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Harden: Could you understand where they were coming from when you were trying to persuade them about the possibility of transmitting AIDS in the blood supply?
Curran: Yes, but they would say, “Who are these people from CDC with STD backgrounds? Why are they talking about blood banking issues?” There were, of course, some people who had backgrounds in both infectious diseases and blood banking. [Dr. Louis] Lou Barker in the Red Cross had an infectious-disease background from his time in the FDA. They tended to believe in the infectious hypothesis more than some of the people in some of the other blood banks. There were certainly people in other NIH institutes who were believers and who were trying to convince NHLBI people initially. And, eventually, NHLBI really got very much involved in AIDS. [Dr.] June Osborn became head of their advisory panel and changed the orientation. But AIDS forced a difficult marriage among all of these different groups of people who had previously not worked together.
Certainly, if you look at the blood supply now, just as if you look at the dental office now, AIDS has made a revolutionary change in how things are done. It is at some cost. But the paradigms changed completely. We were dealing with this issue of the safety of healthcare workers. We talked about dentists and dental operators wearing gloves, watching out for needle sticks, and wearing masks. They said, “Well, how can they do that?" In 1981 only 70 percent of the dental school professors wore gloves.
Harden: They do now.
Curran: Everybody does. You have to. It was just a different way of doing things that had to be changed. It was among some of the revolutionary things that happened as a result of the AIDS epidemic.
Harden: One of the things that I am interested in here is any cooperation that may have gone on between the CDC and the NIH in setting some of these standards. I know the Dental Institute made recommendations early on for how dentists could protect themselves. And we talked to [Dr.] David Henderson about the hospital epidemiology at the Clinical Center; everybody was looking to the CDC for case definitions and so on. What kinds of interactions were there?
Curran: The first recommendations that the CDC came out with were in November 1982, Guidelines for Healthcare Workers. This was before the discovery of the virus. I do not remember–I could find the guidelines if you do not have them–what the NIH involvement was in that. I would be surprised if it was not shared with the NIH, but I am not sure whether it was co-authored by the NIH or what. But this is the kind of thing the CDC had done a lot of before. It was like the hepatitis guidelines, things that fit that paradigm.
Hannaway: You were very experienced at developing guidelines.
Curran: Yes. In March of 1983, the interagency recommendations on prevention of AIDS came from the CDC, the FDA, and the NIH. Those guidelines were developed following a meeting that we had in January. It was a Public Health Service meeting conducted at the CDC with all the blood bankers and a variety of other representatives. It was a very open public meeting.
Following that meeting, we drafted guidelines that were cosigned by all of the agencies. The bloodbanking guidelines, those from the AMA, etc., were similarly patterned after the PHS recommendations. We were all openly sharing drafts with each other because we were not trying to be secretive, and we thought consensus was important.
You know that the period of time between the identification of hemophiliacs as people who could get AIDS and those guidelines was a period of nine months. During that time there were the first cases of transfusion AIDS. We knew of a few cases of AIDS who had received transfusions; it looked like transfusion-associated Pneumocystis in New York City. But we could not get permission from the New York Blood Center or others to investigate the donors, so we could not determine if the cases were linked to a donor. But we knew that there were men, for example, who had bypass surgery and multiple transfusions, who subsequently developed Pneumocystis. And we went to interview them. We got their blood, but we did not find any connection since initially we could not identify the donors. Men who had bypass surgery received many units of blood. You expected people who received a lot of blood to be most likely to be exposed to a rare new agent. Interestingly, a lot of them had what is now known as acute retroviral syndrome, which we noticed right after the transfusion. But we could not get permission to investigate the donors in New York, initially.
So the first case was a case in San Francisco-[Dr. Arthur] Art Ammann reported it to us–a baby who had Pneumocystis, had received blood from a donor, a closeted gay man, who had subsequently died of AIDS. So that was a direct link, and that was the first transfusion case reported. It came out in January 1983, in MMWR. That kind of blew things open for us to do the other investigations. It turned out when we did investigations of some additional cases–an article would be published in the New England Journal of Medicine in 1984–that we found, not too surprisingly, that there was usually one gay man as a blood donor with a reverse T4-T8 ratio in each case. Then, subsequently, after the virus was isolated, we actually isolated the virus from each of those donors, and, I guess, now we could genetically link them if CDC still has both isolates.
Harden: I have two questions here. You were unable to find out about the donors in New York. Was that due to state law, or the Red Cross?
Curran: They were hiding behind the privacy-of-the-donor issue.
and that is another other sort of issue.
Curran: It was not the Red Cross in New York. It was the New York Blood Center. The question then became, what could we do? I mean, should we try to invoke public health powers to do it? At the time, we still had more cases of hemophiliacs being reported. We were kind of looking for a softer niche to do the investigation because we were trying to cooperate with people at the same time, and there were other cases getting reported in other places. Once you investigate the donors, what do you find? You did not find a virus; there was still no virus. So you find a gay man who is a donor. But we were trying to establish the pattern. And these cases were remarkable, I will tell you that. Do you like anecdotes?
Curran: The second case of AIDS in Tennessee was reported. We had EIS officers always poring over new cases of AIDS. I was motivating them and getting out in the field with these officers. There was a bright physician named [Dr. Steven] Steve Solomon, who was not entirely convinced that AIDS could be transmitted through transfusion. See, we still did not have a virus. By now, most of the rest of us were believers. There was this case of Pneumocystis reported in a young college student from Memphis State in Memphis, Tennessee.
