The Scientist and the Cure
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won't let go of something until it makes sense," says Anton, the
gastrointerologist with whom she will conduct the vaccine study.
"She's focused, intense, extremely clear-thinking and very smart."
When Giorgi began her research, the population of people infected
with AIDS who were not getting sick was very small, he points out.
"If you had 100 infected people, and 95 were dying pretty quickly
and you said, 'I'm going to focus on the other five,' the response
was 'What are you doing?'"
to Giorgi, who tends to downplay her accomplishments, it was a matter
of logic, pure and simple. "When I started in HIV, in '84," she
recalls, "the emphasis was on what the virus did to the host and
how it destroyed the immune system. If you look at HIV effects in-vitro,
in two to four weeks every single CD4 cell in an infected culture
is dead. But if you look at clinical outcome, most people live at
least 18 months. So you wonder what is going on?"
flow cytometry, Giorgi's lab has also provided important insights
into how HIV depletes the immune system. In one groundbreaking study,
Giorgi and colleague Rita Effros found that killer T-cells in infected
individuals showed signs of deterioration similar to that seen in
people who had lived 100 years. It's a discovery that still amazes
her. "You realize how incredible the immune system is in fighting
off HIV, even though it ultimately fails," she says.
greatest achievement, perhaps, is her discovery of the significance
of elevated expression of a molecule called CD38. CD38 sits on the
surface of CD8 cells and its expression is related to immune control
of viral infection. It has also proved to be a fiercely reliable
tool to predict disease progression in HIV. Giorgi's lab was the
first to reveal that the more elevated an infected person's CD38,
the worse the clinical outcome. In further studies, she showed that
the little-understood molecule was an even better measure of disease
progression than viral load. For doctors and their infected patients,
the knowledge was like peering into a crystal ball.