Newsday - July 19, 1992
B.D. Colen and Laurie Garrett

The news is grim and the mood somber as more than 10,000 AIDS researchers, activists and doctors gather for the 8th International Conference on AIDS that starts today.

"Throughout the world . . . the virus is winning flat out," said Dr. James Curran, director of the HIV/AIDS division at the Centers for Disease Control in Atlanta.

"Current global approaches to AIDS underestimate both the scope of the epidemic and what must be done to deal with it," Dr. Jonathan Mann, director of the conference, wrote in a statement prepared for the meeting. Mann, former director of the World Health Organization's anti-AIDS effort, predicts that by 1995, 20 million people will have become infected with the human immunodeficiency virus that causes AIDS.

The epidemic is spreading so freely that no one can agree on how many people will be infected by the turn of the century. Mann, who is now doing AIDS research at Harvard University, recently predicted 110 million. His successors at WHO place the number at 40 million. Whatever the number, it is so high, and portends such worldwide devastation and misery, that those battling the epidemic are at a loss as to how to respond.

"The epidemic is out of control and nothing effective has been done to control it in any country. It's proceeding almost as if we didn't know it existed - that's how little effect our efforts have beenhaving," said Harvard virologist Dr. William Haseltine.

Outside the developed world, the AIDS epidemic comes on top of medical, social and economic problems that are already overwhelming governments and peoples alike.

In Brazil, for instance, where millions of homeless children roam the streets of major cities and an estimated 2 million girls under the age of 15 are reported to be working as prostitutes, "some of the [AIDS] patients get AZT and then sell the AZT to get food to eat," reported Dr. Maria Fernandez. "This [epidemic] is showing in a tragic way the fragility of our health-care system."

Her remarks, at a news briefing yesterday by the American Medical Association, were echoed by Dr. David Walters, who heads the department of health care and promotion for the Canadian Medical Society.

AIDS, Walters said, is "the clinical entity that will expose your [health-care] system as to how well it works or doesn't work."

Poor as it is, Brazil can at least supply AZT to its 25,000 known AIDS patients. Dr. Ruth Nduati, a Kenyan pediatrician, reported that in her nation, patients "are not benefiting from the major advances in the treatment of HIV . . . Antiviral drugs are available only for wealthy people," and drugs are lacking to fight the opportunistic infections that accompany HIV.

If the news from the Third World is bleak, the news from the United States and the rest of the developed world is not much better.

The CDC's Curran pointed out that there had been 1,500 U.S. AIDS cases at the time of the first International Meeting on AIDS in 1985, while today more than 230,000 cases have been reported. The CDC, he said, is projecting that by 1994 there will have been between 415,000 and 435,000 U.S. AIDS cases - with between 320,000 and 385,000 deaths.

Although Curran and other U.S. AIDS experts have been saying for some time they believe the U.S. epidemic is at least leveling off, they are quick to point out that may mean a long-term situation in which more than 50,000 new cases of this incurable disease are reported every year.

And no one is talking in terms of "cure."

"What about a cure?" British researcher Anthony Pinching asked rhetorically at a news conference. "That's just fantasy land. We don't have a cure for most diseases."

Problems with vaccine research have left some scientists pessimistic about that as well.

In fact, not only are those gathered here not talking about cures, one of the more important developments to be discussed this week is the growing threat posed by the appearance of multiple drug-resistant strains of HIV, as well as drug-resistant strains of numerous opportunistic infections.

A Boston lab is expected to report on recently isolating a strain of HIV that failed to respond to AZT, ddI or ddC - the only drugs approved to slow the progress of HIV infection. The finding is particularly disturbing because the patient from whom it was isolated had reportedly never taken ddC, but had become resistant to it nonetheless.

Similarly, researchers and clinicians will discuss the epidemic of drug-resistant tuberculosis, a growing threat in New York City, where there have been several outbreaks in hospitals, and the appearance of drug-resistant herpes.

A "startling parallel epidemic of TB," is developing all over the world, said Dr. Michael Merson, director of WHO's AIDS program.

Unlike some previous AIDS meetings, which have primarily focused on basic research and the epidemic in developed nations, AIDS in Africa, Asia and other parts of the Third World is dominant this year.

Reports out of Thailand raise the spectre of an epidemic in southeast Asia even worse than that in sub-Saharan Africa. For instance, infection rates as high as 14 percent have been found among male army recruits from rural northern Thailand.

At the same time, there is growing dissatisfaction with the way WHO, which is supposed to be coordinating the worldwide war on AIDS, is handling its responsibilities.

WHO's AIDS program has come under attack this year from such divergent sources as the U.S. General Accounting Office and key representatives of African governments most affected by the epidemic. The WHO program has taken great pains in recent weeks to point to success stories in targeted population groups around the world, but antipathy toward WHO is likely to dominate this week's meeting, according to sources involved in the meeting's organization.

Some troubling research developments also are expected. At last year's AIDS meeting in Florence, Harvard's Haseltine presented evidence that HIV invades the dendritic cell, a type of cell in the mucosal linings of such organs as the mouth and vagina, and thus might be spread by deep kissing.

This year he is expected to present one of the more controversial findings as well:

Haseltine's researchers at the Medical Research Council, in London, have found that these dendritic cells rapidly manufacture more HIV and assist those viruses in infecting cells of the immune system - before a person produces antibody to HIV. Thus a person might be particularly infectious for an unknown, but presumably brief, period of time yet test negative for HIV infection because the virus would not yet have entered the bloodstream.

"My recommendation is before you have sex, get tested [for HIV]. That includes before you have French kissing."

The finding that HIV enters the body through mucosal cells is one reason Haseltine is pessimistic about the chances of developing a vaccine. "Nobody has ever been able to stop a virus that uses such a mode of entry through a vaccine," he said.

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