Seven years ago, John McCarthy woke up from heart surgery with a smile on his face, drawing a puzzled expression from a doctor who expected to see a man in despair.
"I never thought I'd live long enough to have a heart attack," McCarthy told the physician, a Johns Hopkins psychiatrist.
An alcoholic and drug addict, McCarthy had tested positive for the AIDS virus in the late 1980s - when doctors could offer little effective treatment, and many of his fellow drug users were wasting away and dying.
But now, on the 25th anniversary of the first case reports of AIDS, the 50-year-old McCarthy is one of many success stories, a beneficiary of powerful drug combinations that have made the dream of long-term survival a reality.
McCarthy, a former biker who sports a thick mane of gray hair and a bushy mustache, has lived long enough to kick drugs and booze, record songs with a band, counsel other patients and plan for the future.
"This represents the triumph of therapeutic optimism," said Dr. Glenn J. Treisman, the psychiatrist who visited McCarthy after his operation. "Very difficult patients are not untreatable; they are just difficult to treat."
Pharmaceutical development has slowed considerably since the mid-1990s, when three-drug "cocktails" revolutionized the treatment of HIV/AIDS. Even so, the outlook could grow brighter with a one-pill regimen nearing government approval and new classes of anti-viral drugs expected to reach the market in the next two years.
"People are living quite long, and it's a remarkable success story," said Dr. John Bartlett, the chief of infectious diseases at the Johns Hopkins School of Medicine and one of the nation's foremost AIDS experts. "It's remarkable what we now have to offer, and it's extended beyond that into a global health effort."
Still, the epidemic rages around the world - particularly in regions of Africa and Asia, where advanced treatments are just beginning to reach the poor. All told, almost 40 million people worldwide are infected, with millions of children orphaned and some economies in ruins.
Last week, the Joint United Nations Programme on HIV/AIDS reported that the epidemic is slowing down but still outdistancing efforts of public health organizations. Last year, 4.1 million people became infected and 2.8 million died. All told, 21 million have died since the epidemic began.
"The epidemic continues to outpace us," U.N. Secretary-General Kofi Annan told the U.N. General Assembly on Friday. "There are more new infections than ever before, more deaths than ever before, more women and girls infected than ever before."
Today marks a quarter-century since the Centers for Disease Control and Prevention published a case report of five gay men in Los Angeles who suffered from a rare form of pneumonia that strikes only people with ravaged immune systems. The underlying disease would later become known as acquired immune deficiency syndrome, or AIDS.
First, it killed gay men who spread the virus through unprotected sex, then addicts who passed the needles they used to inject heroin and cocaine. Needle-sharing contributed heavily to the HIV/AIDS problem in Baltimore, which by 2004 had the fifth-highest per-capita infection rate in the nation.
"I know whole blocks in East Baltimore where mothers and fathers and grandchildren all shared needles," McCarthy said.
But the virus did not discriminate. Men passed the virus sexually to women, and women to men. Pregnant women transmitted it to their babies. A generation of hemophiliacs perished after contracting the virus from blood products they depended upon to live.
"It was a strange disease," said Bartlett, recalling his first AIDS patient - a female drug user who had lost 60 pounds and quickly died of the once-rare Pneumocystis carinii pneumonia. "The patients were terribly stigmatized. People didn't like the people who got it, either gay men or injection drug users, or they feared they'd get it by being in the same room or touching the same pencils.
"And everybody died."
A test developed in the mid-1980s by Dr. Robert Gallo, a government scientist who now heads the Institute of Human Virology in Baltimore, enabled laboratories to screen blood donations for the virus. It also enabled patients to find out whether they were infected and enter treatment.
McCarthy tested positive six years before the introduction of triple-drug combinations that suddenly transformed AIDS into a chronic, manageable disease that many people could live with.
An employee at a state psychiatric hospital, McCarthy had seen the withered frames and hopeless expressions of patients who battled HIV/AIDS along with their mental afflictions. He watched doctors examine their swollen lymph nodes, and when his own started to "explode under the armpit, in back of my skull, under my throat, behind the knees," he knew what was wrong.