Meeting Lays Bare the Abyss Between AIDS and Its Cure
By ANDREW POLLACK,
Published: August 12, 1994
YOKOHAMA, Japan, Aug. 11— The 10th International Conference on AIDS ended here today with no major breakthroughs reported and with the world's researchers still far from defeating the foremost new medical threat of the decade.
Meanwhile, the epidemic marched on.
In the five days it took to conduct the conference, an estimated 41,000 people around the world became infected by the virus that causes the disease.
The grim statistic underscored the gap that became more evident this week between the rapidly spreading epidemic and the slow pace of progress in fighting the disease. Neither cure nor vaccine is expected by the end of the decade.
But as the conference ended today participants said they could take some solace in the belief that painstaking advances are being made in basic science. Eventually this may set the stage for a new assault on the disease.
"There's obviously some fatigue," Don de Gagne, a representative of the Global Network of People Living with H.I.V./AIDS, said today at a news conference. "There's nothing new. I think we have to acknowledge that. But we have to acknowledge that we're moving in small steps, in increments, and that is positive, too."
A mood of realism at this meeting evolved from the profound pessimism at last year's conference in Berlin, where results of clinical trials showed that AZT, the main AIDS drug, provided a limited benefit for a limited time.
When the first AIDS conference was held in 1985 in Atlanta, there were 9,285 cases of AIDS in the United States. Now there have been 402,000, with 243,000 deaths, according to the Federal Centers for Disease Control and Prevention.
Around the world, four million people, including those who have died, have developed AIDS, according to the World Health Organization. It estimates that about 17 million people have been infected with H.I.V., 3 million in the last year alone.
"We are only at the beginning of the H.I.V. epidemic in the world," said Dr. James Curran, associate director for H.I.V./AIDS at the Centers for Disease Control and Prevention.
With a cure or vaccine far off, prevention is the best course, many experts said, especially in Asia, which is expected to become the new center of the epidemic.
Dr. Michael H. Merson, head of the World Health Organization's AIDS program, said that half the infections in Africa apparently occurred in the first four years of the epidemic.
"In places where the epidemic is just moving into the early explosive phase -- like much of Asia -- the overriding need is to act now, without delay, to prevent or blunt the rise in infections," he said. Dr. Merson said that five million infections could be avoided in Asia by the year 2000 for an expenditure of $1.5 billion a year.
But even in prevention, one expert said, the approaches tried until now -- sex education, condom distribution, protecting the blood supply and so on -- have been inadequate. Courageous Yet Insufficient
"The gap between the expanding pandemic and the global response is growing -- rapidly and dangerous," Dr. Jonathan M. Mann, professor of epidemiology at the Harvard School of Public Health, said in a speech. "It is now evident to all that while the first period, the first global AIDS strategy and all our work based upon it, was courageous, extremely important and necessary, it is also manifestly insufficient to bring the pandemic under control."
Dr. Mann said what is needed is to go beyond traditional public health approaches to attack the underlying societal factors that contribute to the spread of AIDS: discrimination, poverty and lack of education.
As an example, he said, in some African nations women do not have the power to demand that their sexual partners use condoms. And divorce is nearly impossible because women get no property when a couple splits. He said a group of women lawyers in Uganda are trying to have the divorce laws changed as a way of fighting AIDS.
On the medical side, there are some obvious priorities. For therapy, a hope is that a new class of experimental anti-viral drugs called protease inhibitors can be developed and used in combination with existing AIDS drugs. Early data presented at the conference showed that this approach had promise but the data were too scanty to prove conclusively it would work, and researchers cited many potential problems. The Few Who Remain Well
But beyond that, scientists are now trying to explore further how the virus wreaks havoc on the immune system and whether the immune system can be made to fight back. The immune system, they say, is normally the best virus killer.
In a presentation today, for instance, H. Clifford Lane of the National Institutes of Health presented data showing that early treatment with interleukin-2, an immune system booster, helped restore in patients the type of blood cell that is killed by H.I.V.
To learn more, scientists are carefully studying the small percentage of infected people who do not seem to get sick, even after 12 or more years. "It's very clear there's a group of people for whom it was not a death sentence," said Susan Buchbinder of the San Francisco AIDS Office, who has followed a group of such survivors.
Besides the medical clues that such people may hold, there could also be a long-term change in society's attitudes toward the disease and infected people if AIDS comes to be regarded as an illness that is not invariably fatal. Long Road From Lab to Life
But what is happening in the laboratories now is likely to have little impact on most people with AIDS, either because the treatments will not be available soon enough or because people cannot afford them.
"We're doing elegant molecular biology and nice clinical studies, and what we're doing is irrelevant for 95 percent of the infected population," said Mark A. Wainberg, director of the McGill AIDS Center in Montreal.
Researchers said that the most promising medical development in the last year has been the finding that use of AZT can sharply reduce the chances that pregnant women infected with the AIDS virus will pass it to their babies. This week, the United States Food and Drug Administration approved an addition to AZT's label endorsing its use by pregnant women.
But AZT is too expensive for use in the developing countries, where the vast majority of women infected with H.I.V. live.
"The young infected woman in Africa is asking this question: When, where, how does she access this wonderful breakthrough?" Noerine Kaleeba, a representative from Africa, said in an emotional farewell address to the conference.
Even in developed countries, the recommended treatment requires medication for many weeks late in pregnancy, then during delivery, and then treating the baby for six weeks. That will be difficult for many women who do not have medical care throughout pregnancy.
"The regimen is totally impractical for any country," said Dr. Peter Piot of the World Health Organization. The agency is hoping to develop a method of providing treatment only during delivery, perhaps using a drug more powerful than AZT.
In recognition of the slow medical progress, the AIDS conference will now be held every two years instead of annually, with the next meeting set for Vancouver, British Columbia, in July 1996.