For the layperson, these beautiful photos belie the horrendous impact of AIDS. The federal Centers for Disease Control and Prevention reports that in the 25 years of the AIDS pandemic, more than 500,000 Americans have died of the disease, and 25 million people have died worldwide. According to Dr. David Holtgrave of Johns Hopkins University’s Bloomberg School of Public Health, in the United States a person dies from AIDS every 33 minutes, and there is a new HIV infection every 13 minutes. Amazingly, about 25 percent of the 1.1 million people in this country living with HIV don’t even know they are infected.
But in many ways, things are less grim than they were 25 years ago when AIDS was discovered, at least in the developed world. While AIDS is still a threat to many Americans--rich, poor, white, black, gay, straight--treatment has advanced considerably. The blood supply is completely safe. And Americans with HIV/AIDS are living longer, more productive lives.
For Dr. Robert Gallo--the scientist who co-discovered that HIV causes AIDS and developed the blood test that detects the virus--the microscopic organisms lining the walls of the Institute of Human Virology represent hope. Without the discovery of the virus, there would be no blood test, no protease inhibitors, no "drug cocktail" treatment. Each advancement in the treatment of AIDS comes back to the discovery of the virus, he says. And now Gallo is on the hunt for the holy grail of HIV research--a vaccine.
Since the genesis of the AIDS pandemic, Gallo, 69, has been on the forefront of research into this aggressive and mysterious disease. He began his work while at the National Cancer Institute at the National Institutes of Health in Bethesda, called into action by a young CDC researcher named Jim Curran. An expert in retroviruses--infectious agents that implant their genetic material into a host cell’s DNA--Gallo had already discovered the first known human retrovirus, which causes an unusual form of leukemia in young adults. In 1984, he announced his discovery of HIV. With two colleagues, he opened the Institute of Human Virology in downtown Baltimore in 1996 to focus on work with HIV. But like much of the history of the AIDS pandemic, his work is not without substantial controversy, which Gallo addresses matter-of-factly during a recent conversation.
Every inch of Gallo’s office and lobby walls is covered with honorary diplomas and commendations, many in unrecognizable languages. Charming, impeccably dressed, even somewhat soft-spoken, Gallo doesn’t mince words. He is known to speak harshly on occasion, so a trusted staff member sits in on the interview to keep him out of hot water. But ask Gallo about his research, and he’s off--interrupting himself and eventually reining in, working hard to keep his discoveries in layperson’s terms.
City Paper: It’s been 25 years. One of the things I’m really interested in is reminding folks what it was like at the very beginning.
Robert Gallo: Sweaty. Hard.
CP: How so?
RG: Well, there were multiple emotions. I don’t know where to begin. One of them was the pressure to, you know, really prove the point, right?
There was no eureka moment. There was a happy moment of exchanging the envelopes with Jim Curran. But I knew the cause [of AIDS] before I walked in the restaurant. So if there was a eureka moment, maybe that was it--when we exchanged coded envelopes at La Miche in Bethesda. Not my favorite restaurant, but anyway, he gave us the code and we gave him the results. And they matched. And we said, "Oh, boy."
CP: So you guys were working on things independently?
RG: [Curran] sent us a whole [coded] serum panel [of both infected and uninfected blood, which Gallo then tested for the virus, without knowing each sample’s status beforehand]. You know, controls and aids and blah, blah, blah, right? And we hit it. I always say, "It was a warm day." I think it was in March. It was a sunny day, if it wasn’t warm. And we came out just smiling. But there was no great moment of discovery. It was a moment of "OK, you got some bars. Is it the cause of the disease?"
How do you know it’s the cause? Well, for one thing it was new. That was a powerful argument. This was not a known entity before. And the second thing is that it affected T-cells [white blood cells that are central to the body’s immune system]. The clinicians told us T-cells were going down, especially the T-helper cell, right? And it was what we were thinking about--we were predicting, more or less, that a retrovirus would be the cause. We were thinking that was logical because of our experience with other retroviruses. We had discovered a few years before that [human retroviruses] were transmitted by blood [through intravenous drug use and/or blood transfusion], sex, and mother-to-child transmission, which fit what we heard about risk groups, right? And we knew those viruses also targeted T-cells. And those viruses were prevalent in Africa, and we were hearing about Africa, and prevalent in Haiti--we were hearing about Haiti. We thought [it] might be a cousin of one of them, you know?
