Jacques Leibowitch

Jacques Leibowitch (1 August 1942 – 4 March 2020 ) was a French medical doctor and clinical researcher known for his contributions to the knowledge and treatment of HIV and AIDS, starting with his initial designation of a human retrovirus as the cause of AIDS, and his ground-breaking use of triple combination therapy for the effective control of HIV in the patient.

A practicing physician in the infectiology department of the Raymond Poincaré University Hospital of Garches (directed by Prof. Christian Perronne, AP-HP), University lecturer Emeritus, he led the treatment program ICCARRE that proposes a dramatic reduction of weekly anti-HIV drug intake, down to 2-3 anti-viral pills a day taken 2 to 3 or 4 days a week, as opposed to the presently recommended seven days a week, as still universally prescribed.

Jacques Leibowitch did his medical studies in Paris (1960–1968), and did his physician training at the AP-HP hospitals (1969–1979) where he majored in clinical immunology, notably at the Necker hospital under Professor Jean Hamburger.

He acquired his initial experience in research in 1962 at the Bellevue Hospital of New York, later returning to the United States for a Post-doctoral research program at Harvard Medical School (Pr John David, Robert Brigham Hospital, Boston, 1970–1972), where he studied cellular immunology.

On his return to Paris, he finished his internship and went on to research Human Complement Biology at the Royal Hammersmith Hospital, London as post-graduate medical registrar (Pr Keith Peters, 1973–74), before undertaking his senior residency in nephrology at Necker, entering the Raymond Poincaré hospital at Garches as immunology assistant lecturer (1980).

Jacques Leibowitch published many articles in international scientific journals.

The contributions of Jacques Leibowitch have marked the history of HIV and AIDS and their treatment:

Jacques Leibowitch was at the center of the research on AIDS since the original outbreak of the epidemic, from the very moment when the investigation on its causative agent was launched.

When the first series of AIDS cases in the United States were published in the New England Journal of Medicine and the Lancet in December 1981, Leibowitch noticed the similarity between the cases described in the United States and the historic case of a multiple-opportunistic infection syndrome in a Portuguese resident in Paris who had spent time in Angola and Mozambique between 1973 and 1976.

He was then contacted by Willy Rozenbaum in March 1982 to set up the informal French Working Group SIDA, a self-nominated body to analyse the cases appearing in France.

When in July 1982, the first cases of AIDS appeared in hemophiliacs receiving highly filtered blood samples, the scientific community realized that AIDS was most likely caused by a virus.

Jacques Leibowitch noticed some intriguing similarities between AIDS and the pathology linked to HTLV (Human T Cell Leukemia Lymphoma Virus), the only known human retro-virus at that time.

Both situations affect CD4 T helper lymphocyte cells.

HTLV induces the massive proliferation of one or several clones and their cancerization, whereas the other virus, the HIV virus tends to eradicate these cells without apparent discrimination.

Leibowitch, informed by the Franco-American literary author Gilles Barbedette of the announcement by Robert Gallo in Medical World News (1 August 1982) that an HTLV type retro-virus could be the cause of AIDS, found in that most succinct brief the profile matching his CD4-tropic exotic viral suspect (in Grasset, Ballantine Books, works cited).

The retro-viral inspiration was thus consolidated and opened between Bethesda (Gallo) and Paris (Leibowitch et al.) from August 1982 onwards.

Failing to find in the Paris team of Professor Jean-Paul Lévy or the Lille team of Dominique Stéhelin a French retro-virus specialist eager to pursue this line of investigation, he contacted upon a recommendation by Jean Paul Lévy Professor Robert Gallo in Bethesda, the then world-renowned virologist on HTLV.

It was then in November 1982 that Gallo informed him from Bethesda of his initial virology findings in keeping with the AIDS HTLV-type virus hypotheses.

For his part, Willy Rozenbaum, warned in private by Leibowitch that an exotic HTLV-type retrovirus could well be the cause of AIDS, embarked upon a discreet collaboration with the Luc Montagnier team of the Pasteur Institute.

Montagnier, along with his collaborator Jean-Claude Chermann, had just recently received news of the HTLV and AIDS hypotheses by Dr Paul Prunet, the then director of « Recherché & Développement » at Sanofi-Pasteur-Marnes La Coquette, where Leibowitch had given a speech at the end of November 1982.

