Oncologist-turned-HIV researcher Dr. Paul Volberding, a member of the Mayo High School Class of 1967, will speak tonight in Rochester before his alma mater's 50th anniversary event.
Volberding was on the front line of early attempts to study HIV/AIDS and remains a prominent figure in that research community. Next month, he will receive the University of Minnesota's Distinguished Alumni Award for his global work in health care.
His Medical Grand Rounds Lecture in the Geffen Auditorium tonight will not be open to the general public, but in lieu of sneaking in, here are some of his insights into HIV/AIDS research 30 years after its discovery. His answers have been edited for length.
How did you go from oncology to HIV research?
When I was in high school, I had a great biology teacher who noticed that I had some talent and suggested that I go to St. Olaf's college for a national science foundation camp, summer of science thing. I went and really fell in love with the idea of growing viruses.
At the time, there was the thought — this was in Nixon's war on cancer — that viruses would be found to be the cause of common human cancers, and so a lot of people studying viruses did so with a background in oncology.
Literally on my first day (at the San Francisco general hospital), I saw the first patient with Kaposi Sarcoma, who had been admitted to the hospital. That was the very, very beginnings of the AIDS epidemic. And almost 50 percent of people in San Francisco had cancer as their presenting problem. So as an oncologist, there was plenty for me to do, and then when the virus was discovered to be the same type of virus I'd worked with all the way through med school and my fellowship, it made perfect sense for me to not just take care of the AIDS cancers, but to get really involved in finding treatments.
What has changed about HIV and AIDS in the 30-or-so years since you started your work on the disease?
The early days were really exciting — really terrifying and exciting because we learned so much so fast. I never imagined really having that opportunity. But horrifying because we had absolutely nothing to prevent the progression and death from the disease.
HIV without treatment is the most deadly infection in the history of the world. Ninety-eight percent of people die without treatment, compared to Ebola, which is 25 to 40 percent.
In a 1991 Post Bulletin article, you said an HIV vaccine was needed. Is that still a goal?
1991 was really almost at the worst part of the epidemic, when the numbers were still exploding, and we didn't have any effective treatments. I think we're doing a great job with making these drugs available in resource-limited settings. They're great for the treatment; they're great for prevention, but there's always the concern that even with the billions of dollars that we're spending, only 50 percent of the people are being treated in Africa. And at a time when there's a rise in nationalism and a concern about how the U.S. should be spending its money abroad, there's always a threat that with a rise in that kind of mentality, that if anything, we'll decrease our investment, not increase it.
So still, the frightening thought of the U.S. pulling back from its commitments makes us freshly interested in coming up with a vaccine. The problem has been — and it's really not a whole lot different than it was in 1990 — we're up against a real challenge because the virus is so … it's almost as though it's designed to escape a vaccine. It mutates quickly — if you put a vaccine in its way, it changes its structure so it evades the immune system.
What's a common misconception about HIV/AIDS?
I'm sure there are a lot, but one of the ones is that people think HIV has already gone away. In 1991, when I was at the clinic, it was still in the news all the time, and everyone knew about it; everyone was worried. Now, because it's really turned into a chronic disease, we think people can live a normal lifespan with HIV, with current treatments. It is just not as compelling a public discussion as it used to be.
What's the next step in fighting HIV?
In terms of HIV, I think the question that comes up now is, there's probably not many people who are going to make an academic career, you know, starting now, just taking care of AIDS patients in the United States. The job has been largely done. But I think there's still a challenge in developing better systems of care, especially in resource-limited settings like Africa.
I think there's basic science still to learn about relevant information for vaccines. There's a lot of excitement about finding a cure. We were able to find a cure for the Hepatitis C virus, and it now is amazingly easy. We can now cure almost 100 percent of patients with one pill a day for eight to 12 weeks. So we would love to be able to do that for HIV, and that's an area where there's still a lot of excitement.