Global Health Chronicles

Dr. Harry Haverkos

David J. Sencer CDC Museum, Global Health Chronicles
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1:29 - Education/EIS

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Partial Transcript: Let’s begin with your background. Would you tell me about where you grew up and your early family life, and then where you went to college?

Segment Synopsis: Dr. Haverkos discusses his medical school background and his early interest in internal medicine. While a research fellow in Pittsburgh, Dr. Haverkos came across his first AIDS patient. He describes learning this patient had Pneumocystis pneumonia and after the usual treatment was not improving. Haverkos also recalls how he was admitted into the EIS program.

Keywords: academic infectious disease guy; AIDS patient; Akron, Ohio; B. Ribner; bathhouse; Battle of the Bulge; cancer patients; Catholic school; chronic diarrhea; Cincinnati, Ohio; December of 1980; early AIDS cases; gay; gay bowel disease; ID Fellowship; ID [Infectious Diseases] doc; internal medicine; June 5, 1981 MMWR; kidney transplant patients; L. Haverkos; Legionella pittsburgensis; lung biopsy; Pensacola; pentamidine; Pittsburgh; Trimethoprim sulfa

Subjects: AIDS [acquired immunodeficiency syndrome]; biology; CDC [Centers for Disease Control and Prevention]; EIS [Epidemic Intelligence Service]; Legionella mcdadei; Legionnaires; Medical College of Ohio at Toledo; MMWR [Morbidity and Mortality Weekly Report]; Mycobacterium avium intracellulare; opportunistic infections; Pneumocystis pneumonia; pneumonia; psychiatric hospital; Roman Catholic; swine flu; University of Notre Dame; University of Pittsburgh; Vietnam War; World War II

11:20 - EIS Work

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Partial Transcript: You came to CDC as an Epidemic Intelligence Service Officer. Where were you assigned, and what were you doing when you first arrived?

Segment Synopsis: Dr. Haverkos explains that he was not overly happy with his first EIS assignment to parasitology. Although, with advice from his new boss he met with Dr. Jim Curran who offered him a position within his group to set up AIDS surveillance.

Keywords: AIDS surveillance; D. Juranek; EIS conference; J. Curran; K. Haverkos; Los Angeles, California; M. Schultz; Pittsburgh, Pennsylvania

Subjects: Kaposi’s sarcoma; Midwest; MMWR; Notre Dame; Parasitology; Pneumocystis

13:57 - Early days

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Partial Transcript: What was the atmosphere at CDC then among people working on the disease? How did CDC organize those of you working on the disease?

Segment Synopsis: Dr. Haverkos reveals that with in his first two weeks of class, Dr. Curran asks him to forego the third week in order to work on a case definition for this new disease. He describes feeling somewhat disappointed because he found the EIS classes riveting. Nonetheless, he read over the 40 cases obtained at the time and reviewed the Pentamidine registry, compiled by Sandy Ford.

Keywords: case definition; case reports; CDC Drug Services; D. Juranek; H. Jaffe; J. Curran; LA [Los Angeles]; M. Gottleib; M. Guinan; P. Weisner; Pentamidine registry; Pittsburgh; S. Ford; San Francisco, California; W. Shandera

Subjects: New York

15:53 - Case definition

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Partial Transcript: Tell me a little bit, for those viewing as students, what was the significance of coming up with a case definition?

Segment Synopsis: Dr. Haverkos explains that in order to count cases for surveillance, one must be able to define what constitutes a case. Haverkos describes reading the reports, and coming up with a three part definition: case must have been diagnosed with a disease that is predictive of immunosuppression, case must fall between the ages of 15-60 with Kaposi’s sarcoma biopsy confirmed, and case must have no evidence of immune suppression. Once Curran signed off on these parameters, early surveillance began using hand drawn check-the-box forms.