Then we started finding it--it took a while to find it regularly. I probably lost a good six, eight months this way. One of my colleagues, he didn’t really believe that the idea was going to be right--a retrovirus. He was really doing it to appease me. And when you look for leukemia viruses, which are called HTLV I and II, and you put those cells in culture, the virus, it’s very slow. It comes out like a week later. So experiments are very convenient, OK? Start on Monday and go home, and Monday morning the next week, you come in and that’s the experiment. I had told him more than once, I said this virus could be very different killing cells. You may have to look earlier. So, he would get positive results sometimes, but let’s pretend you have a lot of HIV, right? You’re looking at day seven, but the peak was at day two. (pause) By the time you get to day seven, you have nothing. But if it gets very high, by the time you get to day seven you’ve got something, but a little. So we’d get these activities on day seven, sometimes.
So we get these variable results all the time. It was driving me nuts. I would say a good six to 10 months loss and frustration. And no competition anywhere in the world. Then we put in more pressure, put more people on it than this one guy, and we started seeing things regularly.
And then there was a significant, not a breakthrough--there was a breakthrough but not a moment of eureka--getting the virus to grow permanently in cells that grow continuously, cancer cells that can grow forever. If you get the virus to take in that, produce the virus forever more, you know you’ve got something. You know you’re going to face light soon. Because you know when you can produce it forever, you can get enough of it to produce what we call in science free agents--free agents, specific antibodies, specific probes, molecular probes.
There were so many questions that were so obvious. Is the virus in the brain? Is it in the cerebral spinal cord? What target cells does it infect besides T-cells--anything else, you know? One after the other. What’s the nature of the virus? What’s its genes? What’s its genetic sequence? What’s its proteins?
Was it exciting? Yeah. Someone asks, "Did you feel good?" No, because you’ve always got another question. It’s like the animal going around in a circle all the time. There’s always more, there’s always more. Every time you find something, it raises more questions, right? And that’s how it was.
Scientifically, the discovery of the virus and blood test was a formidable challenge. And then the politics came in. At almost the same time that Gallo introduced his finding that HIV causes AIDS, Luc Montagnier of the Pasteur Institute in Paris unveiled an almost identical thought. Montagnier had also discovered the virus--a fact that Gallo says he has never denied--but it was Gallo who connected that virus to AIDS. Competition is fierce in medical research, and Gallo is no shrinking violet. Although in 1987 he and Montagnier agreed to share the patent for the blood test and be identified as "co-discoverers" of HIV, some scientists continued to doubt that Gallo did not flat-out steal from the French.
The NIH felt pressured to fire him, and Congress, as well as the U.S. Department of Health and Human Services, investigated. Gallo was eventually cleared of all wrongdoing, but the controversy follows him. He does have advocates, however, as well as detractors.
"What has not been owned up to is that this bitter controversy clouded one of science’s greatest triumphs and drained energy from its brightest stars. Who knows the opportunities that were missed or the patients that may have been lost," former NIH head Bernadine Healy wrote in the Aug. 6 issue of U.S. News and World Report.
Robert Gallo: Pressures galore. The blood-test patent problems. Enormous pressures and enormous confusion. I didn’t know what was going on, because we had never patented anything at NIH in its history before, but we had to patent the blood test to bring in the big companies, they told us. Some wanted exclusive licensing.
City Paper: And the patent problem was just having to go though that process?
RG: Oh, we had a monumental struggle with France over patent rights. But we found the blood-test patent in Europe as well as America--they gave it to us. So we eventually shared.
That wasn’t the only controversy that Gallo found himself entangled in. Gay men were pissed. Pissed that they had this disease with no cure or reasonable treatment. Pissed that no one seemed to be paying any attention to the thousands of horrific deaths they witnessed year after year. Pissed that the treatment they did have made them feel sicker. And when they got pissed, they went on attack.
"There was a lot of apathy in the beginning and a lot of confusion," says Dwight Payne, who was an AIDS activist in Baltimore in the 1980s. "The only truth that we knew was that it killed people. It was a horrible death."
