Dr. Gordon Crofoot’s Lifelong Leadership in the Fight Against HIV

Dr. Gordon Crofoot, one of Houston’s preeminent HIV medical practitioners, has been treating HIV-positive individuals, performing groundbreaking research, and informing the world about the disease for over four decades. “Even before medical practitioners knew what it was, we were treating it,” Crofoot says. “In 1975, we were losing patients to pneumonia for reasons we didn’t yet understand. The impact of HIV infection wouldn’t be known until the discovery of the virus and the first blood test became available.”

Crofoot once tested 1,000 people during a 30-month period. “I kept those results in a handwritten notebook,” he says. “This protected patients, their jobs, their insurance, and their families.”

Parisian Dr. Luc Montagnier discovered the virus in 1984. Prior to that, says Crofoot, “We didn’t have a name for it, and our main concern was we didn’t know how it was transmitted. As a gay male, I was worried about the risk of acquiring it from my patients. Even when the test was available in 1985, I waited eight months to test myself.”

Thus began an adventure for the young physician—one not without risks, challenges, and sacrifice. “I’ve had federal agents show up at my door,” Crofoot says, “investigating what they thought were illegal prescriptions for medications unavailable in the US. Somehow, I escaped arrest.”

Other barriers originated from within the medical community itself. “I was told by one hospital administrator not to admit HIV-positive patients,” Crofoot says. “I tendered my resignation, called another facility, and received admitting privileges for myself and four other colleagues the very next day.”

As the epidemic grew in scope and seriousness, Crofoot shifted his focus away from general medicine and opened his own practice. “I went out on my own in 1980. I’ve always wanted to be creative, and fortunately I worked with a group of very good physicians. We ran our clinic together, collaboratively. Physicians practicing today are constrained by established standards of care and are very closely monitored. I’ve never wanted to be in a situation where I was told ‘No, you can’t do that,’” Crofoot says.

HIV testing was still unavailable in 1980, but physicians were seeing a constellation of opportunistic infections and severely immunocompromised patients. For Crofoot, this work became personal. “My first and second partners both died of HIV. I knew that I wanted to care for patients, not just give test results. From a medical perspective, this disease was interesting and challenging,” he says. 

The previously uninteresting fields of immunology and virology had suddenly sprung to life. Researchers and physicians—and especially a nationwide cohort of gay doctors—became intensely curious about the pathology and treatment of HIV.

“We didn’t know much about the science of the immune system,” Crofoot says. “We realized it was a viral illness, but we didn’t understand it, and there were no drugs to treat it. Buyers clubs and other groups started going out of the country to find medication to treat the secondary infections. A young doctor now would never think to rent a bus, teach grandmothers how to cross the border into Mexico, get experimental drugs, hide them in their boots, and teach others how to take them. We did all of that!”

In 1998, the Montrose Clinic (now Legacy Community Health) asked Crofoot to be its medical director. At that time, the clinic was focused on the diagnosis and treatment of sexually transmitted infections as well as HIV testing. Crofoot was intrigued, thinking the work would be engaging and interesting. “I wanted to work towards running a nonprofit clinic like a private doctor’s office,” he says.

Crofoot’s major accomplishment came when he launched the Ryan White Title I program for newly diagnosed individuals, creating a new model for community-based HIV chronic care, now the primary activity of a much larger and enhanced clinic.

Decades later, Crofoot now inhabits a radically transformed clinical landscape. He currently manages the Crofoot MD Clinic, which is focused on LGBTQ  healthcare; the Crofoot MD Foundation, which advances medical research, accessibility, preventive care, and cutting-edge technology; and Crofoot MD Research, a national leader in innovative medical research.

Through his participation in more than 200 clinical trials (for every single approved HIV medication), he has established himself as a thoughtful and ingenious practitioner. Through the Crofoot MD Research Center, he is again at the forefront of HIV treatment as a clinician and author for the novel capsid inhibitor Lenacapavir. Crofoot has been involved in the research and development of this drug since its  2015 FDA Phase One protocol, administering the first injection of Gilead Sciences’ new molecule into someone with HIV.

“I initially never wanted to go into academic research, present a lecture, author a paper, or get more letters behind my name,” Crofoot remembers. “I wanted to do clinical, hands-on medicine. Then, suddenly, we had patients who became very sick, and the only treatments we could access were experimental. So I was sort of forced into the realm of research in order to provide my patients with the best available care.”

