Magic Johnson, the famed basketball star, is telling the
story of his HIV infection which caused him to retire from the NBA in 1991 when
he was at the top of his game. That was
a time when HIV (human immunodeficiency virus) infection was a medical time
bomb which could rapidly progress to AIDS (acquired immunodeficiency syndrome).
AIDS killed patients by causing an
exotic infection. The disorder was
devastating homosexual men, hemophiliacs, heroin addicts and Haitians. Haiti at
that time was a gay man playground where the infection was transmitted by gay
intercourse. Heroin addicts were infected by sharing contaminated needles. In
this 4H Club, patients with hemophilia were innocent bystanders who got AIDS
from blood clotting factors derived by pooling together the blood of many
donors. Blood donations were not checked for HIV when no one knew what this was.
The tennis star and humanitarian, Arthur Ashe died of AIDS following transfusions
for open heart surgery in 1993.
That was a time when apparently healthy gay men came to the
hospital complaining of recent onset of shortness of breath. The diagnosis of an AIDS
defining infection was usually prompt but often within 48-72 hours, the patient
was dead! This horror was a risk in about
20 percent of patients on medical services in select hospitals in the late
1980’s when the infection spread by sexual transmission to the heterosexual
community. AIDS was a modern day plague.
Medical science mobilized quickly. Laboratories in France
and the United States took credit in identifying the virus so that diagnostic
testing could be done to determine who was infected. The blood supply again
became safe. The human immune response to infection had to be unraveled.
Contrary to the belief that the immune system did not respond appropriately to
HIV, medical science showed that the human immune system realized that HIV
represented the fight of its life. Immune cells threw all that they had into
the battle, but the virus was destroying a key cell in the front live, the CD4
lymphocyte. A dwindling number of CD4 lymphocytes indicated that the virus
would soon claim another life.
I attended a basic science medical conference in 1995 and
AIDS was expectantly a big part of the program. A drug discovery administrator from Merck, showed a lecture slide
which looked like a card from the
Rorschach test used by psychologists to
analyze a patient’s personality. The picture of the symmetrical glob was not from the Rorschach test
but was the electron shadow of the
critical protease enzyme of HIV needed
to replicate the virus. To most of us in the audience, this met nothing, but to
a drug discovery scientist, the symmetry of the protein, indicated that an
inhibiter could be developed which could fit into the enzyme structure and neutralize
its function. The first protease inhibiter to fight AID was put on the market in 1996. Within six months,
the number of patients with AIDS in the hospital was obviously reduced. Our
remarkable immune system, needed a little help from the protease inhibiters to
slow down the proliferation of the virus. That allowed the immune system with
the further help of older antiviral drugs to significantly destroy the virus
load and restore CD4 cells to normal
levels.
Magic Johnson retired thinking he would be faced with the
dismal consequences of HIV progressing to AIDS. He was likely one of the first
patients to receive protease inhibiters. A deadly disease was converted to a chronic
controlled disorder. He has remained healthy and he has prospered. American
medicine faces much criticism from politicians, patients and physicians about
cost and especially drug cost. But there
were no better university, governmental and industry laboratories in the world with
the biomedical expertise to respond to the clinical crisis of AIDS. These labs
discovered the viral cause of AIDS and the pharmaceutical industry discovered
and developed the drugs to treat it in about 10 years. Magic Johnson was lucky that protease
inhibiters came along just at the right time.
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