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Fighting AIDS

On the front lines against the plague.

From the January 12, 1987 issue of New York Magazine.

It is five minutes to nine, and Dr. Donna Mildvan is waiting impatiently for an elevator at Beth Israel Medical Center to take her down from the tenth floor to the center's Monday-morning AIDS clinic. Ten blocks uptown, in his lab at Bellevue Hospital, Dr. Fred Valentine is drawing blood from an outpatient who has AIDS. Down near City Hall, in a building that looks a great deal better outside than inside, Dr. Polly Thomas, a pediatric-AIDS expert at the New York City Department of Health, has two calls on hold and a public-health adviser waiting in her cramped cubicle to talk to her; on her desk sits the draft of a manuscript on AIDS.

Three more veteran AIDS fighters—Drs. Rand Stoneburner, Sheldon Landesman, and Arye Rubinstein—are in Atlanta, discussing with experts at the Centers for Disease Control (CDC) the need to broaden the definition of AIDS.

These doctors have been battling the AIDS plague since it appeared in the city—which, they now realize, was eight years ago. They work with a sense of urgency reinforced by each new case and each inevitable death. "New York is the North American epicenter of the disaster," warns the city's health commissioner, Dr. Stephen C. Joseph. "The impact of the AIDS epidemic on our citizens, our hospitals, and our entire city will be horrific."

On this morning, other doctors in the city are laboring with the same intensity and motivation: They, too, have been fighting AIDS since it was a mysterious, unnamed malady. In his lab, Dr. Alvin E. Friedman-Kien is checking on the development of a test that may detect the AIDS virus in the blood sooner than the currently used ELISA test can spot antibodies to the virus. Dr. Warren D. Johnson Jr. has just come back from a week's research in Haiti. The dean of New York's infectious-diseases experts, Dr. Donald Armstrong, is on a site visit on behalf of the National Institutes of Health, evaluating a scientist's application for a grant to study AIDS.

Other dedicated people, such as Dr. Mathilde Krim, co-chairman of the American Foundation for AIDS Research, raise funds for education and research, or, like the devoted "buddies" of Gay Men's Health Crisis, provide support for the ill.

These doctors routinely work twelve- and fourteen-hour days. They stay in the war, although they see patient after patient die and other researchers have burned out and left. They phone one another regularly and meet often. Some gatherings are formal, such as the weekly Intercity Infectious Diseases Rounds and the Department of Health's monthly AIDS meeting. Some are informal—two or three doctors discussing a problem, a possible approach, a joint study, or a joint paper. Remarkably, they collaborate across institutional lines and share information before publication. In the battle against an epidemic, there is no time for turf fights.

No one knows how many New Yorkers are infected with the AIDS virus. But, based on experience with the disease so far. Dr. Joseph estimates that by 1991, 40,000 New Yorkers will have developed AIDS and 30,000 of them will have died. Another 40,000 or more will have developed AIDS-related complex (ARC), a less severe form of the disease. That 80,000 represents more than 1 percent of the city's population—and many more will have been infected with the AIDS virus. Studies suggest that 20 to 40 percent of people infected will develop AIDS within five years, and another 40 percent will develop ARC. AIDS will continue to increase in all risk groups, but a larger proportion of cases will probably occur in intravenous-drug abusers, their sex partners, and their babies.

And the situation is really grimmer than it seems, because, according to Dr. Joseph, the disease has been defined too narrowly; he believes that there are twice as many cases of AIDS and ARC as are now being counted. A broader definition would include other possible manifestations of the disease, such as endocarditis (a heart inflammation), tuberculosis, and nonspecific pneumonias, all of which are increasing among intravenous-drug abusers, as are other disorders, such as lymphomas. The Centers for Disease Control is now considering broadening the definition.

These frontline AIDS fighters are looking for better tests for the virus, for markers showing which infected patients will develop the disease, for information about how sex partners contract the disease and how mothers transmit it to their babies, for statistics predicting just how bad the epidemic is going to get, and for information that will determine how the virus causes immune deficiency. Most of them are also involved in patient care. Some of the treatments they have just begun using have given them a glimmer of hope.

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