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The Anatomy of an Epidemic

June 2006 marks the 25th anniversary of the first published report about AIDS—a paper coauthored by a DMS alumnus. In the quarter of a century since then, the disease has swept the globe. But doctors and scientists—including many with Dartmouth ties—have been making progress, both scientifically and socially, against the wily virus that has killed 25 million people.

By Laura Stephenson Carter

The story broke not with a bang but a whimper. Today, with 25 years of hindsight, it's easy to see that the emergence of AIDS was one of the biggest health stories of the 20th century. But back in the early 1980s, doctors hadn't yet put together scattered reports of unusual illnesses in New York, San Francisco, and other cities.

Young, previously healthy, gay men were complaining of fatigue, fever, diarrhea, unexplained weight loss, purplish lesions, respiratory ailments, and aggressive infections. Doctors were perplexed. Their patients were exhibiting symptoms normally found in immunocompromised patients. The purplish lesions were signs of Kaposi's sarcoma, a rare but nonlethal cancer more likely to strike elderly men. The patients' respiratory problems often worsened, turning into Pneumocystis carinii pneumonia (PCP), a rare disease first seen in orphanages in post-World War II Europe. Soon the men began exhibiting even more aggressive infections, including herpes; fungal growths; and toxoplasmosis, a parasitic infection of the central nervous system. They were getting sicker and sicker, wasting away, dying.

But the public health system was slow to react to these mysterious deaths. And peer-reviewed journals aren't designed to spread news quickly; during the six months or more that it takes an article to go through the review and editing process, authors are barred from leaking news to the popular press.

But Dr. Andrew Saxon, a DMS graduate, and his colleagues at the University of California at Los Angeles managed to find a way around this problem. Theirs was the first official published report on what we now recognize as the AIDS epidemic.

Breaking the silence
Dr. Andrew Saxon, DMS '70: now chief of

clinical immunology and allergy and a professor of medicine at the University of California at Los Angeles (UCLA)

The patient had a "fungus ball on the end of his finger," recalls UCLA immunologist Andrew Saxon. He was awed. "You didn't see that except in bubble babies"— severely immunocompromised

children who have to live inside a germ-free plastic bubble—"and in leukemics treated with intensive chemotherapy."

It was the fall of 1980. The patient was a young, previously healthy, homosexual man. Over the next few months, Saxon and his colleague Dr. Michael

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Laura Carter is Dartmouth Medicine's associate editor. Sources for the timeline below include The AIDS Reader, March 2006, Vol. 16, No. 3; American Medical News, July 2, 2001; Newsweek, May 15, 2006; www.avert.org; www.aegis.com/topics/timeline/; and aidshistory.nih.gov.

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