As more drugs entered the treatment pipeline, Crofoot’s clinics became experts in the mechanisms and methodology of clinical trials and research. “We have been highly involved in the approval of, and access to, new medications,” Crofoot says. “It’s been increasingly more exciting to be involved in the process. It’s a very difficult area of medicine, but we’ve been able to do it very well.”

Crofoot has been involved in the development of capsid inhibitors since their discovery. “It’s interesting how research that was done eight years ago gets shelved and then reappears,” he says. “Capsid inhibitors were difficult to manufacture, and there’s been a lot of study on them. The chemist from Gilead and I discussed this drug for hours one night in San Francisco at the principal investigators’ meeting for Lenacapavir.”

“I administered it to the first patient in the world seven and a half years ago at my little research center. I was thinking, ‘This has never been given to someone with HIV, but it could be a wonderful treatment.’ I was anxious to do it, and I was definitely going to be involved in the study.”

Research for any new drug has to answer two distinct questions: firstly, is the drug safe? Secondly, is the drug efficacious? “We discovered that Lenacapavir was safe,” says Crofoot, “and we subsequently found that it was effective for a very long time, with only two doses per year at six-month intervals—something that was simply amazing.”

Crofoot soon after co-authored an article in Nature magazine, which led to the drug’s approval by the FDA. The journal Science named the approval of Lenacapavir its 2024 Breakthrough of the Year.

“Now we have an ‘every-six-months’ drug—that sounds great,” Crofoot says. “It became evident, as with other antiviral drugs, that monotherapy treatment with Lenacapavir wasn’t effective, that it had to be combined with other agents in order to prevent the development of resistance.” Even with that limitation, Crofoot asserts that Lenacapavir still represents a milestone in HIV treatment.

Subsequently, Lenacapavir was investigated around the world as a pre-exposure prophylaxis (PrEP)—that is to say, a preventive treatment for HIV infection. It evidenced astonishing effectiveness among men, transgender individuals and, importantly, among pregnant women. “For the FDA to seriously consider a new usage, they need data and a published manuscript from a highly peer-reviewed journal,” Crofoot says. “I was co-author of an article in the New England Journal of Medicine—exactly what was required. Two months after publication, the FDA fast-tracked approval. 

As with every new HIV treatment discovery, access and cost always present significant challenges worldwide. “Gilead is already working to develop generic licensing in developing countries, but in the US, there’s still a financial barrier. They’ve been developing economic guidelines to help with access, but it’s still difficult,” Crofoot says.

Epidemiological benefits from this treatment are immense, especially within the gay MSM community. If an entire generation of sexually active individuals could take this drug, it has the potential to be revolutionary. In order to “break” the epidemic, physicians need a way to prevent a person from acquiring HIV, a way to effectively suppress the virus in a person with HIV, and a way to prevent a person from transmitting HIV to someone else. Each of those components is now available.

“Preventive programs—PrEP—will prevent anyone from getting HIV,” Crofoot says. Lenacapavir represents a significant level of protection for HIV-negative individuals. Additionally, he indicates, there are numerous drug combinations to ensure viral undetectability, preventing transmission to others. “If we can achieve both of these things, you are finally hearing the ‘cure’ word,” Crofoot says.     

At the recent 2025 International AIDS Society conference, the World Health Organization recommended injectable Lenacapavir as PrEP for HIV infection. This, combined with expanded access to rapid HIV tests, could radically shift the trajectory of the epidemic worldwide.

“Unfortunately, we’re not able to access these components in much of the world right now,” Crofoot says. “Ninety-two percent of HIV treatment in the world is funded by America’s PEPFAR program. Much of that has been halted by recent political action and the subsequent dismantling of international aid infrastructure.”

As a result, entire nations are now completely cut off from treatment. This means infected men can’t get medication, increasing transmissibility, and women cannot get PrEP, multiplying their own susceptibility to HIV.  Without maternal medications, 33% of children born to HIV-positive mothers will contract HIV. Additionally, if both parents remain untreated, they will eventually leave children orphaned. “We saw this exact situation in the 1980s,” Crofoot says.

In spite of this, Crofoot remains optimistic about the future. “Recently, the World Health Organization removed HIV from its list of fatal diseases,” he says. He also compares current treatments to a preventive “near vaccine” for HIV. “It’s not a vaccine, I can’t call it a vaccine, but for the first time we are in sight of a cure.”    

At 77, having practiced medicine for 51 years, Crofoot’s life is full of professional and personal successes. He decided, late in life, to father and raise two young sons with his husband of 20 years. “Love and science,” he believes, “are both about the future.”   

For more info, visit crofootmd.com.