2.1 Paul Volberding — The First Patients

Paul Volberding: [00:00:00] Great. Well, it's a thrill to be here, look around the room, and lots of very important people that did so much with this epidemic. Thanks especially to Bob [Gallo] for inviting me. Heard about this I think about when I was giving a talk for you in Baltimore earlier this year. We heard a lot of elegant science last night. [00:00:30] We're going to start with some non-elegant clinical observations. But as a clinician, I'd say that as really thrilling is we heard the science last night for those of us taking care of these early patients, it was I think, equally thrilling and just as stimulating and surprising. 

I think we go through medical training—maybe not so much now, but we did—expecting things to be incremental. [00:01:00] We would learn somewhat more about the diseases that we already knew about. We would do a better job in treating and diagnosing them. But until HIV came along, I don't think any of us were really trained to expect that something is as sudden and revolutionary as we saw was going to happen.

I'll be personal because that's what I know best. I'll talk too much about myself, but I think that's what I was invited to [00:01:30] do. Everything that I say could have been said by any other clinician in those early days and Mike [Gottlieb] has given a nice start to that. This disease erupted in 1981 and 1982 in a way that we couldn't have predicted. I think there were many acts of brilliance and courage. I'd like to just talk a little bit about some of [00:02:00] those early days. 

A little bit about me. I was born on a dairy farm in Minnesota. My first inclination to do this came when I went to an NSF sponsored summer science camp when I was 16 at St. Olaf College. Heard about some weird thing called cell culture, tissue culture, immortalized cell line and I just found it, for some reason, really amazingly interesting, this [00:02:30] idea that you could grow cells outside of organisms.

Then I went to college at the University of Chicago and to help put my way through school, worked in a virology lab. Marc Beem (1923–2014) was doing pediatric diagnostic virology and research with rhinoviruses so my first NSF grant was to work with neutralization of rhinoviruses. During that time [00:03:00] there was a lot happening in the streets. This was '67 to '71. The lab for me was an amazing refuge from a lot of chaos in the rest of the life. It'd go from the lab to the sit-in at the administration building the same day.

I think the slogans in the street, "The Whole World Is Watching" really was a good model for what we, and not just me, but everyone in the room has done. [00:03:30] I think we knew from the start, pretty early in this epidemic, that what we were doing at some level was historic and that people would be looking back and seeing what we did. It's interesting there were a couple of historians in the audience today and I think at some point people will really look back and I hope knowing that we behaved in a way that that will bring credit to the future.

I went from Chicago to [00:04:00] Minnesota for med school. Again, decided to work in a lab. Worked in a lab with this young guy, Charlie Moldow, who had a Rous sarcoma lab. So my first work with retroviruses was all through med school and when it came time to choosing a fellowship, Charlie was a college friend [and] a close friend is Stuart Levy (1938–2013), Jay [A. Levy]'s identical twin, and Jay was working with an interesting xenotropic virus. So I went [00:04:30] to UCSF (University of California San Francisco) in 1978 mostly to work in Jay's lab. This is a photo of me with hair from those early days.

But something happened along the way. San Francisco General Hospital (SFGH) became really a favorite place for me. We rotated through the university hospital, the VA , and San Francisco General Hospital. I was really [00:05:00] completely impressed by the sense of dedication, the mission of the place really a great public academic hospital and I loved working there and I began, began to really like clinical medicine. 

I'd have to say all through med school and during most of my residency, I didn't really enjoy it that much. I liked going into the lab, but I found myself really spending more and more time in patient care, and I knew that in the [00:05:30] laboratory if I was choosing to spend more time in patient care, there was a message there that at that maybe my career choice, wasn't going to stay the way I thought.

Another distraction was Molly [Cooke, MD]. I met Molly, my wife, right away during my fellowship. Molly was, still, is a brilliant clinician, and [00:06:00] I found myself kind of, "Do I want to go to the lab, or do I want to go hang out with Molly?" I found myself choosing the latter. About that time, I was invited to look at a clinical job and I thought, "Yes, maybe that's more for me than I thought."

The other reason to show Molly is that—and Mike [Gottlieb] and I had this discussion earlier, I'm sure every clinician in the room, Bob Redfield, if he's here this morning. [00:06:30]—Molly was a chief resident, and chief residents in medicine are selected by their peers and by the leadership because they are great clinicians and great teachers. Molly was a chief resident at SFGH from 1980 to 1981, serving under Merle Sande (1939–2007)—more of him in a minute—and with [Henry F.] Chip Chambers who later would go on to work for his own ID (infectious disease) career, but they would hear the most [00:07:00] interesting case of the day before in the morning report, where the residents sit with the chief of medicine, hear the most interesting cases.

During that time period, the most interesting cases were often gay men with unusual infections. Time after time and finally—and this was before Mike's paper (1)—no one really put it together but soon when they started hearing a case, they would just say, [00:07:30] "It's a gay man." They knew the setting of these cases. I remember Molly told me a story at the time that a young man with CNS (central nervous system) toxo (toxoplasmosis)—and Molly had trained at Stanford. She had them send the slides to Jack Remington (b. 1931), who said, "Oh, you fucked up as usual. This can't be. It must be a mistake."

I think it shows, first of all, we have blinders that we don't quite see. We were [00:08:00] seeing these cases, didn't appreciate until Mike [Gottlieb] came along that there was really something that was unifying them and we weren't prepared for something really new. We wanted everything to fit the way we thought it should fit. Merle Sande. Merle, close friend of Warner Greene, my colleague here in the audience. Merle came to San Francisco General as chief of medicine in 1980 [00:08:30] from the University of Virginia and hired me. I was offered a faculty job to start a division of oncology. There hadn't been an oncology division. He had hired me right out of my fellowship. This is something that doesn't happen in medicine.

I started and as I remember, and I've learned to distrust memory quite a bit, but as I remember John Clark, one of the other attendings, [00:09:00] who had been coming over to the General from UCSF said, "Paul, there's the next great disease waiting for you: Kaposi's sarcoma." I didn't really listen to him, but it was true.

Merle was, from the whole epidemic, amazingly supportive. He'd let me break all the rules. It all worked out, but he was [00:09:30] also really supportive of things like starting the world's first AIDS' in-patient unit and insisting that it not be a segregation kind of isolation unit, but at that it'd be a regular open ward. Even at a time when we didn't really know anything about this and what the disease was and how it was transmitted. His ethic was really very strong.

This is my first patient. So I was [00:10:00] recruited to start an oncology division, I land at the hospital on July 1st, 1981. I was incredibly well trained in retrospect for what we're going to be seeing. I knew something about retroviruses. I'm an oncologist, I know about patient care, I know about team care, I know about palliative care and for the first years of the epidemic, that's what it was. We were doing palliative care.

My first patient [00:10:30] was a 22-year-old man, had been estranged from his family from the Deep South. Like a lot of the early patients, was very sexually active and came to us with obvious disseminated Kaposi’s, wasting disease, multiple opportunistic infections, and obviously, died quite quickly. The thing that I remember mostly though is that it challenged us, because my [00:11:00] cancer patients at the General [Hospital], even if they're poor recent immigrants, typically had a family of some usual sort at home to help in their care, and the early AIDS patients didn't have that. When we were thinking, "How can we do this?" We immediately started working with the gay community, which had organizations from before and new ones that started that helped us in this work, the model of care was really solidly community-based. 

It was also a time when we [00:11:30] put together multidisciplinary teams. Connie Wofsy (1943–1996) is often not remembered adequately. I was the oncology, she was the infectious disease balance. Connie was one of the first people to really focus on prevention, especially in sex workers, HIV in women at a time when most people didn't think it existed—and tragically died of breast cancer really just before the Vancouver AIDS conference. [00:12:00] Never really saw what happened. 

Donald Abrams came. Donald came from Harold Varmus's lab, where I think, like me wasn't very successful in the lab, but was interested even then in persistent generalized lymphadenopathy. [He] is a gay man who had seen a lot of patients with lymphadenopathy when he was in his residency, now well known as a precursor clinically to HIV. [00:12:30] 

The multidisciplinary nature of this work was something that we were really committed to and still is an important aspect in almost every AIDS clinic in the country. 

This is a shot of our facility, San Francisco General Hospital. Now, the Zuckerberg San Francisco General with a generous Facebook donation by Mark Zuckerberg and Priscilla Chan, but the hospital, it's not fancy [00:13:00], at least it wasn't then, but our clinic was the sixth floor of Building 80 and that's what you see here, red brick building, and it was the top floor.