In 1987, New Yorker Larry Kramer founded AIDS Coalition to Unleash Power--ACT UP. Perhaps the most notorious AIDS advocacy group in the country, ACT UP targeted scientists at NIH for protests, and its members tossed condoms during Catholic Masses and staged demonstrations in front of Ronald Reagan’s White House. Payne remembers attending his first rally at a Lutheran church in Mount Vernon. About 40 people showed up, many of whom eventually became Baltimore’s arm of ACT UP.
In the early ’90s, Payne, along with other activists, got a chance to speak with Gallo. AZT was the big concern then. The drug was scientifically promising as a treatment for HIV, but when doctors put patients on very high doses the side effects made them feel even sicker. Still, Gallo was a breath of fresh air, Payne remembers: "He was upbeat and positive, where at the time a lot of doctors were gloom and doom." Payne is now the Institute of Human Virology’s community outreach coordinator, educating the public about the hopes of a vaccine and inviting HIV+ individuals to participate in Gallo’s vaccine study.
Robert Gallo: Then there were the activists. There was the gay community. Overall, at the beginning, they were terrible. Terrible to us, we couldn’t understand it. I had a lot of aunts when I grew up, patting my head when I did well, you know. I expected more or less the same here. It wasn’t like that. And I couldn’t understand that. Why the hell? These guys don’t know how to shoot their arrows. They’re shooting themselves in their foot when they shoot us.
Part of it was done with knowledge--deliberate, to get attention. They needed it. And the only way to get on the stage was with the scientists. They couldn’t shoot the president. So they went after NIH, the government. Like I really worked for Reagan. (laughs)
City Paper: How did you feel about being part of that strategy?
RG: I felt--what the hell? I’m a scientist. I don’t know. I come out of medical school, internship, residency, NIH. What do we know about this? I didn’t understand it. Why did they think I worked for Reagan? I’m an NIH scientist.
But, I repeat, part of it was strategy. And part of it, they said to me, "Well, you tattooed us." I said, "What do you mean I tattooed you?" "The blood test." So they were worried that they were going to get prejudice, because people would know they were HIV-positive.
"And you developed no therapy for us." And I scratched my head and said, "For Christ sake the blood test preserved the blood supply, allows the epidemic to be followed for the first time"--before you waited till [you had] AIDS--"and . . . allows education, allows you to know." So obviously critical to public health. And it didn’t take very long--within, I’d say, two years of these bad relations, three max--that it became the opposite. I began getting strong support.
CP: So, like ’85?
RG: I would say for me it was clear in ’86 when I was at a press conference. Some reporters were asking me questions that I really wasn’t happy with. So I said, "Oh, screw you," and walked out. And as I was walking away, and this guy--scrawny guy--with act up on his T-shirt comes up. And I thought, Oh Jesus. And he comes and he hugs me, and he gives me a kiss on both cheeks. And pulls my ear and says, "Never change. Just be you." It was Larry Kramer. I said, "What the hell?" I said, "What are you talking about? You guys were--you caused me trouble." He says, "Nah, nah. Don’t worry about that. . . . That’s just to get attention." I said, "Oh, don’t worry about it. OK." But I began to understand.
And then Marty Delaney [founding director of Project Inform in San Francisco and current Institute of Human Virology board of advisers member], the same year, came to see me. And I remember we were standing in about three feet of water in my backyard, in a small pool. And he said, "You’re not anything like I expected." And I said, "What did you expect, a gargoyle?" . . . We started kidding. So we had a long dinner that night and talked, and we became close friends. He had just heard other things, right?
Gallo downplays the political pressures on science during the Reagan years. But Jim Curran of the CDC remembers. In January, he was interviewed for PBS’s Frontline documentary The Age of AIDS, which aired this spring.
"There was an open neglect, if you will, of the [gay] community and the failure of the president for many years to even mention the term ‘AIDS’ that went along with the cutbacks in domestic spending and the concerns about the domestic budget," Curran says in the documentary. "I don’t believe that the cutbacks themselves were strictly related to public health or to AIDS, but I do fault the president and his senior leadership for neglect and hostility [in] dealing with the gay community."
Curran also felt the pressure from gay men--guilt by association, because he worked for the CDC under the Reagan administration.
