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t m c » p u l s e | j u n e 2 0 1 7 16 16 "The first cases of HIV/AIDS in Houston were identified in the early '80s," said Thomas Giordano, M.D., medical director of Thomas Street Health Center. "The first patients were being seen by clini- cians at Harris Health in the tuberculosis clinic and chest clinic because there was this recognition in the beginning that people with AIDS had higher rates of TB. They were scattered with all of these other depart- ments and there was this recognition that we needed some sort of centralized clinic to treat patients with HIV/AIDS." In an innovative and unconventional move, Harris Health acquired a building from the city of Houston to house the clinic. Built in 1910 as Sunset Hospital— a Southern Pacific Railroad Hospital—Thomas Street Clinic did not look particularly innovative. "We were in the basement in a very primitive area and it was almost kind of dangerous," said Wayne Shandera, M.D., an infectious disease specialist at Thomas Street Health Center/Ben Taub Hospital and assistant professor of internal medicine and infectious disease at Baylor College of Medicine. "We were worried about our blind patients falling down the elevator shaft." Before working at the clinic, Shandera served on the front lines of the HIV/AIDS epidemic in Los Angeles. On a summer morning in 1981, while he was serving as the epidemic intelligence services officer for the Centers for Disease Control and Prevention (CDC), five mysterious cases of pneumonia appeared on his desk. "I saw this disease since its inception," Shandera said. "There were three gay men who all had an unusual pneumonia at UCLA and a fourth at Cedars- Sinai and that very day there was another case on my desk from Santa Monica—St. John's Hospital. We described this unusual pneumonia that had only been seen in starvation victims in eastern Europe or kids with leukemia. And these were healthy young men who were getting it and we didn't exactly under- stand why." Before fax machines and email, getting the word out quickly about an outbreak meant publishing it in the CDC's Morbidity and Mortality Weekly Report, which gathers data on infectious and chronic dis- eases from state health departments. On June 5, 1981, Shandera and his colleagues published the first report on this puzzling disease, referring to it as pneumocystis pneumonia. More cases started popping up around the country. Men in New York were covered in purple splotches and red lesions. Haitians in south Florida showed symptoms of Hepatitis B. Heroin addicts with unex- plained swelling of the lymph nodes were heading to hospitals in droves. "No one could pin it down and it was hard to identify," Shandera said. "At the time, I knew it was an outbreak, but I had no idea it was going to be one of the pandemics of the century." A Texas native, Shandera returned to his roots and began his work with Harris Health. "In those days, we weren't curing patients," he said. "We would have one or two patients die each week." But by the early 1990s, the conditions at Thomas Street and treatment for the devastating virus had improved. After a mathematician determined how rapidly the virus was multiplying in the bloodstream, doctors realized it needed to be attacked with force. "We went from treating the disease with one drug, to two, and then when the three-drug cocktail came out in the mid '90s, that changed everything," Shandera said. "The disease became so much more manageable and it became unusual to have an AIDS-related death." … We went from treating the disease with one drug, to two, and then when the three-drug cocktail came out in the mid '90s, that changed everything. The disease became so much more manageable and it became unusual to have an AIDS-related death. — WAYNE SHANDERA, M.D. Top: Charlene Flash, M.D., assistant medical director of HIV services for Harris Health System and assistant professor at Baylor College of Medicine. Below: Wayne Shandera, M.D., infectious disease specialist at Thomas Street Health Center/Ben Taub Hospital and assistant professor of internal medicine and infectious disease at Baylor College of Medicine.