With the recent 30th anniversary of World AIDS Day highlighting just how long we have been dealing with HIV and AIDS, Peter Dunne speaks to clinical virologist, Marty St Clair about the moment she helped discover the medication which would give hope to a ravaged community.

When we think of those early battles against HIV and AIDS, one of the groundbreaking moments was the discovery of AZT – an antiretroviral which could tackle HIV at a time when there seemed no answer.

Marty explains: “In the United States the first indications that we had a new syndrome, which eventually became known as HIV AIDS, was in 1981 when Michael Botley reported on a small group of his patients who were young white males who had pneumocystis carinii pneumonia, which prior to that time had only been seen in very aged men who were close to death. The numbers increased astronomically. Within just a few months we already had several hundred people with this new syndrome and already we were observing a 50 percent fatality rate. Within a few years we had thousands of people, and maintained that 50 percent fatality rate. It was obviously a new disease which was spreading rapidly, causing a great deal of apprehension, fear, stigma. Mostly due to a lack of information and ignorance about how it was spread. It was truly a terrifying time.

“I think in the very early days the scientific community was probably surrounded by the same type of fear that could be found in the non scientific community. At first we didn’t understand what was causing it, how it was spreading. But in 1983, it was determined that this new disease was caused by a retrovirus, so as soon as we we knew it was caused by an infectious agent, those of us in infectious diseases thought we can do this, we know how infectious agents are transmitted, we can deal with it.

“My company Burroughs Wellcome decided late 1983, that we would have a drug discovery and development program. was just a scientist at Burroughs Wellcome at the time but had experience as an undergraduate with retroviruses. Not human retroviruses, they were avian retroviruses, but many of the things that you do to study the virus were exactly the same. So raised my hand and said really wanted to be a part of this. had looked at hundreds of compounds come November when first saw the activity of AZT.

“I think did six different concentrations and every single concentration inhibited virus replication by 100 percent and honestly didn’t believe it. showed this to my manager and said ‘look at this, out of 350 plates look at these 16, do you think forgot to put the virus on these plates’ and of course he said, ‘Out of 350 plates, you forgot to put the virus into these exact 16 plates? don’t think so.’ That was the first indication that we had a drug that might be able to be used against HIV AIDS, but of course, being a scientist, you never believe anything the first time. used lower concentrations so could actually quanticate the activity. And what found was that had just discovered a compound with greater activity against the virus than any other compound that had been discovered up to this point.

“I think still didn’t realise, so of course showed my manager and think called two other people, this was late Friday night, so besides myself there were only three other people that knew this happened. But came to work Monday morning, my phone messages were completely full of people who had called over the weekend and said ‘Did we hear this right, did you find something that could be used against HIV AIDS?’ think that was actually the first time realised how big this might be.”

It usually takes a drug 10 to 15 years to hit the market, but the journey for AZT was markedly quicker. Marty explains: “It went incredibly fast, mainly because there was nothing else out there. People were getting this disease at an increasingly rapid rate, people were dying at an incredibly high rate, nobody else was looking for something, people didn’t actually believe you could use a pharmaceutical against a retrovirus.

“And so the FDA, the regulatory body in the United States actually worked very closely with us to generate data as quickly as we could so that this drug be approved. It’s absolutely amazing that activity was discovered in November of 1984 and AZT was approved on March 19th 1987. This is a story that will never ever be repeated again.”

While it was eventually discovered the drug had toxic side effects and its high cost kept it out of the hands of many who needed it most, its mere existence was hugely important. Marty continues: “AZT was not the best drug, but it was certainly at the time the only drug. We have made such vast improvements since that time, but it gave people hope. It gave patients hope and it gave the scientific and pharmaceutical communities hope, that we actually could use a drug against this virus.”

And vast improvements have indeed been made, both in terms of prevention and treatment. “The change has just been incredible over the years. There are pills that have to be taken every day for essentially the patient’s rest of life. But with the appropriate regimen chosen and each individual patient being absolutely adherent, patients have their lives back, they can live normal lives, they can work and love and live just like anybody else, and in fact their friends and family don’t even have to know their HIV status, because they aren’t sick.”

So where next for scientific study? Where are the goalposts now set for treating those with the virus? “What we want to do is further develop drugs that have less impact on patient’s lives,” Marty replies. “I think that’s where we’re going now.”