"Many of us are left with the feeling like we started too late," he says. "And we wish we had warned people even more loudly and sooner--that every day, whether it was a day or a month or a year, was regrettable."
Gallo agrees that with greater funding things could have moved faster. But while Curran’s concern is public health, Gallo is a different animal. He befriended people who died of AIDS and is not completely unaware of how the political climate of the ’80s contributed to the devastation. But in the end, he is a scientist, and an optimistic one at that.
City Paper: So there were a lot of complaints, in the mid- and late ’80s about there not being a lot done about HIV and AIDS.
Robert Gallo: Well, yeah, you could make that complaint. You could have put money in right away. My lab didn’t grow. I didn’t grow at all. I didn’t get a single extra position or anything like that. I didn’t get nonfunded, but I didn’t get extra help. I certainly didn’t get extra space. And then you could say that if they had more money put into it and talked about it, the field would have formed earlier. I think there wasn’t a realization that it was as significant as it was. It took time to enter the noodle that this is really significant in numbers.
CP: In numbers?
RG: The first time I heard about it, it was like six men in New York City. I always tell these stories, and it comes back to haunt you, because you are portrayed as if you were an uncaring, unfeeling tiger. But, I mean, what am I going to do? Change out of cancer research because of six people? You know, that’s obviously silly, right? Nobody would. And by the way, who did? We did, in the end. And then later, CDC people, James Curran, they said, "This is really significant." And they needed help, and we did.
But I think the government really didn’t realize it was that significant. Was Reagan afraid? Probably. I don’t know what’s in back of it. The CDC was funded, but they didn’t say, "We better really push this and put extra money in it, and NIH, where are your good scientists?" Nobody coordinated anything. Nobody was responsible for finding the cause. That just happened by the whimsical interest of our lab.
CP: And it sounds like there were several complicating factors: one, that the size of the population being impacted by this was so small.
RG: In the beginning.
RG: And little by little they realized--I suppose that they have their day’s events. They have a war over here and a mini-war over there and economic problems over there, and politics are going to the state of Ohio if we don’t do the following, oh, and you’ve got to meet Gorbachev at the end of the week, and blah, blah, blah. And all the sudden you’ve got these 12 people with this new disease in New York. . . . It’s probably not high on the agenda. But as it spread and came out in the media more, they were, you know, in retrospect, I guess, a little slow to marshal a plan of any kind and to make a push.
CP: I guess the question is, is this because these were gay men being infected?
RG: Oh, I have no idea. Could you say this was the Right side of the [Republican] party that could have hurt them those days? Perhaps, but how can I answer that? Nobody ever talked that way, ever, in our lab or to me--actually in my life. I never heard anyone talk like that, ever.
CP: Not that it was intentional. I’m not implying that it was intentional.
RG: But think about it a minute--who would not vote for somebody if he said, "We’ve got to find a cause." How many people were saying this was God’s wrath? Some people said it. What percent of the population said that--0.01? A very, very small percent of the population’s going to say that and believe that. So, I don’t think it’s that significant. I can’t believe that, behind closed doors, Reagan’s coming to that conclusion. I never heard anything about it. But I don’t know if you can say it was all bias. . . .
I guess the thing that I would say is, if I was health secretary, I would have talked to me. Nobody ever did. I would have said, "What did we do here. Did we have a plan to find the cause? How did you get it? What are you doing in cancer? How did it happen to be you?" I would have wanted to understand that. But there was no plan for anybody to find the cause. I would have said, "You need to do that in the future." I would have asked my opinion all along.
Gallo left the NIH in the mid-’90s, just about the time that the cocktail--a combination of AIDS-fighting drugs that is now helping scores of people avoid previously deadly opportunistic infections and live much longer--was introduced. It was the turning point of the disease. Those who got sick before 1996 simply missed their chance at good treatment.
It was also a turning point for funding, some AIDS experts say. With an effective treatment often comes the feeling that the problem is licked, says Dr. David Haltiwanger, the director of clinical programs and public policy for Chase Brexton Health Services, Baltimore’s gay-lesbian-bisexual-transgendered medical clinic. "The trend that worries one the most is the trend toward complacency," he says. "Policy-makers start thinking, It’s just like any other disease."