We were given space, empty space to start a clinic. We moved into there in January 1983, the first AIDS clinic in the world and it quickly grew. We were blessed with political [00:13:30] support. Jim Curran was very involved in working with us in the health department. Mayor [Dianne] Feinstein was very supportive, and we grew really exponentially in the first years of the epidemic. Again, the focus was team care. We talk now about interdisciplinary interprofessional care, that was just what we did and I think it was true in AIDS clinics across the world.

What was [00:14:00] the disease like? It's impossible. The house staff today, the trainees today in medicine—HIV is more remote to them in its early days than polio was when I did my medical training and already by then, polio, polio vaccine was truly ancient history. Never saw a case, of course. It's important to remember how devastating and [00:14:30] stigmatizing this disease was. It still is stigmatizing, but in these days, this is a patient with Kaposi's sarcoma.

In a typical clinic, patients become very well known to the staff. They know them like family members. Some of these patients with KS, the KS causes an obliteration of lymphatic drainage and they would come from one clinic visit to the next, suddenly, their faces swollen with lymphedema, their eyes shut with Kaposi's, their ears obstructed. They couldn't hear, they couldn't [00:15:00] see and they often weren't recognizable by the staff. KS had a predilection for the face. The tip of the nose was one of the most common sites of presentation.

So the first thing a person would see in looking at you would be your KS. Patients felt stigmatized, even in the gay community, and I've had many patients say that they felt looked at when they were outside. The only social activity [00:15:30] some of them would engage in was going to movies at night, so no one would really notice them. Horrible disease, lots of stories. The patient with PCP (Pneumocystis pneumonia) on rounds, who was so desaturated [of blood oxygen], that when we took the oxygen mask off, instantly he turned blue. And put it back on, he looked good. And when he put the mask on, he said, "I want to go home. I insist on going home." [00:16:00] If we let him go home, he would have died on the way down the hallway. What do we do with this, with trainees? We gave him some morphine to help him die  because that's what we had to do. So it's stories like that.

Another patient of mine with a very brilliant past history in art came in the clinic one day, his underwear was soiled with feces [00:16:30] and he couldn't understand why at the gym they kicked him out because he was washing his underwear in the sink. He'd become demented from this disease.

We had one clinic where—it was the CMV (Cytomegalovirus) retinitis clinic, but the CMV was a disease that happened in the very advanced stages of AIDS when patients were also often demented. We'd see demented, blind patients being led to clinic by their friends. Horrible disease that [00:17:00] I hope people can try to remember. Kaposi's in the mouth. 

The other memory I have is that Molly and I were both taking care of patients. Molly still is a very active AIDS clinician and we were having our family. Alex, the guy in the middle, was born in 1981. Ben was born in '84. By the time Ben came along, we knew the name of the virus. Emily was born in '87 [00:17:30] after we had AZT (azidothymidine). Our kids grew up. AIDS was the extra member of the family. But what I really remember about this period is that we didn't know what was causing this disease. My recurring nightmare was that I had given it to my kids. My nightmare wasn't that I had it, was that I'd given it to my kids. Molly and I have a good relationship, but it was so much anxiety, we really couldn't talk about it. We didn't ever talk about not talking about the anxiety. [00:18:00] When the virus is identified and the diagnostic tests were quickly available, I was one of the first people to volunteer to be tested and was obviously hugely relieved to be negative. 

We applied an academic approach. We were in the university. This is our iceberg slide. Every everyone lecturing in AIDS had an iceberg slide. Tony [Fauci], I'm certain you did. We were beginning to get a sense [00:18:30] of what the spectrum of the disease was. But nothing prepared us to think that everyone that was positive would die of AIDS. This almost 100% mortal infectious disease.

And you saw, I think, a version of this last night. We were trying our best, we were groping to find some answers to this and this is a slide that I did well before PowerPoint. I think this was done with Harvard Graphics or something [00:19:00] like that with cameras on a wooden board and we were guessing. 

Just to end with a couple of thoughts, this is now AIDS Clinical Trials Group (ACTG) protocol 019, Doug Richman will remember, was a ACTG (AIDS Clinical Trials Group) trial where we looked at AZT versus placebo in asymptomatic people with HIV infection. We were attacked pretty aggressively by both sides, both [00:19:30] by people that wanted the hope that AZT offered and didn't want placebo and people that didn't want AZT because it was considered to be a toxic drug.

There's a lot to say about activism. We'll hear about that from Mark [Harrington], but I just wanted to give a shout out to Martin Delaney (AIDS activist, 1945–2009), who I rarely argued with, a couple of times, but Martin was the head of Project Inform and really was somebody [00:20:00] who believed immediately that information would help us in this pretty bleak period. His name lives on in the cure efforts that the NIH is supporting.

