20 years later, Duke still fighting AIDS

This is the first story in a five-part series on Duke's 20 years of research and social work against AIDS.

In the early 1980s, a medical mystery began that unexpectedly developed into one of the most daunting medical challenges and public health crises of modern times.

"I can vividly recall being in the emergency room at San Francisco General Hospital, seeing gay men with these terrible skin lesions and cases of pneumonia," said Dr. Charles Hicks, now associate clinical professor of medicine in Duke University Medical Center's division of infectious diseases. "And it was just amazingly puzzling, because they were these men in their early 30s who shouldn't have these problems. We just didn't know what was going on."

The dawning of understanding about the AIDS epidemic--in which the Medical Center played a prominent role beginning in 1982-was a painful and emotionally-charged process, and Duke's existing expertise in immunology forced it into the center of AIDS research.

In 1984, current chair of medicine Dr. Barton Haynes helped provide the clinical samples to National Cancer Institute researcher Robert Gallo that proved HIV was the root cause of AIDS. One year later, researchers at the Medical Center helped discover and then perform the initial clinical trials on the first major weapon against the disease: the anti-viral drug AZT.

Under the leadership of Dani Bolognesi--a James B. Duke professor of experimental surgery currently on leave as head of a Triangle-area company developing a new AIDS drug--the Medical Center quickly became a national center for clinical research on the disease.

"Duke has played a prominent role in just about every aspect of AIDS research," said Dr. John Bartlett, director of the Duke AIDS Research and Treatment Center. "One of the things that distinguishes Duke is the amount of cooperation between members of different disciplines."

That connection between basic science and clinical research unique to the Medical Center was a fundamental part of the National Institute of Health's 2000 decision to locate the national HIV Vaccine Trials Network at Duke, making the University the central site for testing results from and coordinating attempts to find a vaccine for HIV.

Many Medical Center researchers are also looking towards the worsening global picture. At the end of 2001, 40 million people worldwide were infected with HIV, primarily in third-world countries, where access to expensive anti-viral drugs ranges from limited to non-existent.

"There's no health care topic, in my mind, that's more important than treating HIV on a global basis," said Hicks, also associate director of DART. "You have 23 million people infected in Sub-Saharan Africa, but you don't have the medical infrastructure to treat these people."

To Hicks, that medical need demands attention from physicians worldwide.

"We're beginning to say, 'Wait a minute... the situation is that if you happen to be born in the U.S., England, Germany, you're going to live. If you happen to be born in Senegal or Chile, you're going to die?'" Hicks said. "That's something we need to change."

With this in mind, University physicians--including Bartlett, Hicks and Assistant Professor of Medicine Dr. Nathan Thielman--have begun outreach efforts in Tanzania, a country in which 10 percent of the adult population is infected with HIV. They have focused on providing medicine to impoverished people and understanding the social context of the disease.

"We've had the disease for 20 years. It is a completely preventable disease, and yet 40 million people across the world are infected and it's spreading at an extraordinary rate," said Haynes, who is leaving his post as chair of medicine to pursue AIDS research. "HIV is the great pandemic of the 20th and 21st centuries."

Bartlett maintained the current path of the AIDS crisis places great responsibilities on researchers.

"Globally, the HIV epidemic is devastating humanity," Bartlett said. "I think we have the opportunity to do something great here."