Professor John Dwyer shares his work during the start of the HIV/AIDS epidemic during the 1980s for World AIDS Day.
“In 1982, the immunology program at Yale started seeing these men that we first heard about amongst people in New York. We heard that these men who had been having this terrible disease, which obviously saw that for some reason their immune system collapsing, and they were dying of all these opportunistic infections that normally wouldn’t and we didn’t know what was going on.
We just called it Human Immune Deficiency Disease. We didn’t know what it was. We all started collecting samples from these people and sending them down to The National Institutes of Health in Washington, where there was Professor Gallo, who was the first person to find in the lymph nodes of people with this strange virus, which he called the Human Immunodeficiency Virus or HIV.
It was an absolutely tumultuous time. I remember the hospital, we didn’t know what we were dealing with. We all wore masks and gloves all the time was around these patients.
When I got back [to Australia], one of the first things I did was to set up an organisation called the AIDS Society for Asia and the Pacific. And at that stage, working with people at the Red Cross in Thailand, we started to find HIV in great numbers in Thailand. And of course, the disease then spread rapidly through the southern hemisphere, particularly in Asia. And then the numbers started to really rise up. And when I first got back here [in Australia], we still had Prince Henry Hospital, which was out at Little Bay, and we set up a unit up out there to treat people with HIV.
Since most of these patients were we’re basically going into a hospice situation because we couldn’t do anything for them for a while, just to give them tender loving care and to study them.
But I set this unit up out there and I continued to work in about 12 Asian countries trying to convince them that that this was that they had to take this seriously. With more knowledge, came more discrimination. It was a terrible time. The disease was bad enough, but the discrimination and the fear were just terrible.
It was so sad to these people who, for so long we before we got the antiretrovirals that they were suffering and dying, and yet they were so discriminated against. It wasn’t many years before we knew exactly how the virus bound to the surface of these particular T cells called CD4 cells. And they normally and infected cells, whether they would have been killed by cells called CD8 cells, the killer T cells. We started trying to harness CD8 cells and see if we could grow them in the laboratory, see if we can stimulate them and give them back to the patients was very [difficult], we didn’t have the wonderful technology we have got today.
It was very difficult to do. T cells are made in a gland in your chest called the thymus gland. The thymus gland was destroyed by the virus, the virus would get into the gland and then destroy the only source of your T cells. So, we also started doing some research on whether we might be able to do a thymus transplant into these people. That turned out to be impractical because unfortunately, the virus was quite capable of killing any new tissue that you put in. But we did do a lot of work, and even after I left the unit, the Prince of Wales continued to do a lot of work with some Japanese scientists looking at how we might be able to harness these killer T cells to actually kill the virus, infected cells and again, that sort of fell away when the antivirals came through. It as much easier to give people the tablets than it would be to move to power cells and use cell therapy.
So the work didn’t proceed further than that. But we were desperate at the time to try and find something, anything that would slow this thing down. And the first initially we only had one drug and the didn’t take very long for the virus to become resistant to that one drug. It was really only when we were able to give people two or three different drugs at the same time that we got on top of it. And now really the miracle is that if one’s accurately diagnosed and managed, you should be able to live a normal lifespan with HIV because we can keep the virus under control.”
Professor Dwyer sharing his favourite patient memory at Prince of Wales Hospital:
“There was a Swedish filmmaker who came out to Australia to make a movie about HIV in Australia, and he came out to Prince Henry and was [filming] the work we were doing. But there was one patient there that had been there for quite some time. We all loved him; he was a very nice guy, and it was perfectly obvious that he was he was going to die shortly.
We couldn’t help him. And this one morning I went to see him, and the camera was there. He was quite happy about that. He was talking and he said to us, “I’m glad the camera’s here today because I won’t be here tomorrow”. He said, “I think I’m going to die today”. And I put my arms around his shoulder, and I said, “If you die today, you will be alive in our hearts tomorrow just as you are today. But that that day he did die, and he knew he was dying. He died. So that’s a fond memory I have.
But overall, in terms of my own growth as a person and as a physician, I learned a heck of a lot from this [HIV/AIDS epidemic]. And I feel privileged, in fact, to have been able to work around the world on this problem. It was a good time to be an immunologist.”