Keywords: 12 Steps of Outbreak Investigation; academic docs; active or passive; age range; biopsies; biopsy-confirmed; bisexual; cancer; case definition; CD4 count [T-cell test]; CDC library; check-the-box form; clinical diagnosis; cold sores; congenital immunodeficiency; dates; define; disease diagnosed; epi[demic] curve; evidence of immune suppression; foodborne outbreak exercise; gay; healthy individuals; herpes simplex; homosexual; ID [Infectious Disease] fellow; immune suppression; immunocompromised patients; injecting drug use; intensive care unit; J. Curran; K. Nugent; line listing; Los Angeles; M. Gottleib; moderately predictive; name of patient; neonatal cases; older men; onset of symptoms; opportunistic infection; passive system; pentamidine; Pittsburgh; reporting doc; secretary; sexual orientation; steroid use; straight; systematic way to collect cases; tabulating case reports; three-part definition; transplant recipients; transplants; white count

Subjects: Africa; Asia; CDC; Cryptococcal meningitis; Eastern Europe; Kaposi’s sarcoma; New England Journal of Medicine; orphanages; Pneumocystis; toxic shock syndrome; Toxoplasma; Tuberculosis; United States; University of Pittsburgh

25:08 - Case-control study

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Partial Transcript: Can you tell us a little bit about the case-control study and your particular role?

Segment Synopsis: Dr. Haverkos recalls being called to be one of the eight interviewers for the case-control study, he was assigned New York City. The interview was a 25-page form developed by Harold Jaffe, M.D. and Bill Darrow, Ph.D. using a modified case definition. Haverkos explains that the cases used would have to have both Kaposi’s sarcoma or Pneumocystis carinii pneumonia, and the reasoning behind the four control groups. However, due to disagreements on how the data should be used the published study was delayed.

Keywords: age; announced; Atlanta, Goergia; case-control study; controls; data; December of ’81; drug use; drugs; fourth group; friend control; gay controls; gay practices; general public; H. Jaffe; heterosexual controls; heterosexual patients; interview [form]; interviews; J. Monroe; K. Choi; late ’82; Los Angeles, California; M. Tapper; match; more specific case definition; New York City; October of ’83; partners; physicians; Pittsburgh, Pennsylvania; preliminary data; private practitioners; publish; race; rates of STDS; residence; results; sample of gay men; San Francisco, California; sex; spectrum; spectrum of controls; statistician; statistics and study design; STD [sexually transmitted disease] clinics; straight control; surveillance; telephone survey; variables; VD [venereal diseases] clinics; W. Darrow

Subjects: gay; heterosexual; Kaposi’s [sarcoma]; pneumocystis

Hyperlink: Kaposi's Sarcoma and Pneumocystis Pneumonia in Homosexual Men: A Case-Control Study. Protocol for Case-Control study which includes an early case definition. This protocol was used in San Francisco, Los Angeles, and New York City

34:54 - Early hypotheses

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Partial Transcript: What were some of the early hypotheses?

Segment Synopsis: Dr. Haverkos explains the four major early hypotheses. The leading hypothesis; being that CMV [cytomegalovirus] was the cause, second hypothesis; a popular drug known as “poppers,” third hypothesis; immune overload and the fourth hypothesis; that there was some new agent out there.

Keywords: Cialis; D. Francis; drug users; drugs; G. Giraldo; gay community; gay men; hepatitis B surveillance; heterosexuals; hypotheses; immune overload; M. Gottleib; new agent; nitrites; Pittsburgh, Pennsylvania; poppers; reminiscent; retroviruses; second hypothesis; STD clinics; third theory; vasodilation; Viagra

Subjects: Africa; CDC; CMV [cytomegalovirus]; Europe; Italy; KS [Kaposi’s sarcoma]; serologic studies; STDs; Uganda

38:28 - Prison investigation

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Partial Transcript: You were one of the early persons working on cases in injection drug users in a prison, for example in upstate New York. Can you tell us a little about that investigation?

Segment Synopsis: Dr. Haverkos describes an unproductive investigation of some prisoners at “Sing Sing” prison in upstate New York. Drs. Haverkos, Guinan, and Hanrahan were investigating three cases inside the prison that had been diagnosed within months of each other. The team had hoped to find incubation periods and or routes of transmission.

