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My name is Bruce Walker; I'm a professor of medicine at Harvard Medical School and
at Massachusetts Institute of Technology and
the director of the Ragon Institute of MGH, MIT, and Harvard.
I'm a physician-scientist and have been
involved in caring for patients since the very beginning in the epidemic
and involved in doing research, also, to
learn from those patients ever since I finished medical school.
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I want to start this talk by connecting it back to the patients that were really
the harbinger of what was to become the global HIV epidemic.
This is really my own personal experience.
My first experience with this disease was when
I was working in the emergency room at Mass General Hospital.
A 19-year-old man was transferred in from
a chronic care hospital where he was being cared for tuberculosis.
He had profound weight loss, had been diagnosed
by detection of tuberculosis in the sputum, and was on therapy
at this chronic care hospital when he had
an acute change in mental status leading them to
the presumptive diagnosis that this was
probably pulmonary tuberculosis with TB meningitis.
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When the patient arrived in the emergency room I began to work him up and
as the data started coming back we were really quite shocked.
It turned out that he didn't have tuberculosis at the brain as we had expected.
But, rather, he had a mass lesion which results mainly shown to be lymphoma which was
very rare occurrence unless somebody was on profound immunosuppression.
Moreover, as we investigated his lungs,
he didn't have tuberculosis but he had multiple tumors as well as pneumonia.
The tumors ended up being caused by Kaposi's sarcoma.
Now, to me, this was really something unusual.
I had a few months earlier seen a patient who had
Kaposi's sarcoma and was told by the physician in charge of the ward where I
was working that Kaposi sarcoma was typically seen in men of
Mediterranean descent and was usually a skin lesion.
But, here, it was in a young man not of Mediterranean origin and it was in his lungs.
Moreover, pneumocystis was something that had really only been encountered in the context
of cancer chemotherapy to my knowledge and here it was in this young man.
As we further worked up his abdomen he didn't have tuberculosis there either, but had
multiple tumors that were also Kaposi's sarcolemma and
he had disseminated CMV infection of the colon.
So, essentially, cancers and
infectious diseases, all the same time, a life-threatening and they rapidly die.
