WASHINGTON — Out of Mississippi, a milestone in the AIDS pandemic, or at least proof of concept: If you treat an infant early enough — in this case, within 30 hours of infection — it is possible to prevent a reservoir of the virus from being established, as well as to avoid serious damage to the immune system.
These are the optimal conditions for an AIDS “cure.” They are usually not present in adults. It is often months, even years, before adults know they are infected, by which time the reservoir is already established. This breakthrough is most applicable in the developing world, especially southern Africa, where it is not unusual for infected mothers to arrive at the emergency room without any prenatal care. For babies at the highest risk, aggressive treatment before the confirmation of infection seems to provide a jump on the virus. The caveat: Clinical trials would need to precede broad application.
The news about a blessed child in Mississippi followed shortly after the death of a 96-year-old man, former Surgeon General C. Everett Koop, who would have been as pleased as anyone.
Koop was a pioneer pediatric surgeon in the 1950s, specializing in the correction of congenital birth defects. It was Koop's humane innovation to provide extraordinary care to the most helpless of patients. And his concern for the newly born led him naturally to sympathy for the preborn.
His appointment by Ronald Reagan as surgeon general occasioned a serious case of the vapors among liberals. Koop was attacked as scary, intolerant and unqualified.
He became the only memorable surgeon general. Koop turned his notoriety into influence, undertaking public health campaigns against smoking, domestic violence and preventable accidents. But his main contribution concerned HIV/AIDS. In the early days of the crisis, which coincided with the beginning of the Reagan administration, fear and uncertainty produced various proposals for mandatory testing, tattooing and isolation in camps. Koop was initially ordered by a superior to keep any views on the topic to himself.
But Koop maneuvered to produce the “Surgeon General's Report on Acquired Immune Deficiency Syndrome,” explicitly detailing the modes of HIV transmission, making clear it could not be spread by casual contact, and affirming that “We are fighting a disease, not people.” One of the most important public health documents of the last century was approved in a bureaucratic end run, to protect it from those Koop called “political hacks.”
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