Keywords: A. Kelter; Albany, New York; Chronic Diseases [Division, CDC]; D. Kramer; EIS officer; F. Wormser; February of ’82; first experience; H. Jaffe; ID clinician; incubation period; injecting drug use; J. Curran; J. Goodrich; J. Hanrahan; M. Guinan; M. Rogers; P. Drotman; P. Weisner; Parasitology; parole officer; R. Selik; routes of transmission; sexual behavior; surveillance; three patients; Valhalla, New York

Subjects: New York Medical College; NIDA [National Institute on Drug Abuse]; Ossining “Sing Sing” prison; Taconic Correctional Facility; upstate New York

42:16 - Follow-up studies

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Partial Transcript: What was the early thinking as to why some patients were getting one disease or another? I know that’s an area that you have had a particular interest in as time went on

Segment Synopsis: Dr. Haverkos explains the three follow-up studies after the case-control study, and that his nitrate inhalant study brought along a lifelong drive to prove the connection. Haverkos details the tension surrounding the Task Force and CDC. Dr. Haverkos’ recalls the French found the virus and he convinced the French to send a sample of the virus to CDC, unfortunately, the virus would die in transit, it was a hectic time for Task Force.

Keywords: 10 cities; 1984 budget request; 40 cases; 90 patients; A. Hardy; AIDS patients; airline steward; analysis; blood vessel tumor; blood vessels; cancer cell line; case-control; claimed; Cold Spring Harbor, New York; compare; couple of men; D. Auerbach; D. Bregman; D. Juranek; data; dilate; drug users; drugs; early results; emotions; eureka moment; first study; fiscal year; French; French virus; gay men; grow the virus; guys with pneumocystis; H. Jaffe; heterosexual; heterosexual men and women; heterosexuals; injecting drug users; investigating blood transfusion cases; J. Chermann; J. Curran; K. Castro; K. Choi; laboratory data; less sexually active; link; little black book; Los Angeles, California; lymphadenopathy patients; M. Gorman; M. Guinan; marijuana; men who developed Kaposi’s; Montreal; New York City; nitrite inhalants; nitrites; not gay; P. Drotman; P. Pinsky; patients; pneumocystis patients; poppers; R. Gallo; re-analyze; recreational drugs; results; second study; sexual partners; sexually active; single variable; startling finding; tension; third study; three follow-up studies; W. Darrow; W. Dowdle

Subjects: AIDS; CDC; Italy; Kaposi’s sarcoma; PHS [Public Health Service]; pneumocystis; Task Force

52:29 - Poppers

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Partial Transcript: In retrospect, with 35 years of hindsight luxury, what’s your thinking now as to the role of poppers?

Segment Synopsis: Dr. Haverkos stands by his findings that there is a connection to poppers and Kaposi’s sarcoma. He reveals that he was able to make poppers’ manufacturing and distribution in the United States illegal. Haverkos mentions a study of gay men in Beijing in which 50% of the cases admitted to use of nitrites, of those 50%, cases of Kaposi’s sarcoma were emerging. Haverkos reveals he is still pursuing nitrite studies.

Keywords: 1914; 1994; ACE [angiotensin converting enzyme] inhibitors; African cases; aluminous silicates; anecdotal reports; Beijing; blood vessel variable; breaks in the skin in the feet; case-control studies; cause; Chang and Moore; children reported; Cialis; congressman; elderly men; electron microscopy; four types; G. Giraldo; gay activist; gay men; H. Wilson; herpes virus found; HIV positive; HIV-negative Kaposi’s; HIV-positive Kaposi’s; immune suppression; immunosuppressed renal transplant recipient; iron oxides; J. Ziegler; Kaposi’s patients; link to geography; link to walking barefoot; lower leg disease; lymphadenopathy in kids; M. Levine; Nitrite use; nitrites banned; oncogenic effects; organ transplant recipients; paper; parasitic infections; recent Kaposi’s cases; rejection drugs; San Francisco, California; second factor; soil; third factors; Viagra; volcanic soils; young black men

Subjects: Africa; Asia; China; HIV [human immunodeficiency virus]; human herpes virus 8 [HHV8]; Kaposi’s sarcoma; National Institutes of Drug Abuse; poppers; United States

Hyperlink: Nitrite Inhalants: History, Epidemiology, and Possible Links to AIDS

58:37 - Haitians as a risk group

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Partial Transcript: During the fall of ’81and ongoing, there were reports of opportunistic infections and Kaposi’s sarcoma among Haitians living the United States. Early reports were coming from Miami, Tel us a a little bit about your work with Haitian cases.

