Chicago Tribune (CT) - THURSDAY June 2, 1988 Edition: SPORTS FINAL Section: NEWS Page: 1 Word Count: 842
Jon Van, Chicago Tribune

The strongest criticism in the institute's report was aimed at the government's failure to provide treatment for drug abusers, who are most likely to transmit the human immunodeficiency virus (HIV) to heterosexual partners and to their own children.

"The gross inadequacy of federal efforts to reduce HIV transmission" among drug users who become infected by sharing contaminated needles "is now the most serious deficiency in current efforts to control HIV infection in the United States," the report said.

"Waiting lists for entry into treatment programs are a clear indication that the caliber of the ammunition in the war on drugs needs to be increased."

The institute is an arm of the National Academy of Science, a private group charged by Congress with providing advice on scientific matters.

The report, which came just a day before the chairman of the President's AIDS commission is to issue his national policy recommendations, was careful to recognize aspects of federal action against AIDS.

Educational efforts by Surgeon General C. Everett Koop and work by the presidential AIDS panel were singled out for praise.

The report is a follow-up to a call to action against acquired immune deficiency syndrome issued by the institute 18 months ago. The original document said it would be necessary to spend $1 billion annually on AIDS research and another $1 billion a year on treatment and education by 1990. The latest report said expenditures must go "well beyond" the $1 billion figure for education and treatment, but the chairman of the Institute's AIDS oversight committee, Dr. Theodore Cooper, declined to estimate how high spending must go.

Cooper, who is chairman and chief executive officer of the Upjohn pharmaceutical company in Kalamazoo, Mich., said that "$1 billion is not adequate, but we don't have a new number."

Since the 1986 report, Cooper said, "news from the research front is both good and bad."

"The good news is that progress on understanding how the human immunodeficiency virus disarms the body's immune system has been moving forward at an impressive rate," he explained.

"The bad news is that despite much effort, we have not yet been able to apply this new knowledge to development of an effective vaccine or drug therapy. It seems that the more we know, the more complex the picture becomes."

One thing scientists have learned in the last 18 months is that AIDS is the end stage of a continuum of infection by the human immunodeficiency virus, the institute's report said. Anyone infected with HIV should be considered ill, even if he or she doesn't yet display symptoms, the report said.

"The message is frightening," said Dr. Robin Weiss, staff officer for the Institute study. "In one San Francisco group known to be infected for 8 1/2 years, 40 percent have developed AIDS, and another 40 percent have some form of illness. Among the remaining 20 percent, there is laboratory evidence of immune system irregularities in many."

By considering anyone infected with HIV to be ill, Weiss said, doctors may begin treating patients who don't yet have symptoms in hopes of delaying the onset of AIDS.

If effective treatments to delay symptoms are found, they could encourage people at risk to have themselves tested for HIV infection. Voluntary testing is an important factor in the fight against AIDS, the report said, but added that it will be difficult to get people to volunteer until strong federal legislation is approved to guarantee those infected won't suffer discrimination.

"The key to public health policy lies in antidiscrimination," Cooper said. "It is fundamental to the success of the policy."

Dr. Samuel Thier, president of the institute, said the report was timed to come out before the final recommendations of the President's AIDS commission are approved later this month. The institute hopes many of its recommendations will be included in the report to President Reagan, Thier said.

The insitute decided to issue its follow-up because of disappointment at the failure of the administration to respond to many recommendations in the original report, Thier said. "We'll keep doing this as long as it is necessary," he said, "but we'd like to get out of the business."

One recommendation of the institute is creation of a permanent national commission to oversee AIDS policy.

CAPTION: Graphic: Timeline for AIDS Infection. How human immunodeficiency virus (HIV) infection affects the body's immune system.

1. Virus: Acute state of HIV infection causes mononucleosis-like symptoms.

2. Antibodies: Body's immune system produces antibodies to fight HIV infection; symptoms disappear but patient tests positive for HIV infection.

3. T-cells: Years after initial infection, the virus becomes active, reproducing inside and killing the T-cells, which protect the body against infection; symptoms return and the patient has acquired immunodeficiency syndrone (AIDS).

Chicago Tribune Graphic; Source: Institute of Medicine of the National Academy of Science.

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