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Published Jan 1, 2007 8:00 AM


08. Ground Zero: AIDS Research

By Dan Frankel

In the quarter-century-old battle against AIDS, California has always been on the front lines.

In March of 1981, Michael Gottlieb, a 33-year-old first-year assistant professor at UCLA specializing in immunology, encountered five patients with eerily similar symptoms and backgrounds. All of them were gay men, and relatively healthy prior to developing mysterious fevers, unexplainable weight loss and a rare lung infection called pneumocystis, a kind of pneumonia primarily known to occur in people with damaged immune systems. Using what was new technology at the time, UCLA physicians found that each patient was missing critical blood-immunity components called T-cells.

On June 5 of that year, details of these cases were published in the CDC's Morbidity and Mortality Weekly Report. Within days, doctors from all over the country added that they, too, had seen similar rare, opportunistic infections in young gay men.

They didn't yet have a proper name for it, but Acquired Immune Deficiency Syndrome — a disease that would go on to kill more than 25 million people and counting — had been officially discovered.

The fact that a global pandemic like AIDS was first identified by a California-based research institution shouldn't be surprising, given the state's geographical confluence of culture and scientific acumen, says Thomas J. Coates, who pioneered research into the behavioral science of the disease at UC San Francisco in the 1980s and is now a professor in residence at UCLA's David Geffen School of Medicine.

"I think it was because we had three major medical centers — in San Francisco, Los Angeles and San Diego — on the edge of gay communities like Castro, West Hollywood and Hillcrest," he notes. "You had three centers immediately confronted with providing care for people with HIV. Each had staffs with gay employees — they were immediately touched by this. It was just natural that they all got involved in providing both care and scientific discovery. These people were passionate about this issue in ways they were not passionate about heart disease and cancer." Indeed, one of the early heroes of the epidemic was San Francisco Chronicle reporter Randy Shilts, a gay journalist whose coverage of the government's lack of response to AIDS became the foundation of his best-selling book, And the Band Played On.

Only a few months after the first cases were made public, UCSF cancer researcher Paul Volberding emerged on the front lines of the fight, establishing a center specifically to treat Kaposi's sarcoma, a rare disfiguring cancer that was a telltale symptom amid the burgeoning case-load of AIDS patients across the U.S. In 1983, Volberding teamed with fellow UCSF cancer specialist Donald Abrams and the late Constance Wofsy, an infectious disease researcher at the school, to open the first program specifically set up to treat AIDS, operating out of San Francisco General Hospital.

Three years later, another UCSF researcher, Coates, established the Center for AIDS Prevention Studies, which paved the way to understanding how the disease was being transmitted and how its march could be slowed. And in 1990, Volberding led a groundbreaking series of studies on AZT, an antiviral drug that would provide the foundation of the so-called "AIDS cocktail" multidrug therapy that transformed AIDS from a death sentence into a manageable chronic illness in the mid-1990s.

Meanwhile, groundbreaking AIDS research centers at UCLA and UC San Diego produced their own breakthroughs. In the early '90s, pediatric researchers at UCLA pioneered the use of protease inhibitors in children and made more headlines when they documented the case of an infected infant who later tested completely free of the disease. (The UCLA AIDS Institute, established in 1992, is a multidisciplinary think tank that draws on the skills of more than 160 top-flight researchers.)

These days, Coates is spearheading efforts to establish leading-edge disease prevention and understanding in foreign hot spots. Not all of the efforts involve science.

In the Indian state of West Bengal, for example, Coates has teamed with David Gere, co-chairman of UCLA's World Arts and Cultures Department, on a unique project that involves the region's artists. An arts critic in San Francisco during the '80s, Gere vividly recalls how messages conveyed through theater, dance and other art forms helped overcome the many stigmas and misunderstandings that fueled the AIDS epidemic in the U.S., and he hopes for the same result on the subcontinent.

Armed with these kinds of big ideas, AIDS research centers at UCSF, UCLA and UCSD remain among the most robust in the country. Other California research institutions are making notable contributions to the AIDS fight, too: At Stanford, genetically engineered mice without immune systems are helping lead the way to new therapies; and researchers at UC Davis have made headway by studying HIV infection in primates.

"If you added up all the institutions in California doing AIDS research — and you consider all the funding and people involved — that probably represents the second biggest concentration of AIDS science on the planet next to the entire U.S. as a whole," notes John Greenspan, who took over as director of the UCSF program from Coates in 2003.

With the epidemic now largely confined to centers of urban poverty in the U.S. — and no longer on the front page of American consciousness — UCLA AIDS Institute director Irvin Chen hopes the brilliant ideas will keep coming, too.

"There's now a difficulty attracting new scientists to this area," he explains. "We need young researchers with new ideas and the ingenuity to keep this thing going."

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