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Winter 1999

The Scientist and the Cure
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"Janis 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?'"

But 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?"

Using 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.

Giorgi's 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.

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