Leading the AIDS Response

reprinted from Issue 23, Fall 2016 of Frontiers of Medicine (PDF)

Rober Wachter, MD

Chair, Robert M. Wachter, MD

My introduction to AIDS came in 1982, when I was a third-year medical student at Penn. I was on my internal medicine rotation, and our team admitted a young gay man with hectic fevers, profound shortness of breath, weight loss, and diffuse infiltrates on chest X-ray. My attending physician had recently read about similarly unusual cases reported by the Centers for Disease Control. "This thing," he said gravely (the syndrome had not yet been named), "is changing the way we practice medicine."

When I came to UCSF a year later for internship, I had landed in the epicenter of this once-in-a-generation health crisis. While many organizations scrambled to decrease their exposure to AIDS patients, UCSF and our department quickly rallied around the patients, their communities, and the scientists and clinicians working to address the epidemic. Thirty years later, this response stands as one of our proudest moments.

World-class researchers like Jay Levy retooled their laboratories to focus on the new pathogen. Young clinical leaders, led by Paul Volberding, developed innovative care models, ranging from a dedicated inpatient AIDS ward to a new paradigm for academic-community partnership known as the "San Francisco Model." Some of our trainees even became internationally prominent experts. One of them, Julie Gerberding, became interested in needlestick transmission of HIV during her residency, and established a needlestick hotline and widely used prophylaxis protocols. Twenty years later, Gerberding would become director of the CDC.

Our leadership in HIV continues today, and some of today’s giants, including Diane Havlir, Monica Gandhi, and Steve Deeks, are profiled in this issue, along with Levy, Volberding, and Gerberding. There is more work to do, and our faculty, staff, and trainees are doing it.

AIDS not only taught us lessons about the science of virology and the immune response, it also taught us about clinical trial design, health policy, activism, community partnerships, and patient-centered care. It has provided us moments of satisfaction and pride, while offering far too many others of unspeakable pain and disappointment. The lessons we have learned from the AIDS epidemic have helped us grow, not only in our care of HIV patients, but in everything we do.

While no one in 1981 could have predicted the nightmare of AIDS, at the height of the epidemic no one could have predicted that today’s AIDS patients would be living for decades, some retiring from long careers and even doting over grandchildren. Nor could anyone have predicted that in 2016 we would be within sight of a cure. Through the long and tragic history of this remarkable epidemic, our department has led, boldly and passionately. Reading these stories is ample evidence that we are continuing to do so.

Sincerely,

Robert M. Wachter, MD
Professor and Chair, Department of Medicine
Lynne and Marc Benioff Endowed Chair in Hospital Medicine

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