Miami Herald - Sunday, July 10, 1983
Steve Sternberg, Herald Medical Writer

But scientists are mounting a massive counterattack against Acquired Immune Deficiency Syndrome (AIDS), which erodes the body's natural protection against disease, leaving sufferers vulnerable to virulent microorganisms that ravage human tissue.

They are pouring thousands of hours and millions of dollars into a far-reaching research industry that has sprung up virtually overnight.

The effort gained added momentum recently when Assistant Secretary of Health Dr. Edward N. Brandt declared AIDS the "No. 1 priority" of the U.S. Public Health Service.

"People keep saying it is the plague of the '80s, of the coming decade, of the century," said Dr. Jim Rooney, a physician at the National Institutes of Health in Bethesda, Md. "We're going to find out."

The stakes are enormous, not only for patients whose lives are threatened, but also for researchers, medical centers and doctors.

Consider:

* The Public Health Service (PHS) has earmarked $14.5 million for AIDS research in 1983, nearly three times last year's amount. And a request for $12 million more is pending in Congress.

* Thirty-five researchers at the University of Miami, in the state with the nation's third largest outbreak after New York and California, have formed a task force to combat the epidemic.

Though they have not yet received any NIH funding, the UM researchers plan to request more than $1 million in grants for at least six AIDS studies.

* The Centers for Disease Control, the epidemic-fighting arm of PHS, already has spent $4.6 million of that outlay on AIDS this year. If Congress agrees, CDC will receive $2.25 million more -- only two years after it narrowly escaped a threatened 23 per cent federal budget cut.

* The National Institutes of Health (NIH) has received $9.5 million in 1983 to underwrite AIDS research nationwide.

* Five of the nation's top medical centers have received federal AIDS research grants of more than $250,000 -- almost double the average amount awarded for research projects.

* Medical profiteers could earn huge sums for AIDS work. One Tampa lab set up shop in Miami's best-known gay club and charged worried clients $95 for the "best available test" for AIDS -- although no diagnostic test exists, doctors said.

The entrepreneurs are trading on fear of the unknown. Despite two years of research, doctors still don't know what causes AIDS or how it spreads. Despite widespread AIDS panic, they do not believe the disease is highly contagious -- in contrast to the common cold or flu.

Key West victim

That doesn't explain how Ron Johnson, a 30-year-old AIDS patient from Key West, contracted the syndrome. Though he is homosexual, Johnson says that he has not led the promiscuous gay life that doctors have come to expect of AIDS sufferers.

Johnson, suffering from the weakened immune system that is now the trademark of AIDS, is fighting to recover from an intestinal parasite infection that has cost him 20 pounds. He is one of several patients being treated with an experimental drug at Jackson Memorial Hospital.

Research indicates that AIDS victims contract the mysterious ailment primarily through "intimate contact" with such body fluids as blood and semen, doctors said.

And the case toll continues to mount. Three years after AIDS was discovered in the homosexual communities of New York and Los Angeles, the syndrome defies all efforts of modern disease detectives to stop its progress.

Each day, doctors in clinics and laboratories across the United States examine patients and take measures to limit the spread of the illness.

New theories abound: The nation's virologists believe that the disease may be caused by a blood-borne virus, while one Miami physician has suggested that stress causes the illness.

And as the epidemic grows, so does AIDS hysteria. Metro fire fighters, fearful that they will catch the disease from victims during medical emergencies, have been issued gloves, said Dr. Joseph Soler, the agency's medical director.

Some nurses refuse to treat patients.

"Every nurse out there will tell you that she doesn't want to take care of AIDS patients," said one Jackson Memorial nurse, who asked not to be named. "It is lethal."

Rooney of NIH says he's worried because 13 months ago he pricked himself with a needle that minutes before had been plunged into a sex partner of a deceased AIDS patient.

Fear of contagion lingers even after the sufferer's death, with morticians worried that they will catch the disease while embalming deceased victims, officials said.

"We're all concerned for own health," said William Martinez, who works for Stanfill Funeral Homes in Miami. "There is a little more fear with AIDS because there are so many unknowns involved."

Local physicians are gearing up to treat a burgeoning number of AIDS patients. Because of repeated hospitalization and expensive tests, the cost of treating a single AIDS patient can total $200,000 or more.

So far experimental efforts to restore the body's defenses with interferon, a natural virus-fighting substance, have proven largely unsuccessful, as have drugs and bone marrow transplants.

