I MET MICHAEL, the man who became my Patient Zero, in early 1981. I was 33 years old; he was 31. He was rail thin with short, bleached-blond hair and high cheekbones. I remember him in more detail than patients I saw yesterday.
Michael had been admitted through the UCLA emergency room days earlier complaining of fever and weight loss. Quickly, a rare type of lung infection called pneumocystis blossomed on his chest X-ray.
My immediate suspicion was that he was immune deficient. Although rare, pneumocystis was known to occur in immunologic disorders. Using what was then considered new technology to test his blood, we discovered that critical cells, called "T cells," were missing.
In the weeks that followed, two more men were referred to us with virtually identical symptoms. Like Michael, each said he had always been healthy and had no past history of difficulty fighting infections, suggesting that the immune deficiency was acquired. Like Michael, each told me that he was gay. In those days, our subcultures -- white-coated medics and gay men -- were worlds apart. But that was about to change.
Then two \o7more\f7 cases came in. At that point, my colleagues and I felt the information had to be made public. On June 5, 1981 -- 25 years ago today -- I published the details of Michael's case and four others in the Morbidity and Mortality Weekly Report put out by the Centers for Disease Control and Prevention. It was the first description of a new disease, a date that later became known as the official onset of the HIV/AIDS epidemic.
"All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections," I wrote in that initial report. I added that the fact that all the patients were gay suggested "an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact."
Michael and my other early patients died within that first year. Within days of the June 5 report, doctors began telephoning from all over the nation to tell me about their own patients with pneumocystis. Over time, intensive care units at UCLA and across the country began to fill with young gay men requiring ventilators, their lungs choked with the same strange organism. The AIDS epidemic was underway.
