How AIDS Care Became The Way It Is

Jul 22, 2012
Originally published on July 22, 2012 2:43 pm



Few people have a greater understanding of the history of HIV-AIDS and the evolution of treatment and patient care than Dr. Paul Volberding. He co-founded one of the first AIDS-designated clinics in the early 1980s at San Francisco General Hospital. And he is also the co-editor of the most widely used textbook of HIV medicine. Dr. Volberding is now a professor and co-director of the Center for AIDS Research at University of California, San Francisco. And he is here in Washington for the International AIDS Conference.

He joins us in our studios. Welcome and thank you for coming in.

DR. PAUL VOLBERDING: Oh, it's great to be here. Thank you.

WERTHEIMER: Now, as you know better than most, the first AIDS cases were reported in the United States back in 1981. Young gay men began dying of cancers and pneumonia that usually afflicted the elderly. Could you help us understand as a medical practitioner what it was like to see those first patients come through?

VOLBERDING: Well, the thing I remember the most is that they were the age that I was. They were all young people at the time, people that should have been leading healthy lives, came in with diseases that we didn't understand and died very quickly.

WERTHEIMER: Were there any particular cases that have sort of stayed with you through all of these years?

VOLBERDING: Yeah. The one I remember the most is my first patient. I was rounding at the hospital and my first day on the job, July 1, 1981. Saw a 22-year-old man with Kaposi sarcoma, the cancer that we've come to know as caused by the virus - it's a horrible condition. It's a very visible cancer and it was before the AIDS epidemic really only seen in very elderly men. And I had just finished my training as a cancer specialist, as an oncologist, and didn't really bother studying it because it was so rare. But here we were seeing case after case.

WERTHEIMER: There were also some very frightening times when people were not sure what this was and how it was spreading.

VOLBERDING: Well, there was a time, and I recall it as the end of the 1982, when we first started hearing cases in children and in blood transfusion recipients where the likelihood that this was an infection because clear. And those of us that had been working like me for a year and a half by then, went through a period of being really terrified that I was going to catch this. My wife was a doctor. She was working with AIDS patients. We were having our kids at the time. So, afraid that we were going to take it home and give it to our children.

WERTHEIMER: Now, of course, that was all those years ago, in the very early '80s. What about challenges today?

VOLBERDING: I think that challenges today are now that we have really effective treatments, the challenge today is finding the people that are infected, bringing them into care, starting them on treatment and keeping them in care and keeping them on treatment. All of those are challenges. But if we can do that, and we're going to hear a lot about it at the conference this week, I think there is a strong chance that we can turn this epidemic around.

WERTHEIMER: You know, I think a lot of us thought that back at the beginning that it would be curable, and it has not been cured.

VOLBERDING: Well, one of the other really fascinating stories that we're going to hear about during this conference is the search for a cure. There is one man who has been cured - Tim Brown, a patient in San Francisco. And he gives us at least one model of what might be possible. And there are a number of scientists that are really actively looking for that. But I think it's going to take a while to do that. And...

WERTHEIMER: Why is it going to take a while?

VOLBERDING: Well, this is a chronic viral infection. It almost immediately inserts itself into the infected person's own DNA. So it really becomes in a sense a genetic disease. And we really can't remove those genes once they're inserted into the DNA. This becomes what we call a latent virus, a virus that really hides out in the body. And there are a lot of efforts to kind of flush it out, combining those treatments with its standard anti-retroviral treatments. There are a lot of strategies that people are thinking about, but it's a very tough challenge.

WERTHEIMER: How did you know that Tim Brown was cured? How did that come about?

VOLBERDING: Well, it's an incredible story. He was HIV-infected and developed acute leukemia. And in the course of treating his leukemia, had a bone marrow transplant from a donor whose cells are naturally resistant to HIV infection. And after the transplant, his doctors stopped his anti-retroviral drugs, his HIV drugs, and his virus didn't come back. And since then, people have made great efforts to find the virus in him and haven't been able to grow it.

WERTHEIMER: Paul Volberding is a leading expert on treatment for people with HIV-AIDS. He's a professor and co-director of the Center for AIDS Research at the University of California San Francisco. Dr. Volberding, very nice talking with you.

VOLBERDING: Great to be here.

