Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.

Reuters NewMedia, Inc. - Friday November 28, 2:31 pm EST
Maggie Fox, Health and Science Correspondent

Scientists have admitted the cocktail of drugs that originally offered hope of a cure cannot eradicate the virus, they have been told it is still too soon to try out the vaccine considered to be the most hopeful, and have learned the HIV epidemic is worse than anyone thought.

Just over a year ago the community was euphoric over news that a triple cocktail of AIDS drugs -- the old standby AZT, plus a similar drug and one of a then-new class of drugs called protease inhibitors -- could knock the virus into apparent submission.

Now it is clear the virus has not been vanquished, even when a fourth new drug is added to the mix.

Volunteers who had been taking drugs for more than two years still had traces of the virus in their immune cells, specifically "resting" CD4 T-cells.

"The bad news is we can't yet get rid of the virus entirely. The number of immune system cells that remain infected with HIV declines only very slowly," said Dr. Robert Siciliano of Maryland's Johns Hopkins University, who worked on one study.

Siciliano thinks there is a chance the drugs could outwait the virus -- keeping it in check until all the cells it hides in die off. But that would take many more years.

And that's just in the people who take their drugs perfectly, on time, every day. Many more find it nearly impossible to stick to a regime that includes dozens of pills a day, taken at different times and with side-effects ranging from headaches to severe nausea.

In others, the drugs do not work perfectly. Some people are not responding to the protease inhibitors.

And there is the issue of cost. The drugs cost thousands of dollars a year and are beyond the reach of health care systems in many developed countries, let alone Africa and Asia.

New drugs are in the works. AIDS drugs work to stop the virus from replicating itself, and each class targets a slightly different enzyme important to this cycle.

It is hard to kill a virus outright -- in part because viruses are different from other forms of life such as bacteria. They don't eat, they don't breathe and they replicate, by hijacking cells, rather than reproduce.

Nonetheless, scientists are gaining a better understanding of how the HIV virus actually operates in the body, how the body responds to it, and how some people's bodies do actually successfully fight off the infection.

They are working on new drugs that target the virus itself -- the Pharmaceutical Research and Manufacturers of America say 40 are in trials or under Food and Drug Administration (FDA) review.

There are 34 drugs in the works to fight the diseases, ranging from pneumonia to cancer, that mark AIDS, