care of people exactly my own age, dying of horribly disfiguring
42:40disease with often very little that I can do for them.
42:44I'd like to just take a check of your lungs mostly, maybe take off your gown.
42:50Daniel has Kaposi's sarcoma, but he's hospitalized to treat the potentially fatal
42:55lung infection, pneumocystis pneumonia.
43:00Say 99.
43:0199.
43:02Again.
43:03Again.
43:03That's funny.
43:0499.
43:05All right.
43:07You just pound down here.
43:08Just breathe normally.
43:14Sense of humors are not allowed in the hospital.
43:16Oh, sorry.
43:17Daniel has been one of the growing number of AIDS patients who has been helped with
43:21his disease, but for whom Paul Volberding can offer no cure.
43:30In France, the story was much the same.
43:33Doctors helplessly watched as the number of AIDS patients increased.
43:38Dr. Montagnier and his colleagues had personal contact with almost all the AIDS patients
43:43in Paris and felt an urgency to quickly find an answer to end this human tragedy.
43:49Dr. Montagnier's associate at the Pasteur was Dr. Jean-Claude Schermann, head of the
43:54virology lab.
43:56Dr. Schermann recognized that they had to continually add fresh T-cells to the culture
44:01in order to keep the virus growing.
44:03He knew that in AIDS, the T-cells disappeared and wondered if the virus could actually be
44:08killing the cells it grew in.
44:10That summer, they were able to take a clear photograph of the virus in a T-cell, which
44:14confirmed Dr. Schermann's hypothesis.
44:17In this picture, you can see the virus has ruptured the cell wall.
44:21It's killed the T-cell, the very cell that had been disappearing in AIDS patients.
44:25The French were now all convinced they had the right virus.
44:29We were all convinced that we had the right virus.
44:32And in the world, we are the first.
44:34And in the world, we are the first.
44:37But as you know, in science, it's not sufficient to be convinced.
44:40You have to convince the others.
44:43Convincing the others was harder than they expected.
44:46Jean-Claude Schermann remembers what happened that fall at a prestigious scientific meeting
44:51at Cold Spring Harbor, New York, where Dr. Montagnier had been asked to talk about LAV.
44:56Montagnier was invited in Cold Spring Harbor for a meeting.
44:59It's one of the most famous places for the American scientists.
45:03And outside, poor French people coming sometimes.
45:08And at this meeting, Montagnier has 30 minutes to speak.
45:12When Montagnier came back, he said, I spoke, but people are still involved with HTLV-1.
45:18They do not believe.
45:21The frustrating thing was Montagnier and Schermann were convinced they had found the right virus,
45:26but no one believed them.
45:28Lacking the proper technique, they couldn't grow enough of it to do the necessary tests
45:32to confirm that LAV caused AIDS.
45:35Yet their insight that the virus was killing T-cells would ultimately bring researchers
45:40closer to proving the cause of AIDS.
45:44On the clinical front as well, there was deep frustration and painful disappointments in
45:48the search for effective treatment.
45:50Bobby Reynolds had been selected to be one of the first AIDS patients to receive interferon.
45:55He waited over a month for the drug to arrive, and his anxiety grew daily.
46:00And during that time, I kept getting angrier because I could feel the lesion that was in
46:05my throat grow.
46:07And every time I swallowed, you know, you have a lesion in your throat.
46:12Finally, the day came that the interferon was received, and we were sitting there talking
46:17to the nurse.
46:18And she just offhandedly says, do you have any allergies?
46:21And I said, yes, I'm allergic to penicillin.
46:24The interferon that they were using was made with penicillin, and therefore I didn't fit
46:28the protocol.
46:30Bobby was unable to participate in the experiment, but even for those who did, the results were
46:35inconclusive.
46:37There's been lots of suspected breakthroughs, and I used to put my hope on those and constantly
46:43would come crashing down because it didn't pan out.
46:46So I've learned that I can have a little excitement about, well, maybe this is it, but I can't
46:52put a whole lot of faith into it right now.
46:57Throughout the autumn of 1983, Kevin McConville worked with his hospice buddy, Bill.
47:03As winter took hold, he watched Bill slip into the final stages of his illness.
47:09I had a wonderful relationship with my friend Billy.
47:13It took off right from the beginning.
47:15We got to be very, very close.
47:17He was in and out of the hospital about four times in those six months, and he was very,
47:22very brave.
47:23He was really courageous.
47:24He managed, even in the latter stages of his illness when he was obviously very uncomfortable
47:30and a lot of pain, he was in bed for the last two months, still always managed to smile.
47:36He entertained and took care of me just as much as I ever did him.
47:40It was a very mutual relationship, very 50-50.
47:43The last attack came, it was very sudden.
47:46I mean, I knew that Bill was dying, but I didn't think that it was going to happen that
47:49quickly for him.
47:50And he had a seizure, and we took him to the hospital, and he never woke up again.
47:57Nurses told me that even though he was unconscious, that they were sure that he could hear me.
48:02And I went in the room, and we talked, and I talked.
48:09I told him how I felt about him, and that I was going to miss him, and that I thought
48:13he was going to be okay.
