***image2***
A conversation about the past, present and future of aids with a scientist hunting for a vaccine.
Photographs of microscopic organisms line the walls of the Institute of Human Virology entryway. Resembling modern abstract paintings, these framed images of colorful cells are at the root of the deadliest pandemic of our time-HIV.
For the layperson, these beautiful photos belie the horrendous impact of AIDS. The federal Centers for Disease Control and Prevention (CDC) reports that in the 25 years of the AIDS pandemic, more than 500,000 Americans have died of the disease and 25 million people have died worldwide. According to Dr. David Holtgrave of Johns Hopkins University's Bloomberg School of Public Health, in the United States a person dies from AIDS every 33 minutes and there is a new HIV infection every 13 minutes. Amazingly, about 25 percent of the 1.1 million people in this country living with HIV don't even know they are infected.
But in many ways, things are less grim than they were 25 years ago when AIDS was discovered, at least in the developed world. While AIDS is still a threat to many Americans-rich, poor, white, black, gay, straight-treatment has advanced considerably. The blood supply is completely safe. And Americans with HIV/AIDS are living longer, more productive lives.
For Dr. Robert Gallo-the scientist who co-discovered that HIV causes AIDS and developed the
***image9***
blood test that detects the virus-the microscopic organisms lining the walls of the Institute of Human Virology represent hope. Without the discovery of the virus, there would be no blood test, no protease inhibitors, no "drug cocktail" treatment. Each advancement in the treatment of AIDS comes back to the discovery of the virus, he says. And now Gallo is on the hunt for the holy grail of HIV research-a vaccine.
Since the genesis of the AIDS pandemic, Gallo, 69, has been on the forefront of research into this aggressive and mysterious disease. He began his work while at the National Cancer Institute at the National Institutes of Health (NIH) in Bethesda, called into action by a young CDC researcher named Jim Curran. An expert in retroviruses-infectious agents that implant their genetic material into a host cell's DNA-Gallo had already discovered the first known human retrovirus, which causes an unusual form of leukemia in young adults. In 1984 he announced his discovery of
***image4***
HIV: human immunodeficiency virus. With two colleagues, he opened the Institute of Human Virology in downtown Baltimore in 1996 to concentrate on HIV. But like much of the history of the AIDS pandemic, his work is not without substantial controversy, which Gallo addresses matter-of-factly during a recent conversation.
Every inch of Gallo's office and lobby walls is covered with honorary diplomas and commendations, many in unrecognizable languages. Charming, impeccably dressed, even somewhat soft-spoken, Gallo doesn't mince words. He is known to speak harshly on occasion, so a trusted staff member sits in on the interview to keep him out of hot water. But ask Gallo about his research, and he's off-interrupting himself and eventually reining himself in, working hard to keep his discoveries in layperson's terms.
LL: It's been 25 years. One of the things I'm really interested in is reminding folks what it was like at the very beginning.
RG:
Sweaty. Hard.
How so?
Well, there were multiple emotions. I don't know where to begin. One of them was the pressure to, you know, really prove the point, right?
There was no 'eureka' moment. There was a happy moment of exchanging the envelopes with Jim Curran. But I knew the cause [of AIDS] before I walked in the restaurant. So if there was a eureka moment, maybe that was it-when we exchanged coded envelopes at La Miche in Bethesda. Not my favorite restaurant, but
***image5***
anyway, he gave us the code and we gave him the results. And they matched. And we said, 'Oh, boy.'…
But there was no great moment of discovery. It was a moment of 'OK, you got some bars. Is it the cause of the disease?'
