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Irrational fear, paranoia and apocalyptic statements have abounded. More than one normally understated scientist has termed AIDS "the disease of the century." Others have, in the tradition of divine justification, viewed it as God's revenge on sodomites and junkies. There have been far more pervasive epidemics, certainly. In 1918 and '19, Spanish flu killed more than 500,000 Americans and ultimately 20 million worldwide. A million Russians may have died of cholera in 1848 alone. But during these scourges there were always the possibility and hope that the fever would lift, strength would return, and life would go on. With AIDS, says Dr. Michael Gottlieb, the UCLA immunologist who is overseeing Hudson's care, "the word cure is not yet in the vocabulary."
It is the virtual certainty of death from AIDS, once the syndrome has fully developed, that makes the disease so frightening, along with the uncertainty of nearly everything else about it. Despite the progress in medical research so far, huge questions remain about its origin and fundamental nature. In trying to understand AIDS, says Dr. William Haseltine, a leading investigator at Harvard's Dana-Farber Cancer Institute, "we have moved from being explorers in a canoe to explorers with a small sail on the vast sea of what we do not know."
Since the first cases were identified in the U.S. more than four years ago, AIDS has baffled the experts. UCLA's Gottlieb was among the first physicians in the country to notice that something strange was going on in the winter of 1981. In the space of just three months, he treated four patients with an unusual lung infection called Pneumocystis carinii pneumonia. PCP is what doctors term an "opportunistic infection," one that strikes people when their immune response is weakened. Typical victims are frail cancer patients and transplant recipients. Gottlieb's four patients departed strikingly from this pattern. Though tests showed their immune systems were severely depressed, all four were young men around 30 who had previously enjoyed excellent health. All were also avowed homosexuals, three of them with a history of many partners.
"The third case cinched the realization that what I was seeing was something new," Gottlieb recalls. Then, when another case turned up so quickly, he says, "I knew I was witnessing medical history, but I had no comprehension of what this illness would become." He notified federal health authorities of the four cases, and in June 1981, Atlanta's Centers for Disease Control published what was to be the first report on the strange new ailment.
No sooner did the report appear than the CDC began hearing from doctors in San Francisco and New York City, who were also seeing PCP in young homosexual men. And that was not all they were seeing. Many of the patients bore the purplish lesions of Kaposi's sarcoma, a rare skin cancer that in this country is usually found only in elderly men of Mediterranean extraction. They had other infections as well: Candida albicans, a fungus that cakes the mouth and throat, making it difficult and painful to speak or eat; herpes, not just the garden variety of sores, but ulcerating infections of the mouth, genitals or anus that raged for months. The patients fell prey to exotic bugs seen more often in animals than humans, like Toxoplasma gondii and Cryptosporidium, which causes diarrhea. Doctors were appalled. Says Dr. Paul Volberding, 36, who heads the AIDS clinic at San Francisco General Hospital: "You see someone your own age dying of such a gruesome disease that you can't do anything to stop."
By late August, less than three months after its initial report, the CDC knew of more than 100 cases of what was already being called the gay plague (despite the fact that at least six patients said they were heterosexuals and one was a woman). What they had in common was something Gottlieb observed in the first four cases, "a near wipe-out" of helper T cells, a class of white blood cells that plays a central role in orchestrating the body's immune defenses.