November 1996
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His study of feline leukemia laid the groundwork for HIV research

Dr. Myron "Max" Essex was in Botswana last month, looking at yet another strain of the virus that causes AIDS. Botswana, where one-third of all pregnant women are HIV-positive, now has the highest rates of infection in the world. "We're trying to understand what it is about the virus that makes it different, if it's not some behavioral issue," Essex says.

Essex, president of the Harvard AIDS Institute, has been doing such medical detective work since the AIDS epidemic started. His years of work studying feline leukemia laid much of the groundwork that allowed him, Dr. Luc Montagnier at the Pasteur Institute, and Dr. Robert Gallo of the National Cancer Institute to establish HTLV-III (later called HIV) as the cause of AIDS.

In 1986, the three shared the Lasker Award for their work. "It's the highest award that has been given for medical research related to AIDS," Essex boasts.

One in Ten: What is your earliest memory of AIDS?

Max Essex: The reports and clinical papers describing four or five homosexual men with the disease called GRID (Gay-Related Immunodeficiency Disease). I remember reading about them in a CDC report. Soon after that a former student of mine, Don Francis, who was an employee of the CDC working in the hepatitis program, called and asked me what I thought of it. That was in late 1981. The first point where I did anything useful, in 1982, was to ask whether this disease might be caused by a virus in general and a retrovirus in particular. I did that essentially at the same time as Gallo, at least according to Gallo. The reason we thought a retrovirus might be the cause was because we had discovered in the early 1970s that cat lymphotrophic retroviruses caused a lot of immunosuppression in cats.

OIT: Do you have opinions yet about whether the protease inhibitors might work for the long haul?

ME: The information coming in suggests that using these drugs in a highly strategic way to attack different enzymes of the virus will create ways to control the rate of HIV replication and keep people alive for quite a long time. And I don't think the viruses will all develop the same resistances that they developed to AZT. But it already costs $100,000 or more to treat a patient without the protease inhibitors. With them, it will take millions, and that's certainly unavailable to the 90 percent of infected people who live outside the US and Europe. So it's a very inadequate solution, and it's worthless to people in Africa. The last thing we need is to go from $5 or $10 billion a year in treating people to $50 billion a year because they all live longer. So it's a mixed blessing.

OIT: What do you think some of the major stumbling blocks have been in the fight against AIDS?

ME: We've had trouble making a vaccine and getting sufficiently serious about vaccine research to start tests of vaccine efficacy in people. That may be the only chance for people in the developing world.

OIT: What about the biggest victory?

ME: The development and availability of the blood test. Just having the blood test per se doesn't seem significant now, but at the time it was tremendously important. If we had gone on for another two years with people getting infected by blood transfusions before we realized it, the epidemic would have been totally different.

OIT: Has Boston distinguished itself in the way it has addressed the epidemic?

ME: Yes. Two ways come to mind. One, there were a number of scientists involved very early in looking for the cause, the pathogenesis and mechanism. The New York Times Magazine did a special on this in '85 or '86, talking about how in Boston, four fairly senior people became involved in the research very early on. They were Marty Hirsch at Mass General, head of viral diseases there; myself; Bill Hasletine, a molecular geneticist at Dana Farber; and Jerry Groopman at the Deaconess. There really wasn't any other place where four people with different skills -- two of them clinical, one very basic (Hasletine), and one virological (me) -- came together and had a lot of collaborative discussions to try to solve the problem. That doesn't often happen.

The second is the efforts of Larry Kessler to educate people through the AIDS Action Committee. He and I, along with others, talked to the mayor's commission and several of the governmental institutions to warn them about AIDS and try to get somebody involved, even before we knew the viral cause exactly. And I don't think that happened in most cities.

OIT: How has AIDS affected you personally?

ME: In the '80s, it made me much more committed to solving public health problems immediately, as opposed to just doing fundamental medical research. I had been working in cancer research, and I remember thinking it wasn't terribly important whether I worked 80 hours or 60 hours. I didn't have the sense of urgency about whether I finished an experiment today or next week. With AIDS, I think we all felt that putting in the extra hours this exact week could make a big difference. And it made me aware of the need to look at infectious diseases in a global way. Until that time, I'd say I didn't have a particularly international outlook in what I perceived as the problems in virology or medical research. Since then I've become much more international -- I've had to address what's happening in Africa and Asia to know how to solve the problem here.

OIT: Look down the road five years. What do you think AIDS will look like?

ME: It will definitely still be with us. There will be twice as many people in the world infected as there are now, and the larger part will be in Africa and Asia. AIDS will be a much more tropical disease, and in the West it will be more a disease of poor inner-city heterosexuals. It will follow the risk groups for syphilis and gonorrhea. It will remain a concern for sure among homosexual men and drug users, but the ratio will continue to shift toward heterosexuals. A much larger fraction of the infections in Europe and the West will involve the newest strains, which are the ones that are infecting people in Asia and Africa right now. The combination therapy will be pretty effective, and new drugs will be made all the time. Corporate players, especially, will have enough research incentive to continue to play a role in drug discovery, recognizing that it's a billion-dollar market.

P R O F I L E S, Boston-area AIDS activists: Larry Kessler | Max Essex | Denise McWilliams |
Matt Florence | Ray Schmidt | Ken Mayer | Barbara Gomes-Beach | Brian Rosenberg

T I M E L I N E, 1981 - 1985 | 1986 - 1989 | 1990 - 1996 | The N A M E S | AIDS L I N K S

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