Spencer Cox, an AIDS activist whose work with a cadre of lay scientists helped push innovative antiretroviral drugs to market, creating the first effective drug protocols to combat the syndrome, died on Tuesday in Manhattan. He was 44.
His death of AIDS-related causes at the Allen Hospital in Upper Manhattan was confirmed by his brother, Nick.
Mr. Cox was a prominent voice in the fight against AIDS for more than two decades. After three years as a student at Bennington College in Vermont, he moved to New York. By 1989, at age 20, he had joined the AIDS Coalition to Unleash Power, better known as Act Up, the organization devoted to pushing government and private industry, often with demonstrations, sit-ins and other tactics, to dedicate more resources for AIDS treatment and prevention.
In 1992, he was among the Act Up members who formed the Treatment Action Group, known as TAG, to focus on accelerating treatment research.
Along with other TAG colleagues, Mr. Cox schooled himself in the science of AIDS, the workings of drug trials and the government approval process. While still in his 20s he represented people with AIDS in high-level meetings with the Federal Drug Administration and other agencies and private companies.
“You can’t understand how incredibly scary it was for him to sit down at the table of the F.D.A. Anti-Viral Advisory Committee as the ‘P.W.A. representative’ and take on the scientific establishment,” David Barr, an original TAG member, wrote in a Facebook post about Mr. Cox. He added: “It took incredible courage and a whole lot of arrogance. You need to understand how lonely it was to sit at those tables, how much you felt like a complete fraud, yet also right and right to be there.”
In 1995, when antiretroviral drugs known as protease inhibitors began to show promise for treating AIDS patients, Mr. Cox designed a human drug trial for one of the earliest, ritonavir, which was being developed by Abbott Laboratories. The trial created two groups: one would continue taking the medications already prescribed by their doctors and receive a placebo, the other would continue on their medications and also receive ritonavir.
The plan was controversial because no one wanted to receive a placebo, and many AIDS patients and activists believed the best course of action was to approve the drug first and test later. Mr. Cox’s design, however, allowed for both speedy data gathering and a relatively accelerated approval process.
After six months, those on the ritonavir had half the mortality rate of those on the placebo; the drug was approved on Feb. 28, 1996. The next day, a rival drug developed by Merck, indinavir, was approved as well.
“Spencer pushed for data-driven decisions,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview on Wednesday. “He wanted the facts and was always very meticulous about getting good data rather than just screaming for getting something approved. It’s a great loss. He was part of a historic group of people.”
Patrick Spencer Cox was born in Atlanta on March 10, 1968. His parents, Jerry and Beverly, were both accountants. At Bennington, he studied theater and literature and aspired to be an actor and playwright. He discovered he was H.I.V. positive shortly after arriving in New York. His mother and brother survive him.
A young Mr. Cox can be seen in the documentary about Act Up, “How to Survive a Plague.” In recent years he wrote on AIDS issues for POZ and other publications, and founded a short-lived organization called the Medius Institute for Gay Men’s Health, which was concerned with issues faced by gay men as they grow older, among them loneliness, depression and substance abuse.
Mark Harrington, the executive director of TAG, said Mr. Cox himself struggled with an addiction to methamphetamines. Some months ago, he said, a despairing Mr. Cox had apparently stopped taking his medication.
“He saved the lives of millions, but he couldn’t save his own,” Mr. Harrington said.