Segment Synopsis: Dr. Haverkos discusses his time working on the Haitian study. He describes Haitians as being among the first groups, except IV drug users, to show heterosexual transmission. Haverkos also explains that the Haitian government wanted money for research and Haitians removed as a risk group. The investigation led to Haverkos’ job at NIH. Haverkos touches briefly on voodoo practices that could have aided in the spread of this new disease..

Keywords: A. Fauci; A. Saah; B. Weniger; biopsies; blood transfusions cases; brain abnormalities; C. Lane; case definition; D. Juranek; different spectrum; drug users; EIS officer; exposed to HIV; fairly rare disease; G. Hensley; gay men; H. Masur; Haitian immigrants; Haitian patients; Haitians; hemophiliacs; herpes virus infections; illegal immigrants; investigation; J. Curran; J. Goodrich; J. Johnson; J. Remington; lion; M. Malison; Miami; Montreal, Canada; New York City, New York; Nine cases; P. Drotman; pneumocystis patients; Port-au-Prince, Haiti; prisoners; R. Edelman; R. Krause; removed; research meeting; risk group; spacesuit; stigma; T. Quinn; Tallahassee, Florida; toxoplasmosis of the brain

Subjects: antibiotics; Candida esophagitis; case-control studies; cases; Catholic mass; CDC; chicken blood; children diagnosed; clear evidence; clear links; components of needles; controls; drug use; EIS [Epidemic Intelligence Service]; family members; FDA [Food and Drug Administration]; first clusters; first groups; Haiti; Haitian government; HCW [health care worker]; heterosexual transmission; HIV infected; immigrants; infection to women; J. Pape; K. Castro; Kaposi’s sarcoma; kids; malnutrition; money for sex; mosquitoes; needle use; NIAID [National Institute of Allergy and Infectious Diseases]; NIH [National Institutes of Health]; Notre Dame; perinatal transmission; pneumocystis; rituals; Seder; sex; sex with shamans; sexual interactions; shaman; South Carolina; Stanford University; TB [tuberculosis]; toxoplasmosis; trances; tuberculosis; United States; upstate New York; very independent; vitamins; voodoo practices; West Virginia; women Haitians

Hyperlink: Unusual Causes of Death in Haitians Residing in Miami, High Prevalence of Opportunistic Infections

72:29 - Blood transfusions

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Partial Transcript: One of the things I wanted to ask you about is one or two areas of the blood product and blood transfusion cases. What were some of your major efforts in that area?

Segment Synopsis: Dr. Haverkos describes a hemophiliac case in Los Angeles, a son of prominent attorney and supporter of President Reagan. The father wanted to know whose blood was used in his son’s transfusion as Dr. Haverkos traced all the donors. Haverkos receives a call from Mike Gottleib who had two patients with AIDS and no risk factors but had recently received blood transfusions. Dr. Haverkos requests samples to be started in Los Angeles rather than ship them back to Atlanta. These samples, became two of the first three patients that CDC grew retrovirus from. Haverkos also describes Bob Gallo’s reaction to learning CDC named their organism LAV [lymphadenopathy-associated virus], as opposed to his HTLV III-LAV.

Keywords: Atlanta, Georgia; blood donors; blood transfusion series; claims no risk factors; D. Francis; D. Warfield; four children; French virus; H. Jaffe; hemophiliac; HTLV III-LAV; hysterectomy; Koch’s postulates; LAV [lymphadenopathy-associated virus]; Los Angeles, California; M. Gottleib; men; mistake; names; naming; Naples, Italy; one gay male; one patient; P. Feorino; prominent attorney; R. Gallo; R. Reagan; Reagan supporter; retroviruses; two blood transfusions; unmarried; woman

Subjects: Africa; AIDS; CDC; Los Angeles Health Department; NIH; Ohio; PHS [Public Health System]; Reagan Administration; STD; third-world countries

78:28 - Italian conference

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Partial Transcript: You mentioned the conference in Naples, Italy, that took place in the spring of ’83. Can you tell us a little bit about that?