How do you know it's the cause? Well, for one thing it was new. That was a powerful argument. This was not a known entity before. And the second thing is that it affected T-cells [white blood cells that are central to the body's immune system]. The clinicians told us T-cells were going down, especially the T-helper cell, right? And it was what we were thinking about-we were predicting, more or less, that a retrovirus would be the cause. We were thinking that was logical because of our experience with other retroviruses. We had discovered a few years before that [human retroviruses] were transmitted by blood [through intravenous drug use and/or blood transfusions], sex and mother-to-child transmission, which fit what we heard about risk groups, right? And we knew those viruses also targeted T-cells. And those viruses were prevalent in Africa, and we were hearing about Africa, and prevalent in Haiti-we were hearing about Haiti. We thought [it] might be a cousin of one of them, you know?
Then we started finding it-it took a while to find it regularly. I probably lost a good six, eight months this way. One of my colleagues, he didn't really believe that the idea was going to be right-a retrovirus. He was really doing it to appease me. And when you look for leukemia viruses, which are called HTLV I and II, and you put those cells in culture, the virus, it's very slow. It comes out like a week later. So experiments are very convenient, OK? Start on Monday and go home, and Monday morning the next week, you come in and that's the experiment. I had told him more than once, I said this virus could be very different killing cells. You may have to look earlier. So he would get positive results sometimes, but let's pretend you have a lot of HIV, right? You're looking at day seven, but the peak was at day two. [pause] By the time you get to day seven, you have nothing.
***image10***
But if it gets very high, by the time you get to day seven you've got something, but a little. So we'd get these activities on day seven, sometimes.
So we get these variable results all the time. It was driving me nuts. I would say a good six to 10 months' loss and frustration. And no competition anywhere in the world. Then we put in more pressure, put more people on it than this one guy, and we started seeing things regularly.
And then there was a significant, not a breakthrough-there was a breakthrough but not a moment of eureka-getting the virus to grow permanently in cells that grow continuously, cancer cells that can grow forever. If you get the virus to take in that, produce the virus forevermore, you know you've got something. You know you're going to face light soon. Because you know when you can produce it forever, you can get enough of it to produce what we call in science free agents-free agents, specific antibodies, specific probes, molecular probes.
Was it exciting? Yeah. Someone asks, 'Did you feel good?' No, because you've always got another question. It's like the animal going around in a circle all the time. There's always more, there's always more. Every time you find something, it raises more questions, right? And that's how it was.
Scientifically, the discovery of the virus and the blood test was a
formidable challenge. And then the politics came in. At almost the same time that Gallo introduced his finding that HIV causes AIDS, Luc Montagnier of the Pasteur Institute in Paris unveiled an almost identical thought. Montagnier had also discovered the virus-a fact that Gallo says he has never denied-but it was Gallo who connected that virus to AIDS. Competition is fierce in medical research, and Gallo is no shrinking violet. Although in 1987 he and Montagnier agreed to share the patent
***image6***
for the blood test and be identified as "co-discoverers" of HIV, some scientists continued to doubt that Gallo did not flat-out steal from the French.
The NIH felt pressured to fire him; and Congress, as well as the US Department of Health and Human Services, investigated. Gallo was eventually cleared of all wrongdoing, but the controversy follows him. He does have advocates, however, as well as detractors.
That wasn't the only controversy in which Gallo found himself entangled. In 1987 New Yorker Larry Kramer founded the AIDS Coalition to Unleash Power-ACT UP-to represent the growing number of gay men who were angry about the lack of federal attention given to the disease. Perhaps the most notorious AIDS advocacy group in the country, ACT UP targeted scientists at NIH for protests, and its members tossed condoms during Catholic Masses and staged demonstrations in front of Ronald Reagan's White House. In the early 1990s, activists got a chance to speak with Gallo. AZT was the big concern then. The drug was scientifically promising as a treatment for HIV, but when doctors put patients on very high doses the side effects made them feel even sicker. Still, Gallo was a breath of fresh air, Baltimore AIDS activist Dwight Payne remembers: "He was upbeat and positive, where at the time a lot of doctors were gloom and doom." Payne is now the Institute of Human Virology's community outreach coordinator, educating the public about the hopes of a vaccine and inviting HIV+ individuals to participate in Gallo's vaccine study.