One of the potentially damaging policies that Haltiwanger cites is attaching names to HIV/AIDS reporting. In the past, the reporting of numbers of HIV/AIDS patients, which determines funding allocations, has relied on a coded system to protect the identities of those patients. All expectations are that Ryan White funding--a federal program that subsidizes health care and support services for those with HIV/AIDS--will be tied to reporting with names attached. At this point, Haltiwanger says, he accepts that as something he will just have to do, but he's not happy about it. "Stigma is still very much a part of this disease," he says.
In addition, he adds, funding for treatment is harder to come by: "The population of people drawing on those funds are going up, while the programs are flat-funded."
But Gallo has always drawn from research funding sources--a different pot of money than the ones that back treatment and social services for those already infected with HIV/AIDS. Leaving the NIH meant that Gallo could not take any existing grants with him, but Maryland and Baltimore wanted Gallo to stay close by. The Institute of Human Virology was formed as a partnership between the state of Maryland, Baltimore City, and the University of Maryland Medical System. To get it up and running, then-Gov. Parris Glendening pledged state funds and then-Mayor Kurt Schmoke chipped in city financing. The 1917 building at 725 W. Lombard St. underwent three years of construction to ready it for the institute’s more than 100 laboratories and office space.
Robert Gallo: In 1996, I came [to Baltimore] to open a new institute to try to bring lab to clinic as quickly as possible--put the research, clinical, and laboratory under one roof, which is this kind of dream come true. By combining these functions in one building, we as researchers see patients coming in and out of the building, so we’re constantly reminded that research has practical benefits. At the same time, the clinicians in the building give us ideas for areas to research, and we give the clinicians ideas for approaching treatment. There’s a much closer collaboration this way.
We were recruited by the state--by the legislature, by the governor. We didn’t announce we were leaving Maryland, but we were looking. I had reached 30 years at NIH and I wanted to have my own institute. So, a couple of other guys who wanted to do the same thing--form a center devoted to viral research and go from lab to clinic--joined me. Dr. William Blattner is the director of the division of epidemiology and prevention, as well as chair of the Baltimore City Commission on HIV/AIDS. Dr. Robert Redfield is the director of the division of clinical care and research and the head of the division of infectious diseases at the University of Maryland School of Medicine.
We expanded our idea to have another division that would be focused on vaccines and still another one that would be devoted to animal models, which are needed. Started out small, simple, with a handful of people. Pretty naked, because we came from NIH with no money, no grants, we didn’t carry anything with us. Got some state aid, the city provided capital costs for a year or three years, so we could get some equipment, and we grew a lot. So today, we’re about 280 people, instead of a handful. And instead of $2 million a year, we’re about $65 million a year. We have a return rate, I’m told, to the state for every one dollar, we return nine.
When we came, Maryland was following about 200 patients with AIDS--HIV-infected people. And now we follow about 20 times that number, or about 4,000.
We also had an outreach program to the African-American community that worked, and that really brought in a lot of the less fortunate people. And we’re the recipients of a few PEPFARs from President Bush--Presidential Emergency Program for AIDS Relief, particularly for Africa. And we’re focused heavily in Nigeria but also scattered in other African countries as well as Ghana and Haiti. I train in Nigeria, help them develop so they can develop in the outskirts, right? Much like in the early part of the century, Pasteur Institutes formed in developing nations, but they were focused on bacterial diseases. They’re archaic now--they’re not scientifically good. I guess you can say that it also keeps satellite monitoring of what is going on.
Basically at the institute, we have some interesting things cooking, needless to say. We have an interesting candidate HIV vaccine that we’re involved in as scientific advisory, so the pharmaceutical company is kind of getting excited about it.
City Paper: What’s on the horizon for HIV/AIDS research?
RG: Clearly preventative vaccine is the biggest push, and clearly the hardest thing to get and the biggest goal from the beginning. Now there’s been an intensification by the effort stimulated by a New York group called the International AIDS Vaccine Initiative, particularly by [Bill] Gates [who, through the Bill and Melinda Gates Foundation, earmarked $287 million for AIDS vaccine research earlier this summer].
CP: Because there’s funding.