Segment Synopsis: Dr. Haverkos describes his experiences in Naples at a European AIDS conference. Cases of AIDS were appearing throughout Europe at this time. Haverkos shares that this was a very exciting moment of his career.

Keywords: Aarhus, Denmark; AIDS patients; clinician; European cases; F. Barre-Sinoussi; G. Giraldo; HTLV1; HTLV2; human retroviruses; husband and wife team; J. Chermann; J. Curran; L. Haverkos; L. Montagnier; Naples; oncologist; Paris; preeminent retrovirologist; press; R. Gallo; retrovirus; San Francisco; W. Dowdle; W. Rozenbaum

Subjects: AIDS; Belgium; CDC; CMV; Europe; France; Germany; Italy; Kaposi’s sarcoma; Uganda; United States; WHO [World Health Organization]; Zaire

83:19 - African connection

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Partial Transcript: Can you talk more about that, and was the connection being made that the source of the virus might be from Zaire?

Segment Synopsis: Dr. Haverkos explains Dr. Giraldo’s African studies in which he found KS in young men who also had other opportunistic infections. These cases, from the late ‘70s, were beginning to show manifestation in cases in Europe. Belgium’s high incidence rate made scientists look to Zaire. Haverkos describes the situation in Zaire was so bad that CDC instantly began setting up Projet SIDA. Haverkos also explains the connection of Haitians and Zaire. Many Haitians left the political unease in Haiti to teach in Africa, possibly contracting the disease there.

Keywords: Belgian natives; Belgians; bisexual men; case-control study; cluster; cluster of cases; dictator; diplomats; economic conditions; expedition to Zaire; F. Duvalier; French; G. Giraldo; gay men; hospital; hundred professionals; immigrants; J. Duvalier; J. Mann; J. McCormick; J. Pape; late ‘70s; leaving; Miami; migration patterns; N. Clumeck; New York cases; New York City; P. Piot; parasitic infections; patient immigrants; people from Haiti; R. Krause; sexual contact chart; son; stigmatized Haitians; T. Quinn; teachers; travel history; Vienna [Austria]; Zairian natives

Subjects: Africa; Belgium; France; Haiti; HHS [Health and Human Services]; Kaposi’s; New England Journal; opportunistic infections; pneumocystis; Project SIDA; syphilis; U.S.; Uganda; Zaire

90:45 - Experience with CDC

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Partial Transcript: As we are drawing to a close, I want to ask: are there any aspects of CDC’s response in the areas you worked on where we fell short or could have done a better job in your opinion?

Segment Synopsis: Dr. Haverkos shares his personal opinions and feelings regarding the early AIDS effort. He shares that CDC and PHS were slow to recognize heterosexual transmission, and that his work felt stifled by leadership. However, he states he still has great relationships with his colleagues and that he wouldn’t have traded this experience for anything.

Keywords: 70% of gay men; A. Fauci; A. Langmuir; bisexual; blood supply; blood transfusion recipients; cofactors; D. Lawrence; D. Sencer; drug users; gay men; H. Jaffe; heterosexual transmission; hierarchical breakdown; hierarchical system of classification; infected heterosexually; internal politics; J. Curran; longer incubation period; male-to-female transmission; my work; nitrites; our case-control studies; pathogenesis of Kaposi’s sarcoma; R. Gallo; R. Selik; recognition; second area; slow; stifling; three areas; [epidemic] curve

Subjects: CDC; STDs

95:16 - Personal experience

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Partial Transcript: A couple of questions about the personal aspects or impacts of your work on AIDS. First of all, did you worry about becoming infected yourself Were you worried about your family?

Segment Synopsis: Dr. Haverkos shares that he was indeed uneasy regarding the possibility of contracting AIDS after the first health care worker became infected and that he was tested regularly. Haverkos ends by thanking his wife.

Keywords: case-control study; concern of mine; first healthcare worker issues; kids; needle stick injuries; negative; positive; recapped needles; Washington, D.C.; wife

Subjects: army hospital; NIH; Public Health Service; Water Reed [National Military Medical Center]