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Harden: As a physician-investigator working with others and attempting to cope with AIDS as a new disease, could you describe the strategy the group used? Were people attacking the problem, bit by bit–dealing with discrete opportunistic infections such as CMV or Pneumocystis–or did you rapidly shift to efforts to reverse the underlying immune deficiency? Or did you try all these things at once?
Masur: I think our efforts were a function of our interpretation of what the problem was and what resources we had available. Again, one of the real virtues of the NIH community is that there is an expert on almost everything here. When we saw that the herpes virus was a problem, we went to Steve Straus and said, “Why don't you come and do the cultures?” And he said, “Fine.” If we had needed to go to Baltimore or Philadelphia, that would not have happened, or would not have happened very easily. So the diversity here was an important issue.
It thus depended on the personality and the imagination of the people who were here. For instance, nobody had any idea how to go about figuring out what a good antiviral drug was. That was when [Dr. Samuel] Sam Broder made his important contribution. I would doubt that he knew anything about retroviruses, but with intelligence and hard work, he figured out where to start, and he got some people working on it. The therapeutic attacks went along the lines of the people who were involved and what their expertise was. There was a lot of interest, for instance, in herpes virus, but no herpes virus drug, so we did not really do anything about that. There was a lot of expertise in immunology and there are lots of things you can do about immunologic deficiencies, even though most of them had never worked. But there were many things to try and a lot of ideas. Some were crazy; some not so crazy.
It was really Tony [Fauci] who did one of the first remarkable things. Fortuitously, we had a patient who had an identical twin brother. We said, “This sounds like something for which we ought to be able to do a bone marrow transplant and get a cure.” That was one of the exciting first initiatives. The problem was that it did not work. There was somebody else who was interested in the interferons. So using alpha interferon was one of the first big initiatives, just because there somebody here who measured alpha interferon levels. We were able to figure out the dynamics of gamma interferon and alpha interferon. The initiatives were the function of the expertise and methods that were available for attacking AIDS. Some things you could attack; some things you could not. Again, we did not know it was a retrovirus, and, besides, there were not any antiretroviral drugs. Drug therapy was not a possibility until Sam Broder helped develop AZT [3'-Azido-2', 3'-dideoxythymidine], and those trials started in 1985 or 1986. The researchers started unsuccessfully with some drugs that did not work, and then eventually came to AZT.
Harden: I would like to ask one more question before we end the interview. From the patient's perspective, what did he see during treatment–a whole host of doctors crowding around him, or one primary care physician with consultants?
Masur: Most of the NIH people did not see the patients. Cliff Lane, Ed Gelmann and one of his Fellows, [Dr. Ronald] Ron Steis, and I saw all the patients and took care of them. If they needed an ophthalmology consult, Alan Palestine was particularly interested, so he would come and see them. If they needed a gastrointestinal work-up, Phil Smith would come and see them. So, we had our own AIDS service, which would act like any other service around here. The patients would see a few people as their primary people and then we would call in a consultant as needed. We quickly had an informal AIDS team rather than the traditional clinical services. Some of the patients were on Cancer Institute [NCI] protocols, some were on Allergy and Infectious Diseases [NIAID] protocols, and some were in critical care, so they were spread around, depending on where we could find a bed.
Harden: Thank you very much, Dr. Masur.
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