HIV pioneer has roots at Rice
Houston doctor Wayne Shandera among first to flag epidemic 30 years ago

BY MIKE WILLIAMS
Rice News staff

Wayne Shandera wants to set the record straight.

The physician and Rice alumnus is not solely responsible for discovery of HIV, the virus that causes AIDS, which has infected more than 60 million people and killed nearly 30 million worldwide. He was, he said, one of a small group of Los Angeles-based physicians who identified the first serious infection associated with what became AIDS.

	JEFF FITLOW
	Houston physician and Rice alum Wayne Shandera ’73 was part of the small group of Los Angeles-based physicians who identified the first serious infection associated with what became AIDS 30 years ago.

But Shandera’s role in the initial report to the federal Centers for the Disease Control and Prevention (CDC) and its publication, Morbidity and Mortality Weekly Report (MMWR), is well-known. For that, the Texas native received nationwide attention on the report’s 30th anniversary this month.

Shandera ’73 is an assistant professor of internal medicine at Baylor College of Medicine (BCM) and an attending physician at Harris County’s Ben Taub General Hospital and at the Thomas Street Health Center, one of the nation’s largest HIV/AIDS treatment facilities.

But in 1980, fresh out of a residency at Stanford University (which followed medical school at Johns Hopkins), Shandera was the CDC’s epidemic intelligence services officer in Los Angeles, where a former immunology fellow (and thus supervisor of residents) at Stanford, Michael Gottlieb, had taken a faculty job at UCLA.

Gottlieb “went on to make what I think was the important connection in Los Angeles,” Shandera said this week. “We’d often talked about doing a project together, and over the ensuing eight or nine months, we all knew something was going on in the gay community in Los Angeles.

“No one could really identify it completely. In fact, a famous lymphoma pathologist called me from the University of Southern California’s L.A. County Hospital in December of ’80 and said he had six patients with very distinct lymphoma pathology and asked if we could identify what that was,” Shandera said.

Gottlieb was seeing strikingly similar cases of severe immune deficiency in gay male patients and was advised to report his findings on what appeared to be an outbreak to the CDC’s journal. That’s when he, too, called Shandera.

From the CDC’s perspective, Shandera said, we had heard about the outbreaks, though he hadn’t seen the symptoms himself. “As an epidemiologist, I didn’t get to do very much clinical work,” he recalled. “I was dealing with outbreaks of neuromyasthenia in Santa Monica, stillbirths in Long Beach and diarrhea in a day care center in East L.A.” He was also volunteering in the city’s free clinics and elsewhere, “just to keep up my skills.”

And he was working on the paper with Gottlieb and other L.A. physicians who had seen patients with what they presumed to be a strain of Pneumocystis (an organism formerly called a parasite, whose DNA today suggests a fungus) pneumonia. Shandera said the culture of caring among public health workers in Los Angeles, along with the Stanford-oriented scientific background he and Gottlieb brought to their professions, provided the unique combination of skills that allowed them to recognize the genesis of an epidemic.

“People knew about it in San Francisco, but it was in New York and Los Angeles where the disease first broke, where the first isolates were described,” he said. “Mike was very aggressive about getting it into the papers first because he knew other cities were about to report it.”

Shandera remembers delivering the initial report — titled “Pneumocystis Pneumonia — Los Angeles” — to the journal by phone, dictating it word by word. “There were no faxes, of course, or emails,” he said.

In fact, Shandera’s name doesn’t appear on the paper. By CDC tradition, its staffers were not named; Shandera is credited as “Field Services Div., Epidemiology Program Office, CDC,” along with co-authors Gottlieb and doctors at UCLA and Cedars-Mt. Sinai Hospital in Los Angeles.

A week after the paper appeared in MMWR on June 6, 1981, Shandera himself encountered three men dying of the condition in a county hospital ICU and realized the magnitude of their discovery. “We had thought this was just an isolated, unusual phenomenon occurring in gay men in LA. But it was the literal tip of an iceberg, a phenomenon that epidemiologists talk about all the time. There are many more cases than you ever see,” he said.

A year later, the mysterious disease became officially known as Acquired Immune Deficiency Syndrome — AIDS.

“There’s been a sort of revisionist history since that time,” Shandera said, “because a number of physicians have said, ‘Oh, we noticed an increase in the requests for pentamidine,’ the medication used for Pneumocystis pneumonia. But none of us remember that from back then. In fact, CDC was criticized for not noticing an increase in this one medication. They should have picked up on it in Atlanta.”

Shandera’s work soon took him away from AIDS research to CDC’s Atlanta headquarters. He subsequently spent time in Boston, San Antonio, Portland, South Carolina and Dallas, where he worked at the Parkland University of Texas Southwestern Hospital AIDS clinic, before joining BCM in 1988. At BCM, he teaches courses on HIV/AIDS and studies malaria, both subjects of a recent talk at Rice.

“I was elected to the Houston Philosophical Society at Rice last year and gave a lecture on the past, present and future of HIV and malaria,” he recalled. “To learn about malaria in Houston, I called the state health department, and on that day, they were throwing out their files! I rescued the data.”

Shandera doesn’t consider himself to be an advocate for HIV research, aside from the occasional interview about his historic link with the disease. He prefers to work with patients one on one at Ben Taub and at Thomas Street, where he spends two days a week, often seeing patients he’s treated since the late ’80s.

“It is amazing that they have lived so long,” he said, crediting the drug cocktail that keeps the disease at bay for so many sufferers. Shandera said the turning point against HIV came via mathematical modeling studies by Alan Perelson at Los Alamos and others that showed combinations of protease inhibitors could effectively lower the levels of virus in the blood. “Because of that, it was decided that you have to hit this virus very hard with a combination of agents,” he said, a strategy that has also proven worthwhile in treating malaria, tuberculosis and hepatitis B.

Shandera might have become a mathematician himself if he’d pursued his initial course at Rice. “I took a class with (Professor Emeritus) Ronny Wells and 120 people, all of whom had placed out of calculus, and it was an unbelievable experience,” he said. “But I realized that to pass the course, I’d have to spend all my time doing nothing but that. So I realistically decided I would do something else.”

He turned from science and engineering to biology, influenced by a physician uncle in San Antonio. “I remember discussing with Frank Fisher (professor emeritus in ecology and evolutionary biology) whether I should go academe or SE, and he said if you’re going to be a treating physician … it’s much better to be an academic.

“But I learned great deal about science,” he said. “I was able to explore political science and history and a whole variety of things as a student at Rice, and that’s what I liked about having a lot of elective time. You could use it to sink or swim, literally. You could take what you wanted.”

He greatly enjoyed enhancing his keyboard skills by learning pipe organ with Klaus (Christhardt) Kratzenstein, a skill he still employs as a church organist in Houston.

Shandera said he’s gratified by ongoing efforts at Rice’s BioScience Research Collaborative to improve the diagnosis of HIV and malaria to meet urgent global health needs. But he downplayed his own role as a pioneer, preferring to wage the fight side by side with his patients.

“One shouldn’t be in this to be a hero,” he said. “You do what’s necessary at the time. You recognize that with each stage of evolution of the disease, there are going to be profound developments that are far beyond what you can do yourself. You do what you can at that stage, and the next generation will take it to another level.”