The Anatomy of an Epidemic
Gottlieb treated four more gay men, all strangers to each other but all diagnosed with unusual infections. The five also developed pneumonia, which lung biopsies confirmed to be the rare PCP.
They had a "profound T-cell deficiency," too, says Saxon. T-cells, a type of white blood cell that fights infection, had just been discovered in the 1970s. "We knew there was something going on."
By May 1981, Saxon and Gottlieb were sure they had an epidemic on their hands and were anxious to alert the medical community. They hoped to publish their findings quickly in the New England Journal of Medicine (NEJM), one of the largest-circulation journals. But the NEJM editors were unwilling to accelerate their several-months-long review and editing process, and in the meantime they couldn't even guarantee that the article would be published. But if the physicians leaked their findings to the popular press, the journal would unquestionably pull their paper.
But then they thought of a way to get the news out quickly without jeopardizing their chances of being published in the prestigious NEJM. They sent their report on the cluster of five unusual patients to the Centers for Disease Control (which still goes by "CDC," even though "and Prevention" was later added to its name), for inclusion in the agency's weekly newsletter, the Morbidity and Mortality Weekly Report (MMWR).
So on June 5, 1981, their article, "Pneumocystis
Pneumonia—Los Angeles," became the first
published report on the emergent AIDS epidemic.
A longer version, "Pneumocystis carinii Pneumonia and Mucosal Candidiasis in Previously Healthy Homosexual Men: Evidence of a New Acquired Cellular Immunodeficiency," appeared in the NEJM on December 10 of that year.
In July 1981, the MMWR ran another AIDS-related report. This one told of 26
cases of Kaposi's sarcoma (KS) and other opportunistic infections among gay men. It was titled "Kaposi's Sarcoma and Pneumocystis Pneumonia Among Homosexual Men—New York City and California."
No one knew what was causing these infections. Some thought "poppers," a nitrate-based inhalant, were to blame. Although meant for heart patients, the drug was widely abused by gay men in the 1970s and '80s to enhance sex. Saxon and Gottlieb, however, suspected that an infectious agent—possibly cytomegalovirus, a herpesvirus that is normally harmless in healthy individuals—was to blame. But, Saxon admits, "we didn't recognize it as bloodborne at first."
Over the next few years, Saxon became immersed in the AIDS epidemic. (His research specialty was, and still is, B-cell immunity and allergy.) He read every article he could on the disease. In 1983, he started the first AIDS newsletter. He spoke frequently at medical meetings and was interviewed often by the media.
He believes the cause of AIDS might
have been harder to find if Japanese researchers hadn't laid the groundwork in the 1970s by identifying the first human retrovirus, adult T-cell leukemia virus. "If that hadn't happened, we would have thought we had the plague," he says. Instead, within two years after the
seminal MMWR report, Dr. Luc Montagnier at the Pasteur Institute in France and Dr. Robert Gallo at the National Institutes of Health in the United States independently discovered that AIDS was caused by a retrovirus. Montagnier called it lymphadenopathy- associated virus (LAV), and Gallo dubbed it human T-cell lymphotropic virus type III (HTLV-III). By 1985, researchers had determined the two were the same, and the virus was renamed human immunodeficiency virus (HIV).
By the early 1990s, Saxon had suspended publication of his AIDS
An AIDS Timeline
The following events are among the milestones that have marked the recognition, understanding, and treatment of HIV/AIDS.
- Gay men in the United States and Sweden, and heterosexuals in Tanzania and Haiti, begin showing signs of a disease that is later determined to be AIDS.
- AIDS has spread, it is later clear, to at least five continents—North America, South America, Europe, Africa, and Australia.
- With the disease's spread unchecked by awareness or any preventive action, between 100,000 and 300,000 persons may have been infected by this point.
- The June 5 Morbidity and Mortality Weekly Report (MMWR) publishes word of five gay men with P. carinii pneumonia (PCP).
- The July 4 MMWR publishes a report on 26 cases of Kaposi's sarcoma in gay men in New York and California.
- In July, NY Times publishes the first article about AIDS in the popular press—"Rare Cancer Seen In 41 Homosexuals."
- In December, the first cases of PCP are reported in intravenous drug users.
- U.S. Centers for Disease Control (CDC) coins the term AIDS (acquired immune deficiency syndrome) and names four risk factors: male homosexuality, Haitian origin, hemophilia A, intravenous drug abuse.
- CDC announces that the virus that causes AIDS may be in the nation's blood supply.