RG:
Then there were the activists. There was the gay community. Overall, at the beginning, they were terrible. Terrible to us, we couldn't understand it…. Why the hell? These guys don't know how to shoot their arrows. They're shooting themselves in their foot when they shoot us.
Part of it was done with knowledge-deliberate, to get attention. They needed it. And the only way to get on the stage was with the scientists. They couldn't shoot the president. So they went after NIH, the government. Like I really worked for Reagan. [laughs]
How did you feel about being part of that strategy?
I felt-what the hell? I'm a scientist. I don't know. I come out of medical school, internship, residency, NIH. What do
***image11***
we know about this? I didn't understand it. Why did they think I worked for Reagan? I'm an NIH scientist.
But, I repeat, part of it was strategy. And part of it, they said to me, 'Well, you tattooed us.' I said, 'What do you mean I tattooed you?' 'The blood test.' So they were worried that they were going to get prejudice, because people would know they were HIV-positive.
'And you developed no therapy for us.' And I scratched my head and said, 'For Christ's sake, the blood test preserved the blood supply, allows the epidemic to be followed for the first time'-before you waited till [you had] AIDS-'and…allows education, allows you to know.' So obviously critical to public health. And it didn't take very long-within, I'd say, two years of these bad relations, three max-that it became the opposite. I began getting strong support.
So, like '85?
I would say for me it was clear in '86 when I was at a press conference. Some reporters were asking me questions that I really wasn't happy with. So I said, 'Oh, screw you,' and walked out. And as I was walking away, and this guy-scrawny guy-with 'act up' on his T-shirt comes up. And I thought, Oh Jesus. And he comes and he hugs me, and he gives me a kiss on both cheeks. And pulls my ear and says, 'Never change. Just be you.' It was Larry Kramer. I said, 'What the hell?' I said, 'What are you talking about? You guys were-you caused me trouble.' He says, 'Nah, nah. Don't worry about that…. That's just to get attention.' I said, 'Oh, don't worry about it. OK.' But I began to understand.
And then Marty Delaney [founding director of Project Inform in San Francisco and current Institute of Human Virology board of advisers member], the same year, came to see me. And I remember we were standing in about three feet of water in my backyard, in a small pool. And he said, 'You're not anything like I expected.' And I said, 'What did you expect, a gargoyle?' … We started kidding. So we had a long dinner that night and talked, and we became close friends. He had just heard other things, right?
***image7***
But there were a lot of complaints, in the mid- and late '80s about there not being a lot done about HIV and AIDS.
Well, yeah, you could make that complaint. You could have put money in right away. My lab didn't grow. I didn't grow at all. I didn't get a single extra position or anything like that. I didn't get nonfunded, but I didn't get extra help. I certainly didn't get extra space. And then you could say that if they had more money put into it and talked about it, the field would have formed earlier. I think there wasn't a realization that it was as significant as it was. It took time to enter the noodle that this is really significant in numbers.
In numbers?
The first time I heard about it, it was like six men in New York City. I always tell these stories, and it comes back to haunt you, because you are portrayed as if you were an uncaring, unfeeling tiger. But I mean, what am I going to do? Change out of cancer research because of six people? You know, that's obviously silly, right? Nobody would. And by the way, who did? We did, in the end. And then later, CDC people, James Curran, they said, 'This is really significant.' And they needed help, and we did.
But I think the government really didn't realize it was that significant. Was Reagan afraid? Probably. I don't know what's in back of it. The CDC was funded, but they didn't say, 'We better really push this and put extra money in it, and NIH, where are your good scientists?' Nobody coordinated anything. Nobody was responsible for finding the cause. That just happened by the whimsical interest of our lab.
I guess the question is, is this because these were gay men being infected?
Oh, I have no idea. Could you say this was the Right side of the [Republican] party that could have hurt them those days? Perhaps, but how can I answer that? Nobody ever talked that way, ever, in our lab or to me-actually in my life. I never heard anyone talk like that, ever.
I'm not implying that it was intentional.
