By Karen Ocamb
Photo by Linda Mason

(Editor's note: This is the first in a series of interviews leading up to June 5, the 25th anniversary of the first report published in the Centers for Disease Control's Morbidity and Mortality Weekly Report (MMWR), marking the official start of the AIDS epidemic. Dr. Michael Gottlieb, then a 33-year-old assistant professor and immunology researcher at UCLA, was the lead author of that 1981 report.)

In the late 1970s, post-Stonewall sexual freedom was at its zenith. There were no restrictions and no one worried about sexually transmitted diseases -- just line up for a shot of penicillin from Hugh Rice at the Gay Community Services Center's STD Clinic. But in 1979, Rice noticed that some men looked painfully thin and one man showed up with spots that turned out to be Kaposi's sarcoma. Later, Rice realized they had Gay-Related Immune Deficiency (GRID), the first name given to the mysterious illness that would later become known as AIDS.

"He was probably right," Dr. Michael Gottlieb told IN Los Angeles magazine. "I have a patient who probably became infected in 1978, and we know in retrospect that the virus was in the U.S. as early as 1977 and we know there was a case in the Congo in 1959. So the irony is that this viral illness from central Africa was discovered in 1981 in Westwood. But, in fact, it had been on U.S. shores since 1977 and was just kind of a stealth epidemic for four years in small numbers, but here undetected."

Gottlieb's first patient with the mysterious illness came to him through the UCLA emergency room in November 1980. "I was relatively new on faculty and I wanted to teach some of the interns and post-doctoral fellows in immunology," Gottlieb said. "We asked one of the residents to see a patient -- any patient -- who might have a disease with an immunologic feature. He let us see our own 'Patient Zero.' The patient had fevers and weight loss and then there was this distinctly uncommon Pneumocystis -- this bizarre organism filling up the air space of his lungs.

"Once that patient was diagnosed with Pneumocystis carinii pneumonia," Gottlieb continued, "word spread through the grapevine to doctors in the community. That's when I met with Joel [Weisman, a West L.A. internist] and he referred two more patients who had weight loss and fevers. And we diagnosed those two patients with Pneumocystis. We also tested their T-cells, because having Pneumocystis implies there's some T-cell problem, and discovered the now characteristic depletion of CD4 cells. At that point, early in 1981, we had three patients, three gay men in their early 30s, with Pneumocystis -- and we all had the queasy feeling that this was not going to be rare.

"We also knew from the experience of Joel and others that there were many other gay men with enlarged lymph glands and other milder unexplained illness," Gottlieb said. "That lead us to believe that something peculiar was going on. But if anyone back then had predicted that four case reports in 1981 would become 40 million people infected worldwide -- they would have been considered mad."

Gottlieb and his colleagues didn't know the cause of the mysterious illness, but they had suspicions. "We had an uneasy feeling that this was an infection," Gottlieb said. "Why was this happening in gay men, patients known to have an increased prevalence of sexually transmitted diseases? And of course these patients had fevers. From the perspective of an immunologist, a viral infection seemed a possibility. But some common exposure to a toxin or to radiation had to be considered also. At least in those first three patients, none had a common exposure that we could establish to anything immune suppressant. They hadn't had a common radiation, didn't know each other, they hadn't used drugs in common that were identified -- poppers or anything else.

"So what was it about being gay, about their sexual preference? One of the commonalities was the high rate of STDs. And when the first three patients were all gay men, a possibility of sexually transmitted infection had to be considered as a leading possibility," Gottlieb said.

On April 4, 1981, Gottlieb called the editor of the New England Journal of Medicine to report a new epidemic. "I can remember sitting with Randy [Shilts] in a little coffee shop in Westwood -- it feels like yesterday -- telling him this story," Gottlieb said. "And Randy's account [in the book And the Band Played On] is all true. However what Randy left out -- it might have been my fault -- but the editor said, 'You should call the CDC. That's the way to do it.' I frankly hadn't thought of that. What the editor was saying was -- we're a peer review journal. We're not a newspaper. We're not the early warning system. The MMWR is the early warning system. And that's what you should do.

"I called this fellow [Dr. Wayne] Shandera, the CDC's man in Los Angeles. He was the epidemic intelligence service officer. I knew him from Stanford and I knew him personally and I said, 'Wayne, are you aware of unusual illness going on in gay men in L.A.?' And he said, 'No. But I'll look into it.' He quickly found a fifth case on his own. He and I wrote up the cases and he communicated with the editor of the MMRW who agreed to publish our cases. Frankly, if not for the suggestion made by the editor of the New England Journal to call CDC and publish in MMWR, it's quite possible that my name would never have been the first name associated with the new disease."

That report on June 5, 1981, prompted others. On August 28, 1981, The Associated Press reported: "Two rare diseases have struck more than 100 homosexual men in the United States in recent months, killing almost half of them, and a medical study group has been formed to find out why, the National Centers for Disease Control said today."