Also, Jacques Leibowitch was the first in France to collect sequential cell specimens from individual patients at follow up, preserving living cell samples at extremely low temperatures since 1982.

The Montagnier team subsequently detected in the cell culture of patient BRU the traces of the first non HTLV retrovirus in January 1983, a virus eventually recognized as the cause of AIDS thanks to the conclusive additions by Robert Gallo and his group (April 1984) Regarding Chronological Summary of Experiments Leading to the Isolation of HTLV-III from AIDS and ARC'' sur le site de la Jon Cohen AIDS Research Collection, 2 pages.

In 1984, while Luc Montagnier was working at the Institut Pasteur on an industrial test for HIV antibodies, Dominique Mathez and Jacques Leibowitch were working at Garches to elaborate a working test on tumour cells infected by the HTLV-III given to them by Pr Daniel Zagury at Paris University on behalf of Robert Gallo.

Using this craftsman test, Mathez and Leibowitch discovered a disturbing frequency of individuals contaminated by the retro-virus amongst the polytransfusion recipients, and later, in collaboration with Dr François Pinon, head of transfusions at the Cochin hospital, go on to discover, the alarming proportion of HIV positive blood donors (1 in 200) in a pilot study carried out on 10,000 donors in the Paris and Ile-de-France area.

Otherwise, these two pathological descriptions are present in both Africa and the Caribbean (see A Strange Virus of Unknown Origin Jacques Leibowitch, Ballantine Books, New York, 1985, translated from Un Virus Etrange Venu d’Ailleurs, Grasset Paris 1984).

Indeed, in both Paris and Brussels, doctors had seen cases of patients having lived or spent time in Francophone Africa or in Haiti who suffered from a disease with an undeniable resemblance to that arising at the time in the United States in "immuno-deficient homosexuals".

The health authorities were alerted on this issue together with their dramatic consequences for hemophiliacs (« if the Cochin Hospital study is correct, then all anti-hemophiliac stocks are contaminated … », Jean Baptiste Brunet at the French General Directory on Health, Mars 1985 13 ).

It was thanks to this artisanal test that 50 HIV positive blood donations, established then to be 100% contaminating, were taken out of the transfusion process, and 150 potential receivers of this blood were protected from contamination.

At Garches, Dominique Mathez and Jacques Leibowitch developed a sophisticated and reliable biological test enabling them to quantify active HIV virus levels in patients both before and during their antiviral treatment.

Indeed, from 1987, patients in France most affected by the virus receive AZT treatment in the hope that this molecule might block the reproduction of the virus.

It was with the aim of monitoring the progressive decline of virus levels in the treated patient that the team at Garches worked on their method.

Leibowitch presented to world specialists assembled for the conference at Marnes la Coquette (Pasteur-les Cent Gardes symposium, November 1989) his results showing that the AZT monotherapy becomes quickly ineffective as demonstrated by returning viral levels in the treated patient, though in the first month such levels were significantly, yet only transiently, reduced.

The measuring of HIV viral levels is later to become, in its commercial and industrial version, the universally used test to follow the development of the virus and the effectiveness of various treatments.

These reduced medical dosages are adequate, necessary and sufficient according to the results of his exploratory clinical research carried out since 2003.

He is the author of the books "Un virus étrange venu d'ailleurs" (A strange virus of unknown origin), and "Pour en finir avec le sida" (Putting an end to AIDS).

In a letter to the prestigious magazine Nature Medicine in 2003, as well as in his Nobel Prize acceptance speech in 2008, Luc Montagnier recognized Jacques Leibowitch as being the initiator of the retro-virus hypothesis in France.

However, the patented list of the discoverers of AIDS and HIV do not take Jacques Leibowitch into account for his contribution in the initial phases of the discovery.

The scientific historian Mirko Grmek reflects back on the details of the stages that led to the discovery of the AIDS virus in his work "the History of AIDS" and the Jon Cohen AIDS Research Collection contains numerous archived documents on the subject.

The book "Sida.O" (AIDS.O) written by D. Lestrade and G.Pialoux contains also many details on the history of AIDS.

Luc Montagnier and Françoise Barré-Sinoussi received the Nobel Prize for Medicine in 2008 for their work.