Curran: There was a man, the state health epidemiologist, who wanted to help us with this. This was only the second case of AIDS in Tennessee. The student died almost immediately of Pneumocystis. To be exact, Solomon went and interviewed him and obtained some specimens. Then he died very shortly thereafter. This young man had received blood from two donors. We interviewed the young man's family and people with whom he attended college. He was a shy young man, and he had been to New York once, and they felt it was unlikely that he had homosexual contact. So we found those two donors who had given him blood. One of the donors was in this major blood bank and was a prison guard. We rushed people to get his blood. He was married and worked in a prison in Tennessee. So we obtained his blood, his T-cell subsets were normal, and he was healthy. He was married and had three kids, and it looked like he was not the source of the student's infection.
There was one other donor from a paid blood bank that had gone out of business–and the records were gone. It turned out, however, that somebody found out we were looking for the records, and eventually we were introduced to the man who had bought the blood bank. Steve Solomon went down in this guy's basement and found the records of the blood donor. The man was supposedly from a military base in northern Tennessee. Well, Solomon could not find him. So he went up to northern Tennessee just south of the Kentucky border looking for him. It turned out that a woman, who had been a preventive medicine resident of mine when I was in Ohio, was running the health services for this little military base. This blood donor had been discharged from this base, given an honorable discharge, because he had health problems. What he had was an extensive lymphadenopathy syndrome, which had been diagnosed in California when he was assigned there back in the late 1970s. He was a single man. Where was the man?
We tried to find him. Solomon tracked all over Tennessee looking for this man. He found his mother. His mother said, “If you find him, let me know where he is. He's been drinking a lot, and we do not know where he is, and we're worried about his health. He is somewhere in this small town.” Steve said, “Do you have any gay bars?" They said, “Not really, but sometimes we think there are some gay people that hang out outside of this one bar.” Solomon went and hung out there, and found this man. He did a physical examination of him; and he had extensive lymphadenopathy. Solomon drew his blood, and results showed an inverted T-cell T4/T8 ratio.
Solomon came back as a total believer: “AIDS is transmitted through the blood. This is too much of a coincidence. This man was a gay man who was discharged from the military for lymphadenopathy syndrome, which started in California, comes back, donates blood to a blood bank that goes broke in Memphis. The blood goes to this college student who gets Pneumocystis and dies.”
I worked a case myself in Huntsville, Alabama, at about the same time. There were no reported cases of AIDS in northern Alabama. It was a case of AIDS in an old man, one of whose donors had evidence of immunosuppression in his blood. After you do a few of these kinds of investigations yourself, tracking the cases down, you understand how people became convinced of the infectious hypothesis.
Meanwhile, the blood-banking community was concerned about the integrity of the blood supply. They were concerned about putting it in perspective. They did not realize that the problem itself would change the perspective, and that it was much more common than it was.
Harden: Let me go back to Dr. Robert Gallo and ask you to talk a little more about your relationship with him. Here you had all these cases, and you were thinking it sounded very much like an infectious disease, and you are looking at these T4/T8 ratios. You know Bob Gallo, and you know he has been working on T4 cells. Would you go through it for me? How well did you know him?
Curran: I did not know him at all until, I think, it was the National Cancer Advisory Board meeting where we first met.
Harden: This was in December of 1982?
Curran: It might have been before that. One time I met him was at the Board of Scientific Counselors for the Division of Cancer Treatment. The next time was at the National Cancer Advisory Board.
Curran: I think it was the National Cancer Advisory Board, because it would be the latter meeting that [Dr. Vincent] DeVita was chairing. The two presentations for the afternoon were going to be one by me and one by Bob Gallo about his work on retroviruses. This meeting, as they often do, ran late. Gallo and I were waiting, and they got to the point where they were saying, “We only have time for one more presentation.” Now, NCI had paid my way up there. The NCI people probably thought, “Well, Gallo can present next quarter or next meeting.” So they said, "Bob, we will ask you to wait. Let Dr. Curran present.”
So I got up and I dedicated my talk to him. I said, “Since you have worked on T4-tropic viruses, what you need to do is find this one.” And I presented this data, which I am sure was obscure to many people on the National Cancer Advisory Board. But Gallo listened, and he is not a patient man. He listened, and that is probably why he occasionally attributes his involvement in AIDS to me. I became a member of his group of advisors and was communicating with him over time. He pulled a group of people together. It included [Dr. Dani] Bolognesi and people like that, but also Dr. Luc Montagnier and others to get together to brainstorm over what to do and how to find the cause.
Harden: Were you traveling back and forth to Washington a lot? Were you in and out of the NIH and presenting seminars?
Curran: The first year I spent more time in New York than I did in Washington. Then, starting with the reports about hemophiliacs, I began spending more time in Washington. After the virus was discovered, by 1984-85, I was spending much more time in Washington than anywhere else. But, by then, we had a larger team of people, and we had funding.
Harden: I was just trying to pin down whether your interactions with NIH people were more formal or informal in 1982.
Curran: I would say more informal. The formal mechanisms did not start until there were PHS task forces and things like that.
Harden: Nineteen eighty-four, I think.
Curran: Yes, or even later.
Hannaway: Was Bob Gallo interacting with CDC virologists as well, or was that a separate enterprise?
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