UAB on the front lines in 30-year war on HIV/AIDS

A look at the part UAB researchers and physicians have played in combating the deadly disease, and what is to come.

In a span of three decades a disease appeared, created a public health crisis and killed millions worldwide before modern medicine commuted a certain death sentence into a chronic, manageable disease.

Such is the history of AIDS, inextricably intertwined with the University of Alabama at Birmingham.

“In the history of medicine it’s unusual for most medical professionals to have been around at the onset of a brand new disease. On June 5, 1981, we saw the first description of five cases of what we’d come to call AIDS. It took about a decade to really understand what we were up against,” says Michael Saag, M.D., UAB professor of medicine and director of the UAB Center for AIDS Research (CFAR).

Since then, researchers and physicians at UAB have conducted research worldwide and developed therapies to combat the virus and its spread. Saag, who holds the Jim Straley Endowed Chair in AIDS Research, made seminal discoveries in the genetic evolution of the human immunodeficiency virus (HIV) in vivo and also directed the first in-patient studies of seven of the 25 antiretroviral drugs.

UAB’s CFAR opened in 1988 as one of the seven inaugural centers established by the National Institute for Allergy and Infectious Diseases (NIAID) to stimulate and advance HIV/AIDS research and conduct clinical trials. UAB opened its 1917 Clinic later the same year to provide comprehensive, outpatient care to patients with HIV. Saag was its founding director.

“People who had moved away and become infected were coming home to Alabama to die. In many cases, they were returning to rural communities that were not prepared to care for someone with HIV, so they were referred to our clinic,” Saag recalls.

During the next few years as AIDS became the No.1 cause of death for American men ages 25-44, UAB emerged as a world leader in HIV/AIDS research and patient care:

  • Its scientists defined the measure of high virus for acute HIV infection in 1989.
  • In 1990 UAB joined the AIDS Clinical Trials Group (ACTG), and
  • In 1991 UAB led the ACTG study of treatment of a type of fungal meningitis.
  • UAB helped describe the first use of a “viral load” to treat HIV in 1993.

Then in 1994, UAB first used a three-drug combination prescription that would become the highly active antiretroviral therapy or HAART that today is the standard of care today for treating HIV patients.

In the 21st century, anyone diagnosed with HIV who gets treatment and takes their medicines regularly should be able to live a normal lifespan, says Saag. “We learned much about how the virus causes disease, how it replicates and how we can stop it from replicating. The simple process of keeping the virus from reproducing itself in the body enables someone to live a normal lifespan,” he says.

UAB’s research isn’t limited to the United States. Since 1997, 43 research projects have been completed at its Centre for Infectious Disease Research in Zambia (CIDRZ). Twenty projects are under way now, and 20 more are planned.

In 1999, UAB made world headlines when a team of researchers led by Beatrice Hahn, M.D., a professor of medicine in the Division of Hematology/Oncology, solved a 20-year-old mystery by tracing the exact route of HIV’s spread to humans. Scientists long had suspected that African primates first transmitted the virus to humans but did not know the species of origin. Hahn’s team identified the subspecies of chimpanzee in West Central Africa bearing the simian virus linked to all major HIV-1 variants identified in humans. The native hunters’ exposure to the infected blood while field dressing is the most likely route of infection.

And it continues to spread. The Centers for Disease Control and Prevention estimates that 1 million people in the United States are infected with HIV, and 200,000 — one in five — of those do not know they are infected. The CDC estimates more than 56,000 people are newly infected each year.

UAB’s 1917 Clinic Director James Raper, D.S.N., CRNP, who first joined the staff in the mid ’90s, says the number of patients seeking the specialty care they provide is growing.

“When I first started at the clinic 16 years ago, we had about 650 patients. Today we have more than 2,000 patients receiving care here from almost every county in Alabama and other states and nations,” Raper says.

“We want people to know they can live a good life with HIV and not become despondent, and we make every effort to keep people from getting infected. Anyone with HIV will tell you that it is not an easy life, Raper says.

Saag says barriers remain to eradicating this disease.

“I think during the next 30 years we have two major challenges. The first is creating a cure to eliminate long-lived cells that are infected, and the second is prevention.

“The biggest hope for prevention now is to find everyone infected with HIV today through testing. If we could get everyone in the country infected with HIV into care and suppress the virus, we would stop transmission of the disease,” Saag says.

Saag long has been among the chief voices arguing that treatment is prevention, an idea adopted by the Obama administration in 2010 as a cornerstone of the first National HIV/AIDS Strategy. Results from a randomized study in Africa that revealed a 96 percent reduction in the risk of infection through prevention confirms the wisdom of this strategy, he says.

Beginning this summer, UAB Hospital and 25 metropolitan hospitals will begin screening every adult patient treated in the emergency department for HIV through a program developed by the CDC.