From the Frontlines: Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, Talks About the Fight Against HIV

DR. ANTHONY FAUCI: The amount of activity that is needed to face this problem and the amount of adrenaline that gets pumped up when you know that you're dealing with a situation where people literally every day by the thousands and tens of thousands are getting infected and are dying at an equal rate, you don't have time to get tired. And I guess that's a good thing. Maybe it's a bad thing.

But I've been doing it now for - it'll be 21 years this summer, and if anything I've gotten more energized, unfortunately because the problem has gotten worse and worse as opposed to better and better.

I've been fighting HIV from essentially the very first day. We saw our first patient that ultimately turned out to have AIDS before the description of HIV/AIDS or the AIDS patients in the summer of 1981, and we didn't know what it was because we had been studying a variety of immunodeficiency diseases. It turns out retrospectively -- though, we didn't know it -- that patient happened to be an AIDS patient. But as soon the reports came from the CDC, from Morbidity and Mortality Weekly Report in the summer of 1981, I immediately felt that this was something that I wanted to pursue in my clinical research career.

I had a fellowship in immunology and had a fellowship in infectious diseases. I was very enamored of the study of global and public health, infectious diseases that have a significant impact on society. And when this disease came along that was acting like an infection and was destroying the immune system, it was almost as if this is something that I had inadvertently been training for for my entire career up to that point. So it was almost the most natural thing for me to do was to study this disease because it had all of the characteristics for which I had been specifically trained, even though none of us knew what it was.

It's opened up a whole new world for me, beyond the world of classical science, biomedical research, clinical trials and things like that.

So it went well beyond just sitting at the bench and doing experiments, or going to the clinic and seeing patients. It drew you into looking at society in a very different way, and then you started to deal with issues the way we did, for example, with the activists, to understand that you may be confined to your little protected environment of science, and there's a whole world out there that's depending in an acute way on what you're doing. So it isn't that you need to rush what you're doing and do it sloppily, but you need to be aware that as you're involved in the evolution of an epidemic, when the needs far outstrip what you have available to meet those needs, that takes a whole new perspective on the urgency of what you're doing, the commitment that you have towards it. Your job is not only never finished but you're behind because people are dying out there. You're not dealing with a theoretical situation.

In the 20th century, we had influenza of 1918, which killed 25 million people worldwide and 750,000 people in the United States. In 1981, we were introduced to the beginning of an epidemic that in the year 2002 has already killed over 22 million people, of which there are 40 million people who are infected and there's no end in sight, so this is really part of the evolution, the co-evolution of man and microbes. It's a very important one. It's like getting hit with a Mack truck. That doesn't happen very often. But it happened at least twice in the 20th century and I fully expect that before we get to the end of the 21st century, you're going to see another big one come along that's an emerging or reemerging microbe.

I just got back a week ago from a trip to Africa in which I visited Mozambique, South Africa, Botswana and Cote d'Ivoire, teaching me a few things. One, Africa as a continent is very diverse. What people do in response to a disease like this may differ greatly from country to country, but at the end of the day when you have a disease like this in the developing world, it brings you back to remember that you may have developed drugs that can bring the viral load to the low detectable level, and you might have drugs for opportunistic infection, but when you have a country that for decades if not centuries has been suffering from public health problems that don't minimize HIV but are just part of the big picture of what people are going through, who don't have clean water, who don't have a public health infrastructure, who have malaria that's infecting a substantial proportion of the population, who have TB that's killing so many people in their society. You just add HIV there, it's like the straw that broke the camel's back.

So HIV in our society, although it has been devastating our Western society, is an entirely different disease than it is in a society which is bending, if not breaking, under the burden of other diseases.

I think the curve of what we're doing is improving. We're not flat, and we certainly are not doing badly. We have accomplished a lot, but we'll enumerate those when we get this epidemic under control. You can't talk about that now because we're still chasing a global pandemic.