Confronting AIDS

Prof. Max Essex and Dr. Joseph Makhema in Jwaneng, Botswana, site of an HV vaccine trial conducted by the Botswana-Harvard Partnership. Photo credit: Richard Feldman

In June 1981, the U.S. Centers for Disease Control and Prevention issued a report with a deceptively bland title: “Pneumocystis Pneumonia ­ Los Angeles.” It summarized the first reported cases of the fatal pandemic later named AIDS. When the long-simmering infection surfaced, the School helped lead a grueling counter-assault. Its laboratory discoveries have pointed the direction for ongoing research into vaccines and treatments. Its epidemiologic modeling and data analysis helped describe the contours of the epidemic and the best interventions. Its public policy and human rights commitments have set standards worldwide.

As early as 1975, the School generated the first strong evidence that a lethal suppression of the immune system could be caused by an infectious agent—a discovery that was later central in the unraveling of AIDS. School researchers led by Max Essex were the first to suggest that the causative agent was a retrovirus. They also determined that the virus could spread through transfused blood and identified which antigens were most useful for blood-bank screening. And School scientists proved that HIV could be transmitted through heterosexual intercourse.

By the mid-1980s, investigators at the School identified two glycoproteins on the HIV-1 surface that enabled the virus to infect cells and became targets for vaccine development. They uncovered evidence of a second AIDS virus, HIV-2. In 1990, School researchers showed that the drug AZT was safe and effective for HIV-infected adults who had no symptoms of AIDS but low levels of CD4 immune system cells. Later, a School study found that giving the drug to HIV-positive pregnant women dramatically reduced HIV transmission from mother to fetus.

In the early 1980s, the School established a presence in Africa to meet the challenges posed by the pandemic. In 1996, it launched the Botswana-HSPH AIDS Initiative Partnership, a research and training program that was the largest of its kind in Africa at the time, as well as the first dedicated HIV research lab in southern Africa. In 2004, based on its longstanding commitment to confronting HIV/AIDS on the continent, the School was awarded one of four President’s Emergency Plan for AIDS Relief (PEPFAR) grants. By 2009, the overall PEPFAR effort was credited with saving approximately one million lives in Africa.

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