Early AIDS treatment centered in San Francisco

John Luce, MD, shares his perspective from being at the forefront of the AIDS epidemic.

John Luce, MD, shares his perspective from being at the forefront of the AIDS epidemic.

A physician who witnessed the evolution of AIDS treatment took a heartfelt look back on the disease during the Saturday evening Opening Ceremony.

John Luce, MD, emeritus professor of clinical medicine and anesthesia at the University of California, San Francisco, is a specialist in pulmonary diseases and critical care medicine. He has cared for patients with AIDS at San Francisco General Hospital (SFGH) since the earliest days of the epidemic. His address focused on the evolution of the epidemic and the hospital’s response to it.

When Dr. Luce arrived at SFGH, he was confronted with a new type of patient with diseases that indicated some sort of underlying immunodeficiency.

“(They were) young white, gay men who had a variety of diseases I’d never seen before, such as Kaposi’s sarcoma and Pneumocystis carinii pneumonia (PCP),” he said.

The hospital’s Chest Service was involved early in clinical and research collaborations with clinicians from other specialties, including infectious disease specialists and oncologists, who were also encountering a growing number of these patients.

“The first patients who came to us were very sexually active, and they used a number of drugs to enhance orgasm,” said Dr. Luce, adding that they called the condition gay-related immune deficiency—GRID—thinking that perhaps the immunocompromise was due to the drugs they were taking.

However, patients who were IV drug users, who were living in Haiti and who were receiving blood transfusions began to fill the patient rolls.

“It became clear that this disease was probably related to some sort of transmissible agent, presumably a virus,” Dr. Luce said.

In 1982, the Centers for Disease Control and Prevention brought forth the term Acquired Immune Deficiency Syndrome or AIDS to describe this condition, and in 1984, the virus was isolated.

“In the 1980s, getting HIV meant you got AIDS, and getting AIDS meant you died. In fact, the mean life expectancy was about 18 months for patients with AIDS, and well over half of the patients who had severe Pneumocystis pneumonia required intubation and mechanical ventilation and died in our ICUs. We had to come to terms with death very early in the epidemic,” Dr. Luce said.

In the late 1980s, AIDS changed. It was no longer a disease of young, white gay men in the U.S. It was a disease of minorities, and around the world it was a disease of heterosexuals.

“As the disease changed, our hospital’s response changed with it,” Dr. Luce said, pointing to outreach efforts in Africa and around the world focusing on patients with tuberculosis and HIV/AIDS.

“What also changed was progress, thankfully. We got better drugs to treat patients. The main change was the introduction of antiretroviral therapy. Now we have a disease that is treatable and may be less communicable, even though it’s not curable yet.”

After the Opening Ceremony, more than 250 fellows, junior faculty members, ATS leaders, program directors, members of the organizing committees and national public health decision makers gathered for the annual Fellows and Junior Professionals Exchange. They mingled in an informal relaxed atmosphere at the event, which is sponsored by the ATS Membership, Members In Transition and Training and Training Committees. Later that evening, the Foundation Research Program Benefit program was held at the Marriott Marquis.