48:15And his eyes never opened, he never moved.
48:18But a tear came down the side of his face, so I knew that he heard me.
48:23And I'm really thankful that I had that opportunity.
48:33Bill was only one of nearly 800 men who died that year.
48:38As the toll mounted, Dr. Gallo, with new insights gained from the Cold Spring Harbor
48:43meeting with his French colleagues, began to close in on the suspect in the AIDS tragedy.
48:49When we appreciated that the virus was making the cell unable to grow, an observation I
48:54should say that Sherman, in the Pasteur Institute, was aware of earlier, we set out to try to
49:00find a safe place for the virus to grow.
49:04We set out to try to find a cell that this virus would grow in and not kill.
49:11And we succeeded in developing one, and better than anything we hoped for, we ended up with
49:16a tremendous virus-producing cell line.
49:20This was the breakthrough the scientists had needed.
49:22The permanently growing cell line solved two problems which had blocked previous efforts.
49:27First, we could give this out.
49:30You could give out a permanently growing cell line producing the virus to other colleagues.
49:34That solves the problem of other people seeing it and reproducing and analyzing and so forth.
49:39Second, for the first time, we could get sufficient virus to develop antibodies.
49:46Once you have the antibodies, you have reagents or probes that would allow us then to go back
49:52to our freezer, to all the early isolates we had, and in one large set of experiments
49:59to be able to type them and essentially prove that each virus was the same as every other
50:04virus.
50:06And therefore, we had something important.
50:09Dr. Gallo named the virus HTLV-3.
50:13His team now had the biochemical tools necessary to complete the final proof.
50:19In January of 1984, Dr. Gallo called the CDC and asked that blood samples be sent to him
50:24from Atlanta.
50:26The samples were secretly coded so that Dr. Gallo's team could not tell which were from
50:30patients with AIDS and which were not.
50:33They had been developing a blood test to detect antibodies to the virus.
50:38Antibodies are produced by the immune system in response to infection.
50:42If the new test could accurately identify HTLV-3 antibodies, it would help open the
50:46door to the next phase of AIDS research.
50:50When the secret code was broken, the test proved accurate.
50:55They were now ready to release their data to the public.
50:59On April 24th, 1984, a press conference was held.
51:03It was almost three years to the day since the first report from Los Angeles of the five
51:07mysterious cases.
51:09Secretary of Health and Human Services, Margaret Heckler.
51:13The probable cause of AIDS has been found, a variant of a known human cancer virus called
51:19HTLV-3.
51:20Second, not only has the agent been identified, but a new process has been developed to mass
51:27produce this virus.
51:29This discovery is crucial because it enables us for the first time to characterize the
51:34agent in detail to understand its behavior.
51:37Coverage of the announcement focused not only on the virus, but also on the apparent competition
51:42between the French and the American researchers.
51:45Comparative testing eventually showed that Dr. Gallo and Dr. Montagnier had separately
51:49found and separately named the same virus.
51:53Whether it was competition or collaboration, the cause of AIDS had been found and the story
51:58underlined the synergy of the scientific process.
52:02The groundwork was laid by Dr. Gallo's original discovery of HTLV-1 in 1980.
52:08The first solid lead came when Dr. Montagnier published his isolation of the LAV virus.
52:14Next, the French team achieved a conceptual breakthrough when they determined the virus
52:19was killing its host cells.
52:21Finally, Dr. Gallo independently found the virus and developed a permanently growing
52:27cell line as well as a simple blood test, which set the stage for the next phase of
52:31AIDS research.
52:34I think finding the cause of AIDS is tremendously important, even though at the moment it doesn't
52:40give us a way to treat AIDS patients or prevent AIDS.
52:43The discovery of the virus does not represent the cure, does not represent a vaccine at
52:48this point.
52:49Much, much more work needs to be done.
52:52The way I think about it, the analogy I've given to other people is that this is a book,
52:55we hope it's a small book, one chapter is closed.
52:58And without that chapter being finished, it would be very difficult to move to the second
53:02one.
53:04For Kevin McConville, chapter one ended when his hospice buddy Bill died.
53:10But for Kevin, and thousands like him, the story is not over.
53:15About a month after Bill died, I started experiencing a lot of symptoms that were
53:20classical of depression, fatigue, loss of appetite, weight loss, persistent diarrhea.
53:31I also knew that those were symptoms of AIDS, and for about two months managed to convince
53:41myself that it was emotional rather than physical.
53:47Finally by April I knew, I mean there was no denying it anymore, and I was diagnosed
53:55on May 15th with pneumocystis.
53:58I'm only 28 years old, but I had a great life.
54:06I can look at my life and honestly say, I'm proud of myself, I've always done the right
54:12thing, I've always followed my conscience and I've never heard a fly, and I've had a
54:16good time along the way.
54:19I have a wonderful family, my friends have been terrific.
54:25I want more of that, but I haven't missed a thing.
54:31Bill always wanted more, more life, more time.
54:38Ultimately I'm convinced that we're going to win.
54:41Someday, someone, maybe not in my lifetime, maybe in my lifetime, I don't know, but someday
54:46somebody's going to beat this, and it's going to be over.
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