Jeff Getty in 1996

Jeff Getty: Lessons in desperate measures By Gail Dutton

Steven G. Deeks has been known for gutsy approaches, starting in the dark days of the mid-1990s. "1993 was the low point, the worst, of the epidemic," Deeks remembers. "Everyone was dying." His first day in the clinic coincided with the release of a major clinical study, the Concorde study, which investigated the use of early AZT therapy in 1,749 asymptomatic patients and showed that it didn't work. Little was forthcoming by way of replacements. Hospices and hospitals were full, Deeks says. "So we got very, very desperate."

In 1994 Deeks got involved with the Dobson Project, a West coast immunology think tank that activists had founded. Based on lim-ited evidence, a multicenter group, including Deeks and Dobson Project member Paul Volberding (now at San Francisco Veterans' Administration Medical Center), performed a bone marrow transplant from a baboon into AIDS activist Jeff Getty in December 1995. The goal was to transfer the baboon's natural HIV resistance to Getty.

"This was of the moment," recalls Volberding, "It was very novel, and I'm proud we were crazy enough to do it."

Getty was 38 years old at the time, and with advanced AIDS he had failed to respond to triple-drug antiretroviral therapy. Preparing Getty to receive and not reject the bone marrow required further suppressing of his immune system. "That was risky because, having advanced AIDS, he didn't have much immune system to begin with," says Deeks.

Getty's viral load declined 1.5 logs and remained low for 11 months, but ultimately, though he lived another decade, it didn't work. Few of the baboon cells survived even one month after the transplantation. "In hindsight, we believe the clinical improvement in the patient's status had nothing to do with the bone marrow and everything to do with the preparation," Deeks says. In suppressing what remained of Getty's immune system, "we think we improved one aspect of the immune system which is actually very pathogenic in pa-tients with HIV: T-cell activation."

The radiation therapy that suppressed Getty's immune system reduced all his T-cell activation. This was one of the first signs that generalized immune activation may have been driving disease progression in patients on antiretroviral therapy.  It formed the basis for much of the subsequent SCOPE work focusing on T-cell activation.¹ That work is still being talked about, "but it hasn't progressed a lot," Volberding says.

"In January 1996, one month after Getty's xenograft, the entire [attitude] changed from one of widespread pessimism to widespread optimism," when data from the first triple-drug cocktail was introduced and put into clinical practice at SFGH.