Anthony Fauci: Unfinished business  pg. 4

Diabolical paradox

Fauci rose quickly through the ranks. He was appointed deputy clinical director of the NIAID in 1977 and chief of the Laboratory of Immunoregulation—a position he still holds—in 1980.

Fauci with his wife Christine Grady, R.N., Ph.D., and their daughters (from left) Alison, 11, Megan, 14, and Jennifer, 17.
Photo courtesy of the Fauci family
In the summer of 1981 came the first reports of unusual illnesses—pneumocystis pneumonia and Kaposi’s sarcoma—in previously healthy gay men in Los Angeles and New York City. “I had a very sinking feeling,” Fauci recalls. “I realized that these first few cases may really be something that is going to lead to a public health catastrophe.”

Some of his colleagues were skeptical, but Fauci went right to work, changing the direction of his laboratory, and assembling a team to investigate what was beginning to be called acquired immune deficiency syndrome.

By 1983, Fauci and his colleagues had reported that the B cells of AIDS patients—the cells that normally produce infection-fighting antibodies—were inappropriately “hyperactive.”

The causative agent, human immunodeficiency virus, would not be discovered until the next year, but the NIH group had described what Fauci calls the “diabolical paradox” of HIV—instead of being destroyed as most other microbes are by the immune system, the virus thrives on the attack.

“Since the immune system is the target, the very activation of the immune system makes it infinitely more vulnerable to being attacked because the virus more efficiently attacks an activated cell than it does a resting cell,” he says. “It’s a totally revolutionary concept, because you always think of the activation of the immune system as a good thing. Here it’s like stepping on your own land mine.”

Once the virus was described, and its sequence of nine genes determined, the NIH team—like thousands of researchers around the world—went to work to figure out how it wreaked such havoc, and what could be done to stop it.

In 1993, Fauci and his colleagues reported that even during the so-called “latent” phase of HIV infection, when little virus could be found in patients’ blood, “the virus is continually replicating in their lymphoid tissue like a time bomb,” he says. “Sooner or later it breaks down the immune system.” The findings, published in the journal Nature, meant that physicians could not let up in their efforts to combat the virus—even when their patients seemed to be well.

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