I've tried to cover quickly, very personal perspective but I have to say it's just an amazing privilege to have been present both at the start of the epidemic, we're not exactly sure the rainbow is here yet but I think of this [00:20:30] as an arc and now we're very interested in maybe a vaccine, I hope a cure, and public health measures that really are having successes again, as we heard last night. So thanks and I hope we have some time for some questions.

Mike Gottlieb (Moderator): I'm informed that we have 10 minutes for questions. [00:21:00] Yes. Of course, yes.

Paul: There's a wandering mic too, I think.

Wasif Khan: Wonderful talk. I just wanted to ask: you talked about Kaposi's but various malignancies and opportunistic infections are common. Does the frequency of any of those lend us information about, other than T cells which might be [00:21:30] responsible for or HIV affects other cell types and other tissues or systems in the body which actually lead to the higher frequency, what's the frequency of Kaposi's, for example? What's the percent?

Paul: Really interesting question that came up last night in response to John Mellor's question about HIV and malignancies in the setting of HIV where [00:22:00] we have these infection-related cancers, KS is the obvious one, where the virus that causes KS, HHV-8, can do so without HIV but rarely does [DL41] and the disease with HIV is a very different one. I think that the interaction between the viruses, whether it's the virus or the immune system, I'm sure probably both. That's interesting.[DL42] 

I also find it interesting that if there's this clonal proliferation we don't see direct HIV malignancies [00:22:30] we haven't yet at least, but there's an interesting thing it's kind of a tangent to your question that in the early epidemic and gay men and KS is pretty much only seen in men who have sex with men and HIV. There was a lot of it. But even before we developed antiretroviral drugs, the fraction of people with initial AIDS with KS decreased. There was something about that early wave of HIV [00:23:00] that especially was associated with Kaposi's sarcoma. I think it's a very dynamic situation and still, I think we have a lot of questions to answer.

Audience 1: There's another question back there.

Paul: Warner.

Warner Greene: Paul, obviously HIV has introduced a barrier of latex between the patient and the physician, universal precautions are now de rigueur. When you were seeing [00:23:29] your first patients, right at the very beginning, before there were policies or procedures, et cetera, how did you approach that? What type of precautions did you take, if any? Zero.

Paul: None. There was a feeling that if you're doing an arterial draw, measuring oxygen. It's a tricky thing technically and you want to feel the pulse and you put the needle in right under your finger so you can feel right where the artery is. These are small arteries. [00:24:00] We felt, you can't wear gloves and do that. Another thing that I've thought is that my dentist, dentists never wore gloves and now the idea that a dentist would put his or her fingers in your mouth without clothes, it's repelling.

I didn't wear gloves, I never wore a mask. I remember—this is a serious tangent, I remember being in an autopsy room, [00:24:30] my first patients where they're opening his cranium with a bone saw. They're sucking out his thoracic cavity with a rubber tube that went into a high faucet, you know the type spraying bloody water into the sink and with bone chips in the air. And I did kind of at that point go, "This might not be safe."

[laughter]

We didn't do anything. It really made me—[00:25:00] When I was tested negative, having worried about it for a long time I said, we can safely say that this is not casually transmitted. It is not or we would have been infected.

Mike Gottlieb: Let's get Susan first. Susan.

Susan Zolla-Pazner: I'd like to talk about 1981 and this is 1981 in New York when we were seeing mainly Kaposi's patients. [00:25:30] I was called by Alvin Friedman-Kien…Alvin Friedman-Kien was a dermatologist. He had four patients with aggressive Kaposi's sarcoma. [00:26:00]  Several of his patients were being seen by Linda Laubenstein (1947–1992) who was a real hero in the early days of the epidemic, a clinician who herself was quite ill and quite deformed. Anyway, Alvin suspected that these patients had some form of immunodeficiency, and since I was the only person in the NYU complex who in addition to doing research was running a clinical immunology lab, he asked me to work up these patients [00:26:30] and they had no OKT4 cells (T-helper/CD4+ cells), as we called them then, lots of OKT8 cells (cytotoxic T/CD8+/killer T cells) and by the early fall of 1981, we had 20 patients with Kaposi's sarcoma. Of course like every lab we were using the techs in the lab to draw blood to do the normal controls. I said, "Wait a minute, this is not the right control group." I called Dan William (1946–2008, prominent gay physician in New York) who had been [00:27:00] an infectious disease fellow at the VA and had a gay practice in New York.

