Alumni Gazette

Medical Milestone

PIONEER: Gottlieb is recognized as the first scientist to identify AIDS.

The paper that earned Michael Gottlieb ’73M (MD) his brush with fame was succinct—a nine-paragraph report in a federal epidemiology newsletter—but 25 years later, the work is heralded as a medical milestone.

Gottlieb, then an assistant professor at the University of California at Los Angeles, is credited as the first researcher to describe AIDS. And the date of his pioneering paper—June 5, 1981—is considered the official beginning of an epidemic that has since racked up 25 million deaths worldwide. In 2005, about 40 million people were living with HIV/AIDS.

“There have been a lot of surprises” since those early days, says Gottlieb from his California medical office. “From (a few) patients to 40 million would surprise anyone.”

In early 1981, Gottlieb was a 33-year-old first-year assistant professor. His laboratory experiments were stalled by a mysterious mouse virus, immunology consults were rare, and Gottlieb spent long days reading medical journals in his windowless office.

That February, he asked one of the immunology fellows to go into the wards to look for an interesting “teaching consult,” the kind of case that would intrigue experts in the immune system.

The result was Michael, who had arrived in the emergency room complaining of severe weight loss, persistent fevers, and a waning appetite. He was tall and handsome, a 30-year-old model with cheekbone implants who was open about his gay lifestyle.

But to Gottlieb and other physicians, Michael was a diagnostic enigma. Healthy just a month before, Michael had thrush, a flourishing yeast infection that coated his mouth and esophagus, and his white blood cell count was low, a sign his immune system was crashing. Readmitted a week later, Michael was sicker than ever. Both lungs had blossomed with Pneumocystis carinii, a rare lung infection then seen only in people with severe immunosuppression or starving, wartime orphans.

Puzzled and alarmed, Gottlieb and other UCLA physicians put the word out. By April, they had come up with four similar cases in or near L.A., all among previously healthy homosexual men.

Soon after, Gottlieb wrote his soon-to-be-famous brief report. The article got second billing in the June 5, 1981, issue of the Weekly Morbidity and Mortality Report, the epidemiology newsletter of the federal Centers for Disease Control and Prevention. “Priority in science is usually defined by authorship,” he says, “and since I was the first author of the report, I am generally credited with identifying AIDS.”

Gottlieb credits his Rochester medical training for preparing him for his role in uncovering the medical mystery.

“One of [Rochester’s] gifts to its students is careful instruction in the methods of clinical observation—using the interview and exam to carefully gather the medical history and psychosocial data,” says Gottlieb, a New Jersey native and graduate of Rutgers University. “Those methods were invaluable in the early observations of patients with AIDS.”

The same interview skills learned at Rochester allowed Gottlieb to be open and nonjudgmental about other lifestyles, he says, including the sexual preferences and recreational drug use of Michael and other early AIDS patients. Beyond clinical observation, though, “there definitely was emotional content,” Gottlieb says. “I remember the first patients by name, and what they looked like. The fear they experienced was palpable.”

By the summer of 1981, two of the five original patients described in the CDC report were already dead. Sitting at a UCLA recreation center, Gottlieb drafted in longhand an account of the emerging disease. It appeared in the December 10, 1981, issue of the New England Journal of Medicine, becoming the first peer-reviewed paper on AIDS.

By then, alerted by Gottlieb’s June report, CDC investigators had fanned out into New York City and San Francisco, cities with large populations of gay men. It turned out that AIDS, undescribed, had been on the rampage since 1977.

During the 1980s, it wasn’t easy to work on AIDS, says Gottlieb. The public feared widespread contagion, hospitals thought AIDS would scare away other patients, gay men were incensed at a wavering federal response and, at the same time, “the public at large was less well-disposed toward gay people,” says Gottlieb.

Gottlieb, the father of a 16-year-old daughter, still teaches at UCLA. In 1988, he opened a clinical immunology practice devoted largely to treating HIV; 85 percent of his patients have the disease. He went on to pioneer antiretroviral drugs that target HIV, was Rock Hudson’s physician in the actor’s last days, teamed with Elizabeth Taylor to start up the American Foundation for AIDS Research, has edited two books, and has written nine book chapters and over 50 peer-reviewed articles.

While gains in treatment have been dramatic over the past 25 years, the intensity of the AIDS stigma is as strong as ever, a fact that presents “an overwhelming obstacle to stopping its spread,” he says. It’s likely that on the 50th anniversary of his June 1981 report, the epidemic will still be raging, with 150 million or more people worldwide living with the infection.

But an alternate view of the future is possible, if access to health care and antiretroviral drugs is improved and if nations work to eliminate poverty, the real engine of AIDS, says Gottlieb.

Of his own generation, Gottlieb will only say: “We made a start.”

—Corydon Ireland

Corydon Ireland is a Rochester-based freelance writer.