In late spring of 1981, Anthony Fauci, MD, then a 40-year-old immunologist, was in his office at the National Institutes of Health (NIH) Clinical Center when a history-changing report came across his desk. The June 5 Morbidity and Mortality Weekly Report (MMWR) from what was then called the Centers for Disease Control documented Pneumocystis carinii pneumonia in 5 gay men presenting at 3 Los Angeles hospitals. Prior to this, the rare lung infection was almost exclusively limited to severely immunosuppressed patients, making these cases in previously healthy patients unusual.
Fauci thought it was a fluke. But a month later, in early July, another issue of MMWR came in, this time reporting that 26 gay men in Los Angeles, San Francisco, and New York were recently diagnosed with the uncommon and aggressive cancer Kaposi sarcoma and other opportunistic infections.
At that point, Fauci knew it was no fluke. It was the beginning of the AIDS epidemic, although the new disease didn’t have a name—or a known cause—yet.
“That turned out to be the real turning point in my career, if not my life,” Fauci says. He and his colleagues assumed that a sexually transmitted virus caused the disease. “But like everybody else, I didn’t have any idea what it was,” he says. As an internist trained in both infectious diseases and clinical immunology, he realized that he was in a unique position to make a real impact on a terrible illness.
Fauci’s research on the pathogenesis of HIV, which he juggled while tending to patients with AIDS, laid the framework for early treatments, and in 1984 he was named director of the National Institute of Allergy and Infectious Diseases at the NIH, a position he’s held for 34 years. In that role, he developed programs focused on the discovery of antiretroviral drugs and their testing in clinical trials networks. Several generations of antiretroviral therapies have since been developed, transforming HIV infection from a death sentence into a manageable chronic disease if treated.
Yet much more work needs to be done, Fauci says. More than a million people in the United States are living with HIV, with tens of thousands of new infections and more than 6000 deaths every year. Globally, 36.7 million people were living with the infection and 1.8 million people were newly infected in 2016. That year, 1 million people worldwide died from AIDS-related illnesses, bringing the total death toll to a staggering 35 million since the start of the pandemic.
Just weeks before the 22nd International AIDS Conference, Fauci spoke with JAMA about how far we’ve come in treating and preventing HIV/AIDS—and how much farther we need to go to reach his ultimate goal of eliminating the disease.
Read the interview and listen to the podcast here.