2023-11-30 17:20:00
In 1983, Jacques Reynes was a young intern in the infectious diseases department of Montpelllier University Hospital. Today an emeritus professor, the doctor remembers these dark years, those of the “panic virus”, said the weekly Le Point. You have to wait three years for people to talk regarding HIV.
World AIDS Day
Where are we in HIV research? For three days, the Pasteur Institute, which identified the AIDS virus forty years ago, with a Nobel Prize to boot for Luc Montagnier and Françoise Barré-Sinoussi in 2008, has been paving the way for tomorrow in Paris. Objective: to eradicate the disease. If it no longer terrorizes, it affects at least 39 million people around the world, recalls the WHO on the occasion of December 1, World AIDS Day.
You were a young doctor when the first cases of AIDS appeared…
I started my internship in 1980. The first identified cases of AIDS arrived in 1983, there were undoubtedly some before, they were retrospectively linked to HIV. It was at this time, in 1983, that the search for serology began (Editor’s note: the identification of antibodies caused by the infection). It was found in 1984 and marketed in 1985. I was able to benefit from it before, and I devoted my thesis to the pathology of hospitalized intravenous drug addicts, and there were both pathologies linked to drug addiction (bacteria, septicemia…) and the first cases of HIV.
This first French serological study showed that half of the drug addicts using intravenous injections who were hospitalized were HIV positive. The tubes of blood were brought to Françoise Brun-Vezinet at the Bichat hospital in Paris, in conditions that would no longer exist today…
That’s to say ?
I took the plane with, in my schoolbag, tubes of blood, half of which were HIV positive!
In 1985, I was assistant clinical head in a team of infectious disease specialists which was not too focused on HIV. I undertook the first specialized consultation at Gui de Chauliac, then I opened day hospitalization, then I created home hospitalization…
How did you view these patients?
They arrived in a very deteriorated condition, with serious infections dominated by lung infections and eye infections that made them blind. There were also digestive problems with germs linked to severe immunodepression, and very severe diarrhea which dehydrated them. The virus remained latent for ten years, before it manifested itself as an opportunistic or cancerous infection linked to AIDS such as kaposi.
My office was in the middle of the floor where the sick ended their days. We had an entire floor, 25 beds of AIDS patients, and at the height of the epidemic, we had two deaths per week, more than 100 deaths per year.
It was a mental burden for the nursing team, doctors… and at the same time, I did research on treatments, and I quickly trained doctors. I created one of the first university degrees on HIV.
“It was desperate, and at the same time a big challenge”
What was the atmosphere of the time, the panic? In 1985, the weekly Le Point spoke of a “panic virus”…
No ! We still had treatments and we were focused on the effort to treat these opportunistic infections, without being able to stop them. We went from one to the other. The drug treatments were heavy, and there was also a risk of contamination if you were pricked; caregivers had to take a lot of precautions.
It was quite desperate and at the same time a big challenge because we managed to save lives. Then, with the arrival of antiretroviral treatments, we saw people getting back on track, with a restored immune system… but we had to wait until the end of the 90s.
From the first cases, do you have the feeling that you are facing something unknown?
The virus was identified fairly quickly. But there weren’t many operational teams for this support. The infectious disease services were very involved, a bit like they were for Covid.
When you are in a service where so many people die, how do you cope?
The team was united, but what was quite disturbing was that we saw young people dying who were our age, or just a little older, 30-45 year olds.
“I fought to recover molecules that were not marketed, we saved people with them”
Do you remember any of these patients?
Of course. And there are some who are still alive. I have patients who have proven AIDS with kaposi and serious infections, who have been rescued. I have followed them for more than thirty years and they have benefited from all the successive treatments, sometimes with the toxicity of these first treatments. They sometimes have following-effects, such as lipodystrophies (Editor’s note: a complication of triple therapy which manifests itself in the accumulation of fat on the arms, legs, stomach, neck, etc.).
