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If you like David Ho's story, you might also like:
Paul Farmer,
John Gearhart,
Jeong Kim,
Antonia Novello,
Jonas Salk and
Bert Vogelstein

David Ho also appears in the video:
Frontiers of Medicine

Related Links:
Aaron Diamond AIDS Research Center

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David Ho
David Ho
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David Ho Interview (page: 3 / 6)

AIDS Research Pioneer

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  David Ho

You were quite young when you first encountered AIDS, but no one knew what AIDS was. Where were you when you first encountered it?

David Ho Interview Photo
David Ho: I finished medical school at Harvard and went to train in internal medicine at UCLA. I was getting ready to pursue research on viruses. Then I was asked to stay on as a chief resident for an extra year. As a chief resident, you see a lot of patients. You hear about all the patients that are admitted. It was during that period that I heard from the interns and residents that the night before a man had come into the hospital with severe pneumonia. He couldn't breathe, and had to be put in the ICU. Pneumonia had wiped out both lungs, but at the same time he also had gastrointestinal problems and seizures, as if there was something else in the brain. This man died very quickly. His pneumonia was due to a parasite called pneumocystus craniae that only occurred in patients who were getting chemotherapy. There was another parasite in the brain, and a virus in the gastrointestinal tract, and this man some weeks before had been "perfectly healthy." in quotes. We couldn't explain the illness.

We knew what the complications were, but we couldn't explain the illness. We saw another one a few weeks later, and then another one and the common link was that these were all young gay men. Upon taking a closer history, we found that they were gay men with lots of sexual contacts. They didn't have exactly the same set of complications, but the conclusion was that something was wiping out their immune system, allowing them to be sick with all of these other things. We were very concerned that something was being transmitted which is capable of destroying the immune system. Without thinking too much, we already believed that this had to be something new, something that wasn't in the textbooks, and in fact that turned out to be the case.

I began with an interest in this medical curiosity, never realizing that this was going to be a big health problem for the public. But, the scientific aspect was extremely interesting in that here we were looking at something that was transmissible, capable of destroying the immune system. That was new and one way or another the science behind that would shed light on bugs and on the immune system. So, I was gung-ho from day one of the epidemic.

[ Key to Success ] Passion

You were in the right place at the right time.

David Ho: Right, I was.

I was at the right place at the right time, having just finished the right type of training, getting ready to do the right type of training that would be relevant to this problem. Chance does play a very, very important role. The other thing I've been telling some of the students here is that serendipity plays an important role, but we have to be prepared to take advantage of the opportunities that are bubbled up by serendipity. And, I certainly, for this particular problem, once I grabbed onto it I did not let go, even though in the early years it was not a problem and people would say, "Well why are you interested in a problem that effects the gay men and drug users?" You know, it's a disease and one should not look upon it in that way. And so, I went full speed ahead on this particular problem.

[ Key to Success ] Preparation

When and why did you suspect a virus so early on?

David Ho: From the very beginning, after seeing the first five cases or so. The common link was that the sufferers were all gay men with lots of sexual contacts. We had seen a lot of gay men with infectious diseases like Hepatitis B and other sexually transmitted diseases. We always put a transmissible agent as the number one cause. There were people who proposed the idea that some of this problem was due to some drugs that were used by the gay community at the time, poppers and nitrates, but it just didn't seem that way to us.

Why do you think we're seeing these new microbes, these new viruses like HIV that we did not grow up with as children?

David Ho: Many have written about the demise of bugs with the development of antibiotics. I think that was overly optimistic, and now we're seeing the revenge of the bugs. Some of the bacteria that are treatable with antibiotics are becoming more resistant to the drugs that we have in our arsenal. At the same time, we're also realizing that there are a lot of bugs that were with us for a long time, but are just newly recognized, Lyme disease for example. We thought it was a new syndrome and the field collectively identified the bug only in the past decade or so. But, looking back in the textbook, that illness has been described for decades. Hunter virus I suspect has been with us periodically in minor epidemics for a long, long time, but now we have the technology to detect it and identify and characterize it.

But there are some other illnesses that truly appear to be new, and AIDS is clearly one of those. Ebola is probably another and related hemorrhagic viruses and that's probably because we have as a human population invaded a new territory. In central Africa, people are going into jungle areas, having contacts with certain bats which allowed the Ebola virus to jump species. It causes devastation and can go through a village very quickly, but it burns itself out very quickly because it's so deadly.

Based on the work that's been done over the past decade and a half, it's clear that HIV emerged about 60 or 70 years ago, and the virus jumped species from an African monkey or ape species into the human. This jump probably was not completely new. It may have occurred hundreds of years ago or thousands of years ago, but it burned itself out, and didn't spread. But societies were changing. Population density was increasing, transportation was getting better, people were able to move around, sexual behavior was changing. A lot of these socioeconomic factors permitted the initial introduction to be transmitted in waves. I think there's a very valuable lesson there for us when we look back upon how AIDS may have started.

We have to be mindful of the factors that allow epidemics to occur. We have to think critically about population density, what transportation actually can do. Today transportation is global, and diseases do not obey any national boundaries. These are lessons we should bear in mind.

What were your first important discoveries about HIV and AIDS?

David Ho: I saw the first patient in 1981. By '82 I had moved to Boston to pursue research on viruses, and I continued to look for the cause. The cause was initially identified by scientists at the Pasteur Institute, and then confirmed by scientists at the NIH. I had a more substantial role beginning in 1984 when my colleagues and I showed that the virus is not just in people who are sick, but in people who are very healthy who belong in the same risk group. We were the first to show that there is a carrier state that can last for a long period of time.

You can be HIV positive, feel well, but still be carrying lots of virus?

David Ho: That's exactly right. Moving on, we showed that the virus, in addition to attacking the immune system, actually could attack the central nervous system. Particularly for late stage patients, there's a great deal of involvement of the brain, causing dementia in some severe cases. We also found an illness, associated with the initial phase of infection that looked like flu. It lasted for several weeks then disappeared. During that phase, the patient has an enormous amount of virus before the immune system begins to kick in to keep it in check. My research has focused on trying to understand how the replication of the virus results in the depletion of the immune system.

There had been an old dogma in the field that HIV comes in and after this acute phase that looks like flu, there's a prolonged dormancy. The virus wasn't doing much and the person is pretty well. And, we know that because we now know that period could be about ten years. And, somehow we realized that during this period the person's immune system is gradually dwindling and I didn't necessarily like the notion that -- we knew the patient is well -- but I didn't necessarily like the notion that the virus is dormant. And, for a long period of time my research effort is to measure the virus, to quantify the virus. I would say that's a decade long effort, having been one of the first to measure how much virus there is, and then very gradually demonstrating that the old notion is incorrect.

[ Key to Success ] Vision

In fact, the virus comes in and grows and churns out lots of virus each day. It's destroying lots of immune cells each day, and the body has to pump out more of those cells to keep up. So we ultimately proved the old notion was incorrect. We're dealing with a highly dynamic virus and a highly dynamic process of replacing the lost cells.

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This page last revised on Feb 29, 2008 12:37 EST
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