• William Miller, MD

Anthony Fauci, the AIDS Epidemic and Me.

Dr. Anthony Fauci announced this week that he will be retiring as director of the National Institute of Allergy and Infectious Diseases (NIAID), a position that he has held since 1984. I have great respect for Dr. Fauci and when I heard this news, I thought of dedicating this week’s article to his remarkable career. Then, I realized that anyone can simply google his name and read many articles about him. So, I thought perhaps a story that might be of interest is the personal one of how Dr. Fauci influenced my own career. He is quoted as having said, “My career and my identity has really been defined by HIV.” The same goes for me to some extent.


The first cases of an unusual pneumonia occurring in previously healthy gay men was identified in May, 1981. It first appeared in New York and then shortly thereafter cases began appearing in San Francisco. This was Pneumocystis carinii pneumonia or PCP. Pneumocystis is a fungus that is common in the environment and rarely causes infections unless the person is severely immune compromised. A few months later, cases of a very rare skin cancer, Kaposi’s sarcoma (KS), started being identified in gay men as well. The KS in these patients behaved very differently than the rare form of KS. It was much more aggressive and spread throughout the body. It was soon clear that there was a link between these two unusual outbreaks. Not only because they were both occurring in the same demographic population, but also some patients came down with both diseases. It wasn’t long before a whole host of other unusual illnesses began to be identified in these patients. All were previously only seen in people with severe immune compromise. At the time, I was a pre-med student at the University of Arizona.


By the time I finished college in 1984 and started graduate school, studying physiology at Hahnemann University in Philadelphia, the cause of this severe immune disorder was identified. Human Immunodeficiency Virus (HIV), which had originated in monkeys in Africa, had mutated and jumped species to humans. The name given to the disease it caused was AIDS (Acquired Immune Deficiency Syndrome). I remember thinking that it was exciting to be entering the medical field at a time when the world was starting to experience a serious pandemic that would potentially equal things like the Plague and Cholera. It was also scary since we didn’t understand how it was spread or how to best protect ourselves as healthcare workers. It was clear that it was nearly 100% fatal and we didn’t have any effective treatments.


I first met Dr. Anthony Fauci at a conference being held in Philadelphia sometime in 1985. He was new in his position as the director of the NIAID, but was already well known in the scientific and medical communities as an expert on the immune system and a researcher in viral illnesses. As a graduate student, I was excited to be able to attend a talk he was giving at the conference. He spoke about how it was expected that we would need doctors to specialize in treating AIDS and that these specialties would be both infectious disease doctors as well as oncologists to treat the complicated cancers that AIDS patients were developing. At the time, I was doing a research project on the gene mutations that cause malignant brain tumors. After his talk, I was able to squeeze my way through the crowd around him and patiently waited to catch his attention. I must have stood out amongst all the doctors, being in my early twenties, since he noticed me and asked what I thought of his talk. I told him that I was considering studying cancer and becoming an oncologist. It was a brief exchange, but he said that given how serious the future might get with AIDS, he encouraged me to become an AIDS oncologist. He gave me his card and said, “Write to me and let me know if you do that.” I went back to my apartment and decided to go into AIDS work.


In 1987, I returned to the University of Arizona for medical school. That was also the year that the first treatment for HIV was approved by the FDA. This was the drug AZT. The drug was a cancer drug developed in the 1960’s that had already shown promise as an anti-retroviral drug by the time AIDS came along. The pharmaceutical company, Burroughs-Wellcome, applied for FDA approval of AZT use in AIDS patients after a rigorous, double-blinded study showed that it could prevent the progression of HIV infection to the disease AIDS. This was one of the first treatments to receive Fast Track approval by the FDA, which later became known as Emergency Use Authorization. Many lives were saved as a result.


As a medical student, I continued to pursue the calling of battling AIDS. Prevention of HIV transmission seemed to be the best way. The idea of teaching high school students about safe sex and condoms as a means of preventing AIDS was just starting to get talked about. I formed a group of medical students interested in teaching AIDS prevention to high school students. We got a grant and founded the Arizona AIDS Education Project. We then did a study using teen pregnancy rates as a surrogate marker for potential HIV transmission. We determined that two teenage populations were at highest risk because of their high rates of teen pregnancy. One group were towns along the Mexican-American border and the second was on Native American reservations. We started making presentations to school boards, getting permission to teach our curriculum in their schools. We met a lot of resistance at first, but over time we started receiving requests. Today, doing AIDS education in schools is not novel, but at the time it was a very new thing.


During that time, I came across Dr. Fauci’s business card and wrote to him. He wrote back and encouraged me to publish our results. Subsequently, I did publish an article in the Journal of Rural Health. In 1989, we also sponsored our own AIDS conference inviting medical students from around the country to replicate our program to teach AIDS education in high schools. I invited Dr. Fauci to be our keynote speaker and, even though he politely declined, he sent a very warm letter congratulating me and our team of medical students on our success.


During my medical school years, I did have opportunity to work on AIDS wards in New York and San Francisco. It was a profound experience caring for so many seriously ill and dying patients. I recall that many of the healthcare staff on these wards were themselves ill with AIDS. I will save those stories for another time. During medical school and residency, I continued my interest in AIDS research, doing research on HIV drugs. I helped develop a PCR test for Coccidioides immitis, a fungal infection that causes Valley Fever in healthy individuals, but can cause life threatening coccidioidomycosis in people with immune deficiencies like AIDS.


I graduated from medical school in 1991 and then completed three more years of internal medicine residency. By then, new drugs to treat AIDS had been developed. Fortunately, this meant that HIV infection could be held in check and not allowed to progress to the terrible illness we had seen the decade before. It was becoming clear that there would not be a need for AIDS oncologists.

After residency, I did train as an oncologist at the Arizona Cancer Center. However, ultimately I decided to shift gears and, in 1997, I entered the newly forming specialty of hospitalist medicine. This is what I practice today and as they say, the rest is history.

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