NEJM commemorates 20 years of AIDS with early-release retrospective

This week’s issue of the New England Journal of Medicine features three articles by prominent physicians and policymakers addressing the first 20 years of the AIDS epidemic. Below are excerpts from these articles, released two days before NEJM’s usual publication day in observance of today’s anniversary of the first media mention of AIDS:

“AIDS – The First 20 Years”: Dr. Kent Sepkowitz, assistant physician and associate chair for clinical affairs in the Department of Medicine at New York-based Memorial Sloan-Kettering Cancer Center, documents the discovery of the cause and “epidemiologic features” of AIDS and describes the progress made in diagnostic tests, treatment and prevention strategies. The article also describes the advent of AIDS-related activism (Sepkowitz, NEJM, 07/06).

“AIDS – Past and Future”: Dr. Michael Gottlieb, lead author of the June 5, 1981, Morbidity and Mortality Weekly Report on the disease that came to be known as AIDS, recalls his first personal interactions with AIDS patients and describes how AIDS has changed the nature of medicine. “For me and many other doctors, the experience of seeing so many patients die was numbing,” Gottlieb writes. However, he adds, “Treating patients with AIDS has enabled me to recapture a large measure of the empathy that led me to medicine in the first place. Twenty-five years ago, during my medical residency, hugging a patient was considered unthinkable; today, I am very comfortable giving a patient an encouraging hug at the conclusion of a visit. … As a result of treating patients with HIV, many of us have matured into more skilful health care professionals than we might otherwise have been.” In addition, AIDS has led physicians to understand “how crucial it is to discuss sexual behaviour with their patients.” Gottlieb concludes, “We physicians must continue to advocate aggressive programs for prevention – especially among intravenous drug users and gay men in Hispanic and black communities” (Gottlieb, NEJM, 07/06).

“The Search for an AIDS Vaccine and an Effective Global Response”: Dr. Michael Merson, who directed the World Health Organization’s Global Program on AIDS from 1990 to 1995, reviews a book, titled “Shots in the Dark: The Wayward Search for an AIDS Vaccine,” written by Jon Cohen. Cohen “explains the reasons” for the “intolerably slow progress” of the development of an AIDS vaccine, attributing the lag to the “domination of the field by ‘reductionists’ (mostly virologists) who are interested primarily in understanding the pathogenesis of HIV infection and the interaction of the virus with the immune system.” This focus delayed the “recognition of the importance of cell-mediated immunity in protection against HIV infection.” In addition, Cohen cites a “lack of interest on the part of major pharmaceutical companies … because of concern about liability and profit,” ethical concerns about trial design and other obstacles. Merson sums up Cohen’s argument that the “wayward search” for an AIDS vaccine “could have been avoided through the centralization of leadership and the unification of direction from the outset,” and cites his proposal of a $1 billion program that would be “privately administered by someone with a deep personal and moral commitment to the development of a vaccine” (Merson, NEJM, 07/06).

This edition of the NEJM also includes an editorial urging wealthy countries to contribute to the global AIDS fund. “For the next 20 years to be a time of success, not continued failure, our approach to AIDS must change radically,” the editorial states (Steinbrook/Drazen, NEJM, 07/06).