The direction of my research career changed dramatically on that summer day in 1981 when I read in the weekly publication of the Centers for Disease Control (CDC) that an unusual infection called Pneumocystis carinii was noted in five apparently healthy homosexual men in Los Angeles. The thought swept through my mind that this was almost certainly due to an immunosuppressed state, the natural setting for this type of pneumonia. However, it was puzzling to me why there was such a clustering of cases. A few weeks later another report from the CDC described the occurrence of Kaposi's sarcoma (another disease associated with immunosuppression) in 26 previously healthy homosexual men in New York City and Los Angeles. I remember thinking that this might well be an infection, but what microbe and why now? The startling answers would unfold over the next few years together with the realization that the biomedical research community would be facing a challenge that occurs less frequently than once in a lifetime: the challenge of science pitted against a totally new, communicable, and deadly disease with staggering global public health impact.

Indeed, AIDS has captured the attention of the world like no other disease in memory, both for its scientific curiosity and complexity and for the sociological setting in which it emerged, i.e., sexuality and drug abuse. In an unprecedented manner, scientific investigation has been carried out in a "fish bowl" atmosphere. High intensity media coverage, countless congressional hearings, and demonstrations by constituency activists complicated an already formidable scientific challenge.

Notwithstanding these confounding issues, biomedical research is again on its way to validating its critical importance to society. Despite the fact that in 1995 we do not have a cure or effective vaccine for HIV infection, scientists have advanced the field at a pace that is truly unprecedented given the relatively short time (14 years) since the recognition of the existence of AIDS. The causative agent has been identified and studied more intensively than any other pathogen in history. Sensitive and specific diagnostic antibody tests have been developed. The complexities of pathogenic mechanisms are being delineated. Several drugs with potent anti-HIV activity have been developed against various targets in the virus life cycle, and a number of vaccine candidates are in various stages of testing. However, the challenges ahead are sobering. Although we already have an armamentarium of antiretroviral agents with potent activity, the rapid rate of replication and mutagenicity of HIV almost invariably lead to the inevitable and prompt emergence of resistant strains. Although vaccine candidates can elicit immunity, we do not yet have a clear understanding of the nature of protective immunity, and so endpoints of vaccine trials remain elusive.

Thus, the scientific triumphs in AIDS research are constantly balanced by formidable and seemingly insurmountable roadblocks. Of particular note from a historical standpoint is the fact that this entire scenario is taking place not in the investigation of obscure microbes such as Ebola virus or Lassa Fever virus with little current public health impact, but in the frustrating battle against a still-raging and accelerating catastrophic global pandemic. There is no doubt in my mind that biomedical research will yield lasting solutions to this plague, and that the positive spinoffs of the effort will ultimately transcend the AIDS epidemic. The decades of basic science on microbiology, immunology, and other disciplines laid the framework for the control of diseases against which the original efforts were aimed at the same time that they provided us with the tools to tackle the unique scientific problems introduced by the AIDS epidemic. So too will biomedical research on AIDS ultimately lead to the control of this disease at the same time as it sows the seeds of knowledge necessary for meeting recognized and as yet unrecognized challenges to the public health in the next century.

Return to Main Page

Copyright © The McGraw-Hill Companies, inc. Permission required for reproduction or display.