07.18.14 4:55 PM ET
HIV’s Greatest Foe Went Down With MH17
Dr. Joep M. Lange, who died in the crash of Malaysia Airlines Flight 17, was one of a handful of brand-name AIDS experts. Of course eulogistic hyperbole is expected after this sort of tragedy, but Lange truly was every inch the visionary, charismatic, and good guy the hurried obituaries suggest.
For many, it seems like forever, but actually AIDS is a new disease. The first reports appeared just 33 years ago and since then, about 75 million people have become infected, half of whom have died. Today one of every 120 adults between 15 and 49 years of age worldwide is HIV-positive.
Given its relatively brief history, it makes sense that the first leaders in HIV management are still around. In the 1980s, the disease was ignored by many of the older, more established clinicians who figured the problem would be simply a passing concern, a fad among overeager new trainees. Thus, to fill the void, these young and impressionable just-minted investigators, including Lange, assumed leadership in the U.S. and Europe. We are lucky that so many were, like Lange, smart, even-handed, and far-sighted. Lange was 60 years old at his death.
Lange started his career examining how best to measure, and therefore predict, disease progression and response to treatment. He and a handful of others developed the HIV “antigen” test, a first-generation attempt at measuring the amount of virus in the bloodstream. Within a decade, his approach led to the routine measurement of the HIV “viral load,” a test performed as routinely as a cholesterol HDL both to diagnose infection and monitor treatment response.
But as he worked on the epidemic locally in Amsterdam and Western Europe, Lange also was thinking globally. Through international meetings, he learned what HIV threatened to do worldwide; therefore, in the early 1990s, he took over oversight of clinical research in the WHO Global AIDS Program. As he wrote in 1993, referring to the newly recognized scale of the epidemic in Africa, “It is clear that countries most struck by the HIV epidemic are unable to cope with the enormous burden of care required.”
He promoted the notion of giving the few drugs available to as many people as possible, flying against the “oh well, it’s hopeless—they’re all going to die” sentiment so prevalent at the time. This refusal to give in to the seemingly relentless force of the epidemic was critical then; from that attitude came the remarkable achievements of PEPFAR and countless foundations that now have helped get more than 60 percent of HIV-infected persons in sub-Saharan Africa onto antiviral treatment.
These achievements were the result of the work of many people and perhaps would have been accomplished even without Lange’s drive, personality, and insight. Where he and few others truly blazed a path was the creation of a community of AIDS researchers. For whatever historic-socio-psychologic reason, Lange and his colleagues realized immediately that the only way to combat the galloping epidemic was through collectivism and subordination of ego. He and others launched multi-city, multi-country studies of patients and treatments. They worried not about who obtained first-author status but rather how to push forward faster and farther.
One of his last articles was conducted in a country he did not live in on a disease he was not that familiar with: the relationship between hepatitis C and vitamin D. What was typical, though, was the large group of authors who worked on the project. Another, on kidney disease in HIV, had 722 collaborators managing 11 patient groups; it followed thousands of patients for an array of complications—the sort of result Lange and a small group of like-minded visionaries foresaw two decades ago when such patient cohorts were assembled on blind faith.
I did not know Lange, though I surely knew of him. I would see him at international meetings, wearing a rumpled just-off-the-plane blazer and pants, hurrying from here to there, always with a calm, wry expression as people scrambled to keep up with him or shake his hand. I never saw him stand still.
Joep Lange’s death leaves a large void in the world of AIDS treatment. Others, though, trained on Lange-ian principles, will rill rise and fill the gap. What will not be restored so easily, soon or perhaps ever, is the remarkable gift he gave to doctors and patients across the world: an unflagging optimism in the face of a raging epidemic, and a belief that humans can and must work together for the public good.