Dr. Arthur Ammann
Dr. Arthur Ammann has been at the forefront of pediatric AIDS research since the epidemic began in 1981. Here, he recounts his early discoveries and how pediatric AIDS has changed his life.
Introduction to medicine and HIV/AIDS
It actually happened in college when I realized that my declared major of mathematics was not exciting. I switched to biology in 1958, focusing on the immune system because there was not a lot known at that time. After graduating with a Bachelor of Science degree, I went on to medical school.
I continued my interest in immunology at Seton Hall College of Medicine and Dentistry, now the New Jersey Medical School, where I decided to focus on pediatrics and genetic deficiencies of the immune system.
Following a fellowship in immunology, I accepted a position at the University of California, San Francisco Medical Center in 1971 as professor of pediatrics and director of pediatric immunology. We performed bone marrow transplants to cure diseases, and I developed a pneumococcal vaccine for children, which was FDA approved in 1976. We were gaining confidence that we could manipulate the immune system to protect individuals from disease.
Afterward, I established the first laboratory in Northern California to evaluate the immune system. In 1981, Dr. Paul Volberding and Dr. Marcus Conant asked me to study young men who might have a new syndrome called AIDS. Doctors were seeing young men with cancers, fungal infections, and blood disorders. It was then that I realized that these young men had something seriously wrong with their immune systems. Doctors in California and New York were seeing the same thing -- it was the beginning of the AIDS epidemic in adults.
In 1982, I was asked to consult on three infants who were suspected of having immunodeficiency. When I got the laboratory studies back, the results were identical to the men with AIDS. I determined that these children had AIDS. The questions became, “How did they get it?” The mother of two of the children was a prostitute and an intravenous drug user. The third infant was a two-year-old who had more than 20 blood transfusions in the intensive care nursery. By early 1982, the three majors means of transmission were identified -- sexual, blood, and mother-to-infant. Those were the first children reported with AIDS. That changed my whole career path.
Elizabeth Glaser and the Pediatric AIDS Foundation
There was not a lot of funding from foundations or the U.S. government for research into pediatric AIDS at the time; what little there was focused on the adult epidemic. When Elizabeth Glaser found out that there was virtually no research into pediatric AIDS, she asked Michael Gottlieb, who had discovered AIDS, to put her in contact with someone who knew a lot about pediatric AIDS, and Michael introduced her to me.
I think Elizabeth was responsible for making the biggest and fastest inroads into getting attention to the pediatric AIDS epidemic. She was personally invested in seeing things happen -- she was HIV infected, as were her two children, Ariel and Jake. One of her quotes was that “AIDS does not discriminate.” She had the unique ability to break through the stigma and to get influential people to listen.
When I joined the Pediatric AIDS Foundation (PAF), my role was to set the PAF research agenda and to link and recruit HIV researchers to focus on pediatric HIV. We held a series of more than 20 think tanks with most resulting in funding specific to pediatric HIV. We focused on how to prevent HIV transmission and how to get new treatment to infected children more quickly.
Elizabeth always asked me if the research we were doing would help children but also herself. I was with Elizabeth when she took her first dose of a new protease inhibitor, but it was too late in the course of her infection. Much like Ariel who got AZT too late, it didn’t come soon enough to save her life.
I especially remember Cathy Wilfert, a pediatrician from Duke University. She was tenacious. She felt that if we gave the HIV drug AZT to pregnant women, we could prevent transmission to infants. She persisted, and she was right. Then we wondered about the rest of the world. With new treatments, infant infections dwindled to fewer than 200 per year in the United States, but in the rest of the world, there were 1,600 infections a day.
In 1999, a group from Johns Hopkins University and Makerere University Medical School in Uganda reported that a single dose of nevirapine (another HIV drug) given to an HIV-positive mother and her infant could prevent 50 percent of infections in infants. With leadership from my organization, Global Strategies, the International AIDS Society, and the Elizabeth Glaser Pediatric AIDS Foundation, a “Call to Action” was launched to advocate for accelerated access to antiretrovirals for pregnant women to prevent transmission to their newborns (PMTCT) and to raise the initial funds to put into place the first international sites to implement PMTCT. The program began with an initial $1.1 million of support and a subsequent $15 million contribution from the Bill and Melinda Gates Foundation. It launched the Elizabeth Glaser Pediatric Foundation into a global initiative that has screened more than 20 million pregnant women for HIV infection and offering of PMTCT services.
Elizabeth always said, you start, but you have to keep pushing. We needed people like Elizabeth to get to this point.
The Future of HIV/AIDS
Right now, we know enough to stop the pediatric HIV epidemic. Answers are not the obstacle -- we have them but are not implementing them even though we know what to do. Now is the time to make certain that every single pregnant woman gets tested, and if she is infected with HIV, ensure that she gets treatment -- not just to prevent HIV infection of her infant, but also to treat her own infection. And we need to move upstream to protect women from getting infected to begin with. At this point in the epidemic, 20 years after we learned how to prevent HIV transmission, we have no excuse for failing to end the pediatric HIV epidemic.
Let’s do it. It’s not complicated.