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AIDS: Dr. Phair: A warrior fighting HIV/AIDS
AIDS@30: A special series in partnership with the AIDS Foundation of Chicago
by Tully Satre

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In the field of HIV/AIDS, Chicago-based Dr. John Phair is a familiar name.

He spearheaded research with the National Institute of Health/National Institute of Allergy and Infectious Diseases' Multicenter AIDS Cohort Study ( MACS ) in 1983. MACS provided groundbreaking contributions to understanding HIV/AIDS through studying the natural and treated history of the HIV infection.

He applied for and received funding from the NIAID to establish the Chicago Adult AIDS Clinical Trials Unit in 1987. Phair served as the Chair of the Executive Committee of the Adult AIDS Clinical Trials Group, overseeing the scientific, administrative, and fiscal decisions of the network during the early stages of therapy.

He was the Chair for the AIDS Research Advisory Committee for the NIAID from 2000 to 2002.

In 2005, Phair was honored by the American College of Physicians with the John Phillips Memorial Award for Outstanding Work in Clinical Medicine. It was certainly not the first time Phair was recognized for his extraordinary impact on HIV/AIDS treatment and research, and would surely not be the last. In the Spring of 2010 Phair became the first recipient of the International AIDS Society—USA Lifetime Leadership Award.

"My interests were focused mainly on complications of HIV infection," said Phair about when he first became involved in treating HIV/AIDS patients. "When HIV infects and you can't treat it, it destroys the ability of the body to resists other infections."

Much of Phair's work was not directly with the virus, but with the complications that resulted from infection.

After graduating from Yale University, Phair attended medical school in his hometown at the University of Cincinnati College of Medicine. Upon completing his studies in 1960, Phair returned to Connecticut to do his residency at the Yale New Haven Hospital where he first began training in internal medicine and infectious disease.

"This was a part of medicine in which we had treatment," Phair explained of the work he started during his residency. "So people basically did well. We could manage to make people better."

In 1967, he joined the faculty at the University of Cincinnati College of Medicine, where he remained for just under a decade before accepting the position of Chair of the Division of Infectious Disease and Director of the Samuel J. Sackett Laboratories at the Fineberg School of Medicine at Northwestern University.

"My research prior to my involvement with HIV was focused upon the immunology of infections," Phair said. "David Ostrow [ who helped form the Howard Brown Health Center ] approached me and asked whether I knew anything about this disease that was killing gay men. I had seen a couple of cases at Northwestern, but because of my immunology research, I was interested."

Before encountering HIV/AIDS, most of the infectious diseases Phair worked with were easily treated with antibiotics or other medicines. "AIDS came along and it became apparent that there was no longer treatment," Phair recalled. "In that period because of fear and the novelty of [ HIV/AIDS ] , infectious diseases at Northwestern became the group who managed patients who came to Northwestern with what we came to know as AIDS."

Initially, Phair helped carry out a small study at the Howard Brown Health Center ( then known as Howard Brown Memorial Clinic ) , which did not yield substantial results. However, it lead to an application to the National Institute of Health, and in 1983, with Dr. Ostrow spearheading the move, the NIH started the Multicenter AIDS Cohort Study ( MACS ) . Dr. Phair was appointed principal investigator of the Chicago part of the study, which worked in collaboration with other researchers and investigators around the country.

"AIDS was basically a change in the whole focus of infectious disease," Phair said, recalling the shift in thought that AIDS had on the medical field. "Before [ HIV/AIDS ] we had been consultants; we saw patients and we would recommend therapy and they would get better. Now we became the primary care physicians for a group of people who we could not really do anything for."

"We had to care for people, rather than treat people," said Phair. "It was a shock in the 1980s not to be able to do something for somebody … it was a very tough time." Phair said that most patients with AIDS at Northwestern were gay men. "All of us were impressed by their grace, and courage," Phair said of his early patients, "and altruism … wanting to participate in research to respond to this epidemic."

For the first six to seven years, there was very little that could be done to help patients with AIDS. "All we could really do was hold their hand," said Phair.

In 1987, Dr. Phair applied for funding from the National Institute of Allergy and Infectious Diseases ( a division of the NIH ) to open a center for experimental treatment in Chicago. The center was setup at Northwestern in relationship with Rush Medical and was a part of the larger AIDS Clinical Trials Group, a network of more than 30 universities, which was established by the NIH. The Chicago Adult AIDS Clinical Trials Unit was established on the horizon of successful treatments for people living with HIV/AIDS. The introduction of AZT to the pharmaceutical market was a breakthrough, "but not perfect," Phair emphasized.

AZT alone did not make much of an impact and it often came with many side effects. It was not until 1995 that new drugs were introduced, which combined with existing drugs at the time provided a treatment that controlled the virus, if taken religiously.

"The initial cocktails were very difficult to take," said Phair. "Drugs today are better, with less side effects. And they're easier to take: one pill, once a day as opposed to the 15 to 20 pills a day in 1995."

But even the safer drugs still have side effects, Phair warns. As HIV infections continue to rise, particularly among a young MSM ( men-who-have-sex-with-men ) demographic, Phair stressed the importance of being safe. "Even though life expectancy is closer to what you'd expect if you weren't infected … life is still shortened a little bit," said Phair. Additionally there are several complications that result from side effects of drugs used today to treat HIV including heart, kidney and liver diseases. "While the drugs suppress the virus," Phair explained, "some of the deleterious effects of HIV infection continue [ and ] chronic infection can lead to complications."

Recent studies across the board have continued to show a dramatic increase in HIV infections for men who have sex with men, particularly among men their 20s. "I think in the '80s when men saw their friends dying it made an impact," Phair said. "The men who were alive and survived those early days are older and the younger men [ today ] don't have that experience. They're not seeing their friends die, so they sometimes don't buy into the message of the necessity of safe-sex and safe behaviors in general. They also think the drugs [ used to treat HIV ] solve things … and people get tired of being careful. There has been some slippage of safe behavior. I think we still have a great number of people with new infections who are gay men."

After 30 years, the response to the disease once dubbed "gay cancer" has seen great progress due to the efforts of people such as Dr. Phair. But the responsibility for the disease has shifted on a different generation.

Demonstrating numerous accomplishments and contributions to HIV/AIDS research, Phair officially stepped down in 2000 as head of the Division of Infectious Disease, and the Samuel J. Sackett Laboratories at the Feinberg School of Medicine at Northwestern University. Dr. Phair continues to work with MACS, but no longer takes responsibility for the treatment center.

Still active today, MACS, which moved to Northwestern after funding controversies at Howard Brown Health Center in 2010 ( HBHC is now a subcontractor ) , is the longest running study of people living with HIV/AIDS. With nearly 7,000 initial participants, MACS studied the long-term effects of HIV and treatment in gay men. As of 2009, the study enrolled just above 2,500 participants, with several of the participants having passed away from AIDS-related illnesses, or having dropped out altogether.

MACS boasts a number of contributions to the fight against HIV/AIDS including more than 1100 peer reviewed publications, which have greatly increased awareness and understanding of HIV/AIDS.

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