I said, "Dan, we've got 20 patients with Kaposi's sarcoma. We need four specimens from 40 healthy age and race matched volunteers." Within a few weeks, we had 40 volunteers. We didn't have to go through IRB at that point [00:27:30] and in December of 1981, I sat down with my fellow Ross Tall to go over the data of these 40 volunteers. We found that a third of them to our utter astonishment had the same reversal on CD4 to CD8 ratio, and it was the first indication. Chilling, chilling, I still get chills when I talk about it, that a third of the gay population in New York was headed [00:28:00] in the same direction. That for me was a turning point in understanding the enormity of the catastrophe that we were facing.

Paul: I forgot to mention that on my first day with my first patient, my first-day fellow had just—Ray Stricker had just come to San Francisco from St. Luke's Roosevelt in New York and said, and this is two weeks before the first report anywhere of Kaposi's said, [00:28:30] "I think we had some of these patients in New York." This networking that happened in those early days, this is before the internet.

Mike: Thank you, Susan. Bob, and then Jeff.

Bob Gallo: Just wanted to say that it was not just in the clinics but in the laboratories. When we first started out there was a microbiology departmental head in New Jersey named [unintelligible 00:28:50] subsequently died, suicide. He was telling me when I was thinking about this after listening to Jim Curran's talk that this was [00:29:00] insane, that we'd kill ourselves that we'd kill people, etc. But the risk factor is that the epidemiology people were describing—and you guys, I guess, at the same time—made us just say: just don't use glassware and just don't use needles, use plastic.

That's the only precaution we used. Yet—to close with this—not in my lab thankfully but there were three—I don't know if it's ever been published—but there were three lab workers that were infected. This certainly in and of itself was probably more than Robert Koch [00:29:30] ever had. This was during the early [Peter] Duesberg (b. 1936, prominent HIV/AIDS denialist) years too. One was infected with a clone, perfect clone came from our lab. It was being mass-produced at Frederick [National Laboratory for Cancer Research, FNLCR] and the technician had an accident with a centrifuge. 

You know the story? Went all over the place and he apparently had some skin abnormalities, I don't know exactly what, and he cleaned bare-handedly. He died relatively rapidly with the clone of the virus. [00:30:00] It was certainly quite [crosstalk] was a contract—

Paul: We heard about that case.

Bob: [crosstalk] at the time. I'm not positive. Then there were two others, and Bill Blattner, my colleague, was following some. Tony [Fauci] will know about this, but I thought it might be mentioned. We know of at least three laboratory workers who died as a consequence of this way, and who must have been given extremely poor instructions. Can you imagine mass production of a virus in a centrifuge, what he was exposed to?

Mike Gottlieb: We have time for one more question, [00:30:30] Jeff.

Jeffrey Lifson: Just real quickly, last night I think a good case was made that a lot of the groundwork that had been done in animal retrovirology and development of techniques set the stage and represented a fortuitous interval for this new disease caused by a retrovirus to turn up and that facilitated early progress. I just wanted to make the point that I think that the same thing is probably true on the immunological side of things as well. I started working [00:31:00] on HIV in 1982 at Stanford. I joined Ed Engleman's lab (at Stanford) because I was interested in doing human immunology. That was a time when Ed and his colleagues had just described some of the first monoclonal antibodies, at that time a relatively new technology, that differentiated human T cell subsets. I was interested in using that approach to study human immunoregulation. I've taken about a 35-year detour from that objective, [00:31:30] but been involved in HIV/AIDS since then. I think that technology, and antibodies, and immunology, and flow cytometry that existed at that time also helped us to make practice much more rapidly than we might have, otherwise.

Paul: Oh, yes, going back at Mike [Gottlieb]'s early finding where, right from the start, we knew that there was a T cell subset deficiency. I was not one who immediately knew that this was going to be a retrovirus. [00:32:00] Some did, but apparently--

Mike Gottlieb: That was lucky because John Fahey's (b. 1924) lab [at UCLA] was right across the hall from [crosstalk] office. That's how it happened. Thank you, [00:32:09] Paul.

Paul: Thanks.