But think about it a minute-who would not vote for somebody if he said, 'We've got to find a cause.' How many
***image12***
people were saying this was God's wrath? Some people said it. What percent of the population said that-0.01 percent? A very, very small percent of the population's going to say that and believe that. So I don't think it's that significant. I can't believe that, behind closed doors, Reagan's coming to that conclusion. I never heard anything about it. But I don't know if you can say it was all bias…. I guess the thing that I would say is, if I was health secretary, I would have talked to me. Nobody ever did. I would have said, 'What did we do here? Did we have a plan to find the cause? How did you get it? What are you doing in cancer? How did it happen to be you?' I would have wanted to understand that. But there was no plan for anybody to find the cause. I would have said, 'You need to do that in the future.' I would have asked my opinion all along.
Gallo left the NIH in the mid-'90s, just about the time that the
cocktail-a combination of AIDS-fighting drugs that is now helping scores of people avoid previously deadly opportunistic infections and live much longer-was introduced. It was the turning point of the disease. But Maryland and Baltimore wanted Gallo to stay close-by. The Institute of Human Virology was formed as a partnership between the state of Maryland, Baltimore City and the University of Maryland Medical System. The Institute puts research, clinical and laboratory under one roof.
What's on the horizon for HIV/AIDS research?
Clearly, preventative vaccine is the biggest push, and clearly the hardest thing to get and the biggest goal from the beginning. Now there's been an intensification by the effort stimulated by a New York group called the International AIDS Vaccine Initiative, particularly by [Bill] Gates [who, through the Bill and Melinda Gates Foundation, earmarked $287 million for AIDS vaccine research earlier this summer].
Because there's funding.
Because there's competition in funding. Now everybody's moving. So I think this gives reason to hope. A lot of people think instead we should do other things, which complicates it all. Science has moved to such an extent that you can maybe see some light. The thing is just continuing to develop new drugs, because we can run out of gas and some of the current ones with some people. A subset of people will be resistant to this or that drug, so we have to always have new approaches to therapy.
And I guess in the more social line, the need for you, for the media, to continually remind people that this is a big problem worldwide, and we can't predict the future even here, because we don't know the future of the sustainability of education and funding
***image8***
and people. You know the blood is protected. That's done, forever, for this epidemic. That's the point that never comes out. This epidemic would be infinitely bigger if it weren't for the blood test. If we'd been three years later for the blood test-let's say it was '87-where would we be? That's pretty rough, right?
What would be the ideal response, in your opinion, to the epidemic?
A lot of people are pushing toward these pills [for use] after exposure. They're interesting and an important area of research, but my guess is that that's going to create some difficulties, if they work, as well as being part of a solution.
What difficulties do you see?
Well, more bravado about having sex, for example. The fact that they won't always work. And I think there's a good possibility that sometimes there will be quick resistance [to the drug], because when you don't treat powerfully, you get resistance. So this is a mixed bag right now, and it's hard to predict what the future of these things will be.
Are there gaps that can be filled that would progress treatment or vaccine possibility?
Ah, well. Money is necessary for science. And if asked, 'Do you have enough money?' scientists should always answer, 'More money sooner, less money later, no money never.' And at least that's the way I answer it when they ask me. There are plenty of people
***image3***
not being funded with good research. And that's going to get harder in HIV/AIDS research, because a lot of money has been given to large programs, including companies for their vaccine trials. Basic science money is really down. It's harder to get funded….
So your ideal solution would be what?
Adequate funding and consistent funding in governmental and social support, and the recognition that the disease is still here-even if it's not in your backyard necessarily-and you can't predict the future. Recognition that basic research is still fundamentally important. Look, go to a baseball game and they raise money for children with cancer. My sister had cancer, childhood leukemia, she was my only sibling, so mind you, I'm greatly sympathetic to that. But who doesn't give money for children with cancer? But when you talk about HIV or AIDS, it sounds like something for those people far away or somewhere else or whatever.
