The First Mystery
During two harrowing years of investigation, James Curran (M.D. 1970) led the team of epidemiologists who defined the scourge that came to be called AIDS.
In the last days of May 1981, James Curran, director of research on sexually transmitted diseases at the Centers for Disease Control (CDC), was startled by one note in the endless stream of articles, directives and data that passed under his eyes each month. It came from a colleague, Mary Guinan, M.D., Ph.D., who had just seen data slated for the next Morbidity and Mortality Weekly Report (MMWR), the CDC publication that alerts doctors and hospitals to outbreaks of disease.
Curran was in San Diego for a national conference on STDs. He had been studying hepatitis B in gay urban enclaves, so he knew more than most straight people about sexual practices among gay men, and how they made the men vulnerable to infection. When he saw Guinan’s note, he thought immediately of the disease pattern he had seen with hepatitis B — a blood-borne virus passed from person to person through sexual contact.
The draft reported a rare pneumonia found in five young homosexual men in three Los Angeles hospitals. The cause of illness was a microbial parasite called pneumocystis carinii. All five men also had a fungus of the mouth and throat known as thrush, and a herpes virus called cytomegalovirus.
As Curran knew, these three microbes were quite common in human populations and normally not life-threatening. They caused serious illness only in people with weakened immune systems, usually transplant recipients who took immunosuppressive drugs to keep their bodies from rejecting new organs.
None of the five men in Los Angeles was a transplant recipient. None was known to have had immune deficiencies before. Now two of them had died. This was exceedingly unusual. It was the sort of thing that makes epidemiologists like Curran fear that a new disease is at large.
If so, and if the evidence pointed to sexual transmission, then Curran, as head of sexually transmitted disease epidemiology, would have to tackle the basic question that must first be answered in any outbreak of unknown origin: What is it? Not what causes it — the question of etiology has to wait. First, epidemiologists must detect the clinical nature and extent of the disease. That means answering these questions: What symptoms and signs define the problem? Is it actually new? Who has it? Who doesn’t? Where are they? In what groups? Starting when? Is it increasing?
Curran scribbled a note back to Guinan: “Hot Stuff …”
While still in San Diego, he spoke with physicians who worked with gay patients. They told him of similar cases in California and New York. Curran then learned that some young men with the rare pneumocystis pneumonia, or PCP, also were suffering from a skin cancer, usually lethal, called Kaposi’s sarcoma. It was not only very rare, but it normally struck only elderly men in Mediterranean countries.
A fatal lung disease and a fatal cancer. At first glance they seemed to have nothing in common. Except that both were associated with compromised immune systems.
Days later, back at CDC headquarters in Atlanta, Curran’s boss asked him to chair an inter-specialty task force to investigate. The appointment was to last for three months. Curran led the task force for the next 15 years.