We had patients of all conditions. The artistic community was very affected. You know some of these Montpellier residents that we supported.
Like the choreographer Dominique Bagouet…
Oui.
Was there some form of inevitability?
Yes. In Montpellier, it was especially the gay community that was affected. We have not really been confronted with the problem of migrants. They were often cultured, intellectual people… and the gay community was very involved, came to support the sick, they were present at the hospital. There were a lot of emotional things. Families who were rejected and others who accompanied these young children.
The funerals were poignant, relatives of the deceased were ill, they knew it…
And then there was cohesion, trust, hope. We allowed people to live a few months, a few years. It was quite different from the oncology of a certain era. At the height of the epidemic, we began to see the arrival of new molecules, to use antiretrovirals, it was a race once morest time to have these treatments. I fought to recover molecules that were not yet commercialized, we saved people with them.
Here we are in the 90s…
Oui.
“Our first patients often have pathologies linked to aging”
And today, the audiences have changed, migrants are on the front line…
The profiles of patients are quite diverse in Montpellier. What has fundamentally changed is that the number of people treated for prevention, particularly through PreP, without completely eliminating the risk of being ill, is at the level of the number of people followed for positive HIV, our historical patients who have experienced complicated periods and who are aging.
These people often have pathologies linked to aging, are isolated, and are in a difficult psychological and sometimes social situation. We age faster following illness.
So you don’t have a migrant problem?
Not as much as in Toulouse, Marseille, Nantes, and let’s not talk regarding Paris.
But we see that this community, whether it comes from Sub-Saharan Africa, the Maghreb or Latin America, has other problems in relation to the disease. There are difficulties of stigmatization, of things left unsaid…
There have always been some in this disease…
Yes, but what is different is that when we were in an epidemic situation, the gay community united around the sick, everyone was concerned. Today there is much less solidarity.
And today there is yet another sociology of patients, who practice chemsex, who are faced with another addiction problem.
Are there still dedicated infectious disease beds for patients?
In the department, we always welcome people who are sometimes at advanced stages of infection. But there are no dedicated beds. There is no particular problem, except that the caregivers who lived through the AIDS years, who have a history of the serious pathologies of the time, are in the process of retiring. Our teaching mission is to transmit what we know.
What are the major turning points in the epidemic, in your opinion?
1983, the discovery of the virus then the arrival of triple therapies in 1995-96, a move towards less and less toxic treatments, and for three or four years, PrEP (preventive treatment which prevents the virus from developing in people who take risks).
“My patients want to remain discreet, personalities are followed, with my blessing, outside the hospital”
Is your active queue decreasing?
No, we are still monitoring 2,000 people in the infectious disease departments of Montpellier University Hospital. The hospital remains a recourse for “old” patients, who have complex pathologies, which general practitioners do not want to follow… and we always have new entrants.
You have experienced other epidemics, Covid at the end of your career. Are the AIDS years special?
Yes, because they cover several things. It was a new virus for which there was no immediate treatment. It has affected communities that have been ostracized and stigmatized. Finally, he had a combination of the viral attack and complications linked to immunosuppression. We were on several fronts. Everything went much faster for Covid, even if there is the problem of long Covid. There is no societal dimension.
But AIDS has caused virology to evolve very significantly, all molecular biology techniques have progressed with HIV and benefit other infectious pathologies.
What I experienced was very, very strong. We fought, we didn’t win on every level, but we were useful.
We easily talk regarding the disease today, Gérard Collomb, who has just died, had communicated regarding his cancer, like Florent Pagny, Johnny Haliday…?
My former patients are having a lot of trouble. I have a very special relationship with them, I am often their only contact. They are often in isolation. And there are personalities who don’t want to talk regarding it.
Do you have people in your active queue?
…some are followed, with my blessing, outside the hospital to remain discreet.
1701408936
#young #patients #die #looked #Jacques #Reynes #remembers #early #days #AIDS #Montpelllier
