By Jaap Goudsmit
From:
10.1126/science.1259453
22 AUGUST 2014 • VOL 345 ISSUE 6199
publish by AAAS
SCIENCEsciencemag.org
Joep Lange and his partner Jacqueline van Tongeren were among the AIDS experts killed on 17 July 2014 in the downing of the Malaysia Airways plane over eastern Ukraine. They were all on their way to the International AIDS conference in Melbourne, Australia. AIDS was the cause to which Joep dedicated most of his professional life—with inimitable passion, tenacity, and energy. He was my friend for 30 years.
Joep was a Dutch physician, born in 1954 in Nieuwenhagen, Netherlands. He received his medical degree in 1981 from the University of Amsterdam. I met Joep in 1984 on medical rounds at the university’s Academic Medical Center where he was a resident internist and I was the attending virologist. The AIDS epidemic was in its early days then, and Joep was interested in the clinical evolution of HIV infection and how to fight it. In January 1986, the British Medical Journal published his paper published his paper of antibodies to specific viral proteins from the blood of HIV-infected individuals who were progressing to AIDS. Joep then unraveled that mystery and published his findings that same year.
The rest is history. Joep showed that elevated amounts of the HIV protein p24 in the blood of HIV-infected individuals predicted immune deficiency and progression to AIDS, and that long-term survivors had reduced p24 antigen in their blood. This insight supported the early use of antiretroviral drugs to reduce the amount of HIV antigen and postpone the onset of AIDS. The antigen test was later replaced by the more accurate and sensitive HIV viral load test.
There was much comradery in our retro-virology lab at the Academic Medical Center in the 1980s. Joep was the thesis advisor for all but one of the MD-Ph.D. students. Four became professors at leading academic institutions. Joep stayed on at the lab until 1995, turning his attention to exploring technologies to benefit AIDS patients. His clinical vision led to a series of pivotal clinical trials of antiretroviral drugs. The most important of these was the INCAS trial (short for Italy, Netherlands, Canada, and Australia Study), published in 1998. It was a close collaboration between Joep and his new comrades-in-arms, the researchers Julio Montaner, David Cooper, Stefano Vella, and Mark Wainberg. The trial showed that three drugs (nevirapine, didanosine, and zidovudine) reduced the HIV viral load better than two, resulted in less drug resistance, and halted the progression to AIDS. From then on, Joep concentrated on getting triple-drug therapy to all in need, particularly people in the developing world.
Joep’s efforts extended well beyond the lab. He served as president of the International Aids Society from 2002 to 2004 and was chief of clinical research and drug development at the World Health Organization’s AIDS program from 1992 to 1995. He also established the Amsterdam Institute for Global Health and Development with the aim of bringing together disciplines, health care delivery, research, and education in search of sustainable solutions to major health problems.
My wife Fransje van der Waals had her own special ties with Joep. She was his physician as well as a collaborator on programs to improve the lives of people infected with HIV. In 2003, they jointly launched Health[e] Foundation to give health care workers in Foundation to give health care workers in information about HIV and other diseases. By then, Joep had co-founded PharmAccess and other organizations with the aim of wiping out AIDS.
Over the past 10 years, Joep increasingly focused on the fight against poverty and for health care access. He was deeply dedicated to eradicating the global inequality in access to life-saving medicines. Lately, he envisioned a new frontier for himself: the rising tide of noncommunicable diseases in sub-Saharan Africa.
Joep and I connected right away not only in our research interests but through a profound love of literature. We started a project to list the 100 books we loved most, with the rule that adding one book meant having to remove another. It took us 5 years to compose the list. He had a comprehendsive knowledge of all the Russian classics and was fascinated by the absurd and surreal, eastern European writers and Europe between the two world wars. Joep kept this book list alive for 30 years, often giving me books in the hope that the list would be amended. He carried his favorites around with him and loved giving them to friends. His increasing appetite for The New York Review of Books may have hinted at wanting to become a nonfiction writer himself when earlier this year he gave me the book New Ways to Kill Your Mother: Writers and Their Families by Colm Tóibín. It was his final gift to me.
As a passionate person, Joep could be caring and difficult at the same time. He could shout at his loved ones and write offensive e-mails to his best friends. Joep was also enigmatic in his ability to be both meticulous and careless. His research was impeccably executed and reported, and he was fastidious about the wording of manuscripts. Yet, he lost the raw data for part of his thesis in an Amsterdam tram and left the entire manuscript in “an even more improbable place,” from where it was rescued by his mother-in-law.
Joep will be remembered for many things. He was a scientist, clinician, activist, father, opera lover, bird watcher, debater, intellectual, and marathon runner. The only con-solation we have is this: The AIDS fighter Joep Lange died in action on the frontline, with his Jacqueline by his side.
