Interview with an HIV/AIDS Specialist

To gain a further understanding of HIV/AIDS, we chose to interview Dr. Sharon Lee.  Dr. Lee is a general family practitioner who works at Family Health Care, a free clinic on Southwest Blvd. in Kansas City, Missouri.  Dr. Lee started this free health clinic after realizing the need of free medical services for the uninsured, and began working with HIV/AIDS patients in 1984.  She has gained a deep understanding of the evolution of the disease, the role of research in HIV/AIDS treatments, as well as the changing societal and cultural perspectives of the disease.  Her experience and vast amount of knowledge about this disease made her an excellent choice of reference for our project.

Dr. Lee's work with AIDS patients began in 1984, three years after the CDC first discovered it.  At this time it was not diagnosed as AIDS because it was an emerging disease.  The CDC noticed clusters of pneumonia and Kaposi's sarcoma in younger populations.  This was unusual because the diseases typically appeared in elderly populations.  At first, the CDC only characterized it as an infectious disease with a suspicion that is was sexually transmitted.  The only way to diagnose the disease was to measure the T-cell count.  In 1983, the CDC began calling it an AIDS related complex (ARC) and it was still not identified in many populations.  In fact, Dr. Lee did not believe that she would encounter patients with this disease.  One year later, her expectations did not hold true, and a patient with this disease entered the clinic. 

There were many unknowns about this disease especially how it was transmitted.  Many doctors were afraid to treat these patients because they wanted to protect themselves and their families from this disease.  Dr. Lee's free clinic became the center for HIV/AIDS patients in Kansas City because many of these patients had lost their jobs, insurance, and homes because of the stigma that was associated with this new disease.  In her first few years of working with the disease, there were over 200 deaths per year at the Kansas City clinic alone, and many of these patients died without the official HIV/AIDS diagnosis because of the fear of cultural stigma that would remain with their surviving families.  Most of the patients admitted to the clinic died within the first 6 months due to the lack of research and treatments available for this disease.

After extensive research for almost a decade, Dr. Lee states, "it became clear that there were medications that can control [AIDS]." In 1996, protease inhibitors were tested as treatments for the disease and were very successful. Prior to that, nucleosides, specifically AZT worked like a "miracle drug" and helped cure Kaposi's Sarcoma. While these two treatments were effective, the patients developed resistance after approximately one or two years. To prevent resistance, doctors started to prescribe cocktails - these were a combination of two or more drugs. These cocktails increased the patients' chances of survival. The reason HIV/AIDS was able to become resistant to drugs was because the occurrence of random mutations in the genome. Resistance developed for many reasons. First, the virus replicates at an alarmingly fast rate, and it does not have DNA polymerase that corrects mismatched pairings of DNA bases.

Bush Meat

http://bushwarriors.org/2011/06/13/is-having-your-chimp-and-eating-it-too-leading-to-%E2%80%98empty-forest-syndrome%E2%80%99/

According to Dr. Lee, "it is very interesting because the HIV we know originated in chimpanzees and crossed over to humans a long time ago. Non-human primates in Africa had a similar virus called Simian Immunodeficiency Virus (SIV) that is common and nonpathogenic in these non-human primates. Through the use of bush meat in Cameroon, the SIV crossed over to humans. Since humans and chimpanzees share 98.5% of DNA, the virus quickly adapted into a form that was pathogenic to humans. It is estimated that since 1930, SIV has crossed over eleven different times. Even today, since bush meat is still consumed, there is potential for other viruses to cross over into humans similarly to the cross over of SIV. Interestingly however,  as of today there is a percentage in the human population that is genetically resistant to the HIV virus.

Through genetic and sociological studies, it has been found that humans in Northern Europe had a gene mutation at the CCR5 allele. For HIV to enter a T-cell, it first binds to a surface receptor called CD4. Then, the CD4 pulls the virus down which allows the virus to bind to the CCR5 receptor. The second binding initiates fusion of the virus to the cell. Some humans have a mutated CCR5 gene that produces a receptor which HIV is unable to bind to. Since this is a recessive trait, individuals that have both alleles with the mutation are effectively immune to HIV, and individuals who are heterozygotes have a partial resistance slowing HIV progression.

When we asked Dr. Lee if it is more important to support the efforts of HIV prevention or support the research of the virus to develop a cure, she said she had no effective way of answering the question. She said that, "it is possible to do things on the preventative side. I think a cure is a very long ways off." She continued by saying that the best preventative measure is to get humans to change behavior (using condoms, being aware and educated about the disease itself), but she did recognize the difficulty of that endeavor.

Dr. Lee told us many stories about her experiences. While we could not include all of them in our description, we have gained new knowledge about HIV from many perspectives. Dr. Lee has done many talks around the United States on this topic and it was a privilege to have conducted this interview with her.