30 Years Of AIDS: Meet The Woman Who Made The First Major Breakthrough In Treatment

30 Years Of AIDS: Meet The Woman Who Made The First Major Breakthrough In Treatment

08.29.11 | By Kate Connors

Mary St. ClairJust over 30 years ago was the first time that a medical journal mentioned the disease we now know as HIV/AIDS. Just three years later, researcher Marty St. Clair was working on the team that is now credited for discovering the anti-HIV activity of AZT (zidovudine) when she was the first to see the physical effects of the drug on HIV cells. She remains dedicated to HIV/AIDS research, and still works in that field today.

It was an incredible honor to speak with her about her experience. Her passion for her work and her commitment to helping patients beat this disease are clear.

You were already working in research at the time HIV was identified. How did you transition into that field?

When I finished school, I went to work in a herpes virus lab that was instrumental in determining the mechanism of the first real antiretroviral approved. I had that as a background, but have to admit that I was becoming tired of herpes viruses. In 1983, HIV was determined to be a retrovirus. Well, as an undergraduate I had worked in an avian retrovirus lab, before we knew they affect humans.

It was fortuitous. I had the right experience for HIV, and was tired of herpes, so when the company I worked for asked who wanted to try to do something about HIV, I raised my hand. I was ready for a change and was very interested in this new disease that was causing so much fear.

So early on in the life of HIV, did you get negative reactions for going to work in the field?

There was so much fear and so much stigma about HIV, but still the reactions were varied. From some people, it was the ultimate pride that they knew someone who was trying to find a treatment for the disease, but other people wouldn't shake my hand or be in the same room as me. They would say, "There are so many other things you could do, why would you choose this?"

But we were proud to go in a direction where we could make an impact.

Can you describe what it was like to realize that AZT seemed to have an effect?

Because of our past experiences and knowledge about reverse transcriptase, we were very directed in our study. Compounds we looked at were almost directly nucleoside analogs. But though we saw little bits of activity, nothing totally wowed us.

It was November 16, 1984, and I was working with petri dishes, holding each up to the light of the window to count the plaques. In my assay of 350 plates, I saw a series of 16 plates with no plaques, which meant no virus. In other words, in those plates, the compound inhibited the virus. It was absolutely an "aha!"moment, but then I wondered whether I might have forgotten to put the virus in those 16 plates in the first place. I mentioned it to my supervisor and he dismissed my concerns. He was confident it was the compound at work.

That was a Friday, and I didn't tell many people about what I had seen. But by the time I came into work on Monday, I had a bunch of calls on my voicemail. Clearly people were very, very excited.

What was the development process like after that "aha" moment?

It was unbelievably fast. Based on the usual development timeline, it should have taken at least 10 years. We determined the activity of AZT in November 1984, started Phase 1 in July 1985, started a double-blind Phase 2 in February 1986, and stopped that trial in the September of that year because although the patients in that trial were very advanced, only one patient taking AZT had died compared with 16 of the placebo patients. We started putting together all the data for the new drug application in October 1986, had an advisory committee panel in January 1987, and it was approved in March. So, it only took roughly two-and-a-half years for approval.

The reason why it all moved so quickly is because there was such a need. People were dying and we all wanted a treatment so badly.

Once AZT reached the market, where did you focus your clinical research?

We didn't stop there. Based on our experience with antiretrovirals in herpes, we assumed that HIV patients would eventually become resistant to AZT, so we started working on combinations, eventually studying three drugs and looking for drugs that would work well together with a greater effect than individually. So as excited as we were about AZT, we were the first to understand that it wasn't going to be the end of the story. We were always looking for something better.

How do you view the progress that has been made since your first "aha" moment with AZT?

It's absolutely amazing to see what has happened. It's amazing that we started out in the earliest days of the disease, when it was a death sentence. If you knew someone with HIV, you knew you'd attend their funeral in six months. Now, the focus is on management of the disease. You probably know people with HIV and AIDS and don't even know it. That is a remarkable change.

What are the challenges ahead in the world of HIV/AIDS?

One of the major challenges is not so much of an issue here in the developed world, but in developing nations, where we are still dealing with the stigma. Really, at the end of the day, it's just another disease and should be treated as such. We should be making sure that people with it get the medicine they need and not worry about any stigma.

Another issue is that the disease is still growing. We know how to prevent HIV/AIDS. It's easy to prevent. We need to stop transmitting it.

And last, in a sense, the progress we have made has also led to a lack of fear in younger people. They think, "If I get it, I'll take drugs." Everyone should see Philadelphia to know what it was like in the early days. We've made progress, but it is still a big deal.

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