RG: Because there’s competition in funding. Now everybody’s moving. So, I think this gives reason to hope. A lot of people think instead we should do other things, which complicates it all. Science has moved to such an extent that you can maybe see some light. The thing is just continuing to develop new drugs, because we can run out of gas and some of the current ones with some people. A subset of people will be resistant to this or that drug, so we have to always have new approaches to therapy.
And I guess in the more social line, the need for you, for the media, to continually remind people that this is a big problem worldwide, and we can’t predict the future even here, because we don’t know the future of the sustainability of education and funding and people. You know the blood is protected. That’s done, forever, for this epidemic. That’s the point that never comes out. This epidemic would be infinitely bigger if it weren’t for the blood test. If we’d been three years later for the blood test--let’s say it was ’87--where would we be? That’s pretty rough, right?
CP: Because you were able to test the blood supply.
RG: And throw it away. And throw it away.
CP: That leads into this question. What would be the ideal response, in your opinion, to the epidemic?
RG: A lot of people are pushing toward these pills [for use] after exposure. They’re interesting and an important area of research, but my guess is that that’s going to create some difficulties, if they work, as well as being part of a solution.
CP: What difficulties do you see?
RG: Well, more bravado about having sex, for example. The fact that they won’t always work. And I think there’s a good possibility that sometimes there will be quick resistance [to the drug], because when you don’t treat powerfully, you get resistance. So this is a mixed bag right now, and it’s hard to predict what the future of these things will be.
CP: So it’s kind of like a morning-after pill for HIV.
RG: Or prevention. You’re going somewhere and you think you’re going to do something, so you say, "Oh, I’d better take the right pill," and all that. If you don’t prevent infection, you might get drug resistance. That’s one possibility, one danger on a social, large scale, on a population scale.
It merits research, it merits going forward. And maybe it will turn out better than I worry about, but my money is with the institute. We’re pushing hard to find a vaccine and to find new drug approach, new therapy. I’d be pretty disappointed if in 25 years we don’t have a good vaccine, but I won’t even know it. (laughs) My mother lived to 95. I could!
CP: Should we be responding differently right now? Are there gaps that can be filled that you think would progress treatment or vaccine possibility?
RG: Ah, well. Money is necessary for science. And if asked, "Do you have enough money?" scientists should always answer, "More money sooner, less money later, no money never." And at least that’s the way I answer it when they ask me. There are plenty of people not being funded with good research. And that’s going to get harder in HIV/AIDS research, because a lot of money has been given to large programs, including companies for their vaccine trials. Basic science money is really down. It’s harder to get funded.
And getting MDs interested in science is harder. Don’t ask me why. Maybe because the country more and more respects money. When I got into science, your brain was washed differently. You know, being rich at the time was not popular. Honestly. You’d say, "Oh, I’m not too sure I want to be having a lot of money--that doesn’t taste right. I want to be a good scientist and have the respect of my peers." If you have too much money, that’s not great. That was the attitude. And that’s changed, so we don’t see young MDs getting into science anymore. "Well," you say, "you’re doing it, so you must be getting some." Of course. [But] the numbers [of MDs] have dropped considerably. They’re not as awestruck as we saw in the days when I first came to NIH.
I mean, obviously you need the Ph.D.s, that’s the backbone. But I think this is a real, real danger. And it’s not just for AIDS.
CP: So your ideal solution would be what?
RG: Adequate funding and consistent funding in governmental and social support, and the recognition that the disease is still here--even if it’s not in your backyard necessarily--and you can’t predict the future. Recognition that basic research is still fundamentally important. Look, go to a baseball game and they raise money for children with cancer. My sister had cancer, childhood leukemia, she was my only sibling, so mind you, I’m greatly sympathetic to that. But who doesn’t give money for children with cancer? But when you talk about HIV or AIDS, it sounds like something for those people far away or somewhere else or whatever.
CP: I hadn’t thought about it that way, because the disease was originally within a population that people felt very distant from, that weren’t like them.
RG: All of the populations. Remember the H’s?
CP: The 4-H club?
RG: Hemophiliacs, homosexuals, heroin addicts, Haitians. The four H’s. Good Lord.
CP: And now it feels far away, because really what people are talking about is Africa.
RG: Yeah. That’s correct. That’s correct.