[applause]

[00:32:13] [END OF AUDIO]

Citations

1. Gottlieb, Michael S., Howard M. Schanker, Peng Thim Fan, Andrew Saxon, Joel D. Weisman, and I. Pozalski. “Pneumocystis Pneumonia—Los Angeles.” MMWR Morbidity and Mortality Weekly Report 30, no. 21 (June 5, 1981): 250–52, https://stacks.cdc.gov/view/cdc/1261/

Index

• 1.6 Harold Varmus — Animal Retroviruses and Cancer Research
• 2.0 Michael Gottlieb — Introduction to Session 2
• 2.2 James Curran — Deciphering the Epidemiology of AIDS
• 2.3 Mark Harrington — The Importance of Activism to the US Response
• 2.4 Robert "Bob" Gallo — Discoveries of Human Retrovirus, Their Linkage to Disease as Causative Agents & Preparation for the Future
• 3.3 Douglas Richman: Antiviral Drug Resistance and Combination ART
• 4.0.1 Jeffrey Lifson — Session 4, Introduction 1
• 6.6 Robert Redfield — The PEPFAR Program to Treat HIV in Africa
• 8.1 John Mellors — MACS and Beyond: Epidemiology, Viremia and Pathogenesis
• 11th International AIDS Conference, Vancouver, Canada, July 7–12, 1996
• Abrams, Donald I.
• ACTG protocol 019 (1989–1994)
• activism, civil rights, protests, and social movements
• AIDS Clinical Trials Group (ACTG)
• autopsy
• AZT (azidothymidine)
• Baltimore
• Beem, Marc O. (1923–2014)
• Blattner, William A.
• bone saw
• breast cancer
• caregiver, caregiving
• cell culture, tissue culture, immortalized cell line
• centrifuge
• Chambers, Henry F. "Chip" III
• Clark, John R.
• community organizing
• control — experimental control, control group, blinded experiment
• Cooke, Molly
• cure vs. remission of HIV/AIDS
• cytomegalovirus (CMV)
• Delaney, Martin (1945–2009)
• demographic cohort
• Duesberg, Peter H. (b. 1936)
• early theories of AIDS etiology
• education and early career
• Engelman, Ed
• epidemiology
• Fahey, John L. (1924–2014)
• Feinstein, Dianne (b. 1933)
• flow cytometry (FCM); cell sorting
• Frederick National Laboratory for Cancer Research (FNLCR, NCI-Frederick)
• Friedman-Kien, Alvin E.
• funding and grants
• gay men, gay community
• gloves
• HIV test
• iceberg of disease
• infectious disease (medical specialty)
• internet
• IRB (institutional review board)
• Kaposi's sarcoma (KS)
• Kaposi's sarcoma-associated herpesvirus (KSHV, HHV-8)
• Khan, Wasif N.
• lab safety, biosafety levels, safety protocol
• lab vs. clinic
• Laubenstein, Linda (1947–1992)
• Levy, Jay A. (b. 1938)
• Levy, Stuart B. (1938–2013)
• lymphadenopathy
• lymphatic system (lymph, lymph nodes, etc.)
• lymphedema
• Martin Delaney Collaboratory
• medical school, residency, and fellowship
• memory
• Minnesota
• Moldow, Charles F.
• morphine
• National Science Foundation (NSF)
• neurological symptoms of AIDS
• New York
• NYU (New York University)
• oncology
• palliative care
• pediatrics, pediatric AIDS
• personal protective equipment (PPE)
• placebo
• Pneumocystis pneumonia (PCP)
• polio
• PowerPoint
• prevention of HIV/AIDS
• public health
• Remington, Jack S. (b. 1931)
• rhinovirus
• Rous sarcoma virus (RSV)
• San Francisco General Hospital (SFGH)
• San Francisco Veterans Affairs Medical Center (SFVAMC)
• Sande, Merle (1939–2007)
• scientific competition and collaboration
• scientific revolution
• Session 7: Prospects for an HIV Vaccine
• Session 9: Public Event
• sex workers
• St. Luke's-Roosevelt Hospital, New York
• St. Olaf College
• Stanford University
• toxoplasmosis, toxoplasma gonii
• UCLA (University of California, Los Angeles), UCLA School of Medicine, UCLA Medical Center
• UCSF (University of California San Francisco)
• University of Chicago
• University of Virginia
• Ward 86, SFGH
• William, Daniel C. (1946–2008)
• Wofsy, Constance (1943–1996)
• Zuckerberg, Mark, and Priscilla Chan