Doctors simply treat infections as they develop -- and sometimes they set in all at once.

A 27-year-old Haitian died of AIDS in May. He was infected with tuberculosis, herpes and intestinal parasites that stopped him from digesting food. He weighed 67 pounds when he died.

Unanswered questions

Despite the rising clamor for a cure, the simplest questions remain unanswered: What causes AIDS? Is it a new disease? How contagious is it? How is it transmitted? Why do certain people seem more vulnerable than others?

Researchers believe the syndrome is caused by a virus because of its long incubation period, the lethargy and swollen glands typical in its early stages, and the fact that other viruses suppress the body's defenses.

They believe AIDS is a new disease because its constellation of symptoms previously was seen only in cancer patients and in transplant patients whose immune responses were blocked by drugs that prevent organ rejection.

Despite fears of widespread contagion, it has remained largely within four "high-risk" groups -- homosexuals, Haitians, abusers of intravenous drugs and hemophiliacs.

"This is not affecting the general population," said Dr. Richard Selick, who records AIDS cases for the federal Centers for Disease Control in Atlanta. "It is primarily affecting people in the high-risk groups."

As of July 1, about 96 per cent of the 1,737 reported cases had occurred within those groups, CDC officials said. Although about 678 of the sufferers died -- for a death rate of 40 per cent -- not one AIDS victim diagnosed through 1980 is still alive.

At least 120 cases and 44 deaths have been reported in Florida, federal officials said.

However, because many local doctors report cases directly to the CDC, state records lag far behind, said Dr. Jeffrey Sacks, the state's epidemiologist. At last count, he said, 90 cases have been logged by state officials. As of July 1, 60 were recorded in Dade, three in Broward and four in Palm Beach.

"That is probably the tip of the iceberg," Sacks added.

No one knows why the disease is slowly spreading through the Haitian community. In Miami, where 2 per cent of the population is Haitian, Haitian immigrants account for approximately 60 per cent of cases, said Dr. Mark Whiteside of the University of Miami School of Medicine.

Nationwide, the number of cases among Haitians amounts to about 5 per cent of the total, Whiteside said.

Some researchers speculate that the disease was imported from Haiti by a vacationing homosexual who picked up a germ there. One Haitian physician, who believes that his countrymen have become victims of discrimination because of AIDS, has suggested that a vacationing homosexual brought the disease to the island.

Experts who have visited Haiti in search of clues say, however, that the ailment's appearance in the Western Hemisphere's poorest nation coincides with its discovery in the United States -- leaving the Haitian question open.

Risk factors

Dr. Margaret Fischl, an AIDS expert at UM, said those in greatest danger of catching AIDS are male homosexuals who repeatedly are passive partners in anal intercourse. Next are Haitians, and drug abusers who share dirty hypodermic needles.

At slight risk are people who receive massive blood transfusions and hemophiliacs who use a clotting agent produced commercially from the blood of numerous donors, CDC officials said.

Dr. Peter Tomasulo of the South Florida Blood Service notes, however, that after three million transfusions, only a dozen blood-related cases of AIDS are under investigation and only one case, in a California infant, has been confirmed.

"And you can't get AIDS by giving blood," he said.

Fischl said people had nothing to fear from casual contact with an AIDS sufferer. The disease cannot be transmitted by mosquitos or such household fixtures as a toilet seat.

The search for that elusive agent thus far has focused on viruses in the herpes family and on a human T-cell leukemia virus discovered two years ago. The so-called HTLV, recently found in some AIDS patients, is the first animal virus known to cause cancer in man.

Two months ago, Dr. Robert Gallo of the National Cancer Institute reported he had found evidence of the T-cell leukemia virus in AIDS patients. Its significance remains a mystery, he said.

Until researchers find the syndrome's cause, they are unlikely to discover an effective treatment. That research promises to open valuable insights into the body's mysterious protection against disease.

It also promises to illuminate the inner workings of the microorganisms that turn normal cells into cancers -- and the body's failure to destroy the rapidly multiplying cells.

"We are just beginning to understand the immune system as it is," said Rooney, of NIH. "We don't have a lot of drugs to modulate it. And if the disease is caused by a virus as we suspect -- we don't have a lot of drugs for treating those.

"Right now it does not look real good."

CAPTION: PHOTO, MAP

Ron Johnson; map: Cases of Aids/State-by- State/June 1981-June 1983

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