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How HIV causes disease 1: identification and characterization of HIV

Part 1 of 2
Published on August 29, 2019   35 min

A selection of talks on Microbiology

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0:00
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.
0:32
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.
1:22
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.

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