OPTIMISM DOMINATED the recent gathering of 15,000 AIDS scientists and health professionals in Vancouver, British Columbia, and for good reason. For the first time, there is more than a glimmer of hope that the damage done by the HIV virus can be dramatically reduced to the point that death is not an inevitable consequence.
Still, there is no cure. But some of the research holds enormous promise to turn AIDS into a manageable, treatable condition. The most notable advance is a three-drug "cocktail" that includes a "protease inhibitor" to block an enzyme critical to the reproduction of the HIV virus. With early and aggressive treatment, scientists think this combination could reduce viral concentrations to undetectable levels.
It is an encouraging advance in the 15-year war on AIDS. Many infected individuals might quite literally get a new lease on life.
Yet there are major problems. Research on the three-drug combination is still in its early stages. Will the cocktail's potency be permanent or temporary? The drugs' toxicity could limit the time an AIDS patient can stay on this regimen. And there's always the chance these clever viruses will find a new way to mutate into a drug-resistant strain.
Then there's the cost: $15,000 to $20,000 a year -- not counting related therapy. Few of the 22 million HIV-infected people in the world can afford this life-extending treatment. Ninety percent of them live in poor countries.
Some AIDS experts, such as Johns Hopkins's Dr. John Gill Bartlett and University of Maryland's Dr. Robert Redfield, warn of unrealistic expectations. Many people won't be able to adhere to the rigorous treatment schedule. Severe side effects pose a risk, too.
Finally, this approach does nothing to stem the AIDS epidemic. In fact, it could worsen matters as people resume engaging in high-risk sexual and drug behavior under the mistaken impression that AIDS is no longer a killer.
We haven't reached that point yet, although Dr. Robert Gallo of Baltimore's Institute of Human Virology, is one of several scientists working with natural substances called cytokines -- chemical signals sent out by many cells -- which they hope to turn into powerful agents against HIV infection. They seek natural defenses that don't have intolerable or toxic side effects. Their quest for a "silver bullet" may be a long way off -- but they're getting closer.
Pub date: 7/17/96