The AIDS Warrior
By Maureen Nolan
When Dr. Martin Hirsch ’60 visited hospitals in Boston and New York in the mid 1980s, beds were filled with young patients wasting away from a disease their doctors couldn’t beat. They can save those patients now, in large part thanks to Hirsch. He’s an acclaimed virologist whose studies of combination drugs in the treatment of HIV/AIDS have revolutionized the field.
Hirsch’s lab was part of the Massachusetts General Hospital and Harvard University Medical School, where he served on the faculty. Throughout his research career, Hirsch also maintained a clinical practice. As a teacher and mentor, his influence has been profound, though he may be as proud of the distinguished physicians he’s trained as he is of his own work. Among them is prominent AIDS researcher Dr. David Ho, whose many honors include being named Time magazine’s 1996 Man of the Year.
These days, Hirsch is editor of The Journal of Infectious Diseases, edits for the online textbook UpToDate, and serves on a number of committees at the National Institutes of Health (NIH) and Harvard. Here is some of what he had to say recently about his remarkable career.
How far along were you in your career when the HIV/AIDS epidemic emerged?
I spent the first 10 years before AIDS basically doing work on other viruses, one particularly called CMV or cytomegalovirus. We had shown that cytomegalovirus could suppress human immune responses, and when the AIDS epidemic came along, one thing that was notable was that all the patients had CMV infection. I had my first aha moment — which turned out to be wrong, like most of them — but it was that CMV caused AIDS. So I got into that field shortly after the first reports appeared in 1981, saw my first patient with AIDS that same year, and got my first NIH grant to study AIDS shortly thereafter with the hope we could show that CMV was the cause of it. But, as it turns out, CMV wasn’t the cause, but it got us started in doing research in AIDS. For the next 30-plus years, that’s been the major focus of the work that I did.
What was an “aha moment” that proved to be valid?
It was a devastating disease — it was an awful period for a lot of people — but it was also a very exciting period to be doing research. Virtually everything that we did had never been done before. For example, we showed pretty early on that the virus was secreted in male semen and in female genital-tract secretions, and that was a novel observation and validated the theory that this was a sexually transmitted infection.
We also showed early on that the virus could be isolated from spinal fluid, and that it could cause neurologic diseases in addition to the immunologic diseases. Those were all early observations that turned out to be important in the scheme of things.
Do you remember a point where you thought, “We’ve turned the corner; I’m glad I spent much of my professional life doing this?”
Well, there were several. The first was in 1987 when the first effective drug, which we don’t use anymore, called AZT, was shown in trials to have some effect on the virus. I remember there was a great deal of excitement. I was on Tom Brokaw’s NBC [Nightly] News saying that we’re on our way, and that even though this wasn’t the panacea, it was a beginning. Then, of course, when the combination drug trials were finally shown to be beneficial, it was very exciting for everybody. The next big thing would be if we ever had a successful HIV vaccine, but I don’t think we’re quite there yet.
Do you think we will be there some day?
When the virus was discovered in 1984, Secretary of Health Margaret Heckler announced that within a couple of years we’d have a safe and effective vaccine. I can’t criticize her because that was a reasonable thing to say. But we’re now, what, 34 years later, and we don’t have it. I don’t think we’ll have it for the next five years, anyway. Whether we’ll have it in 10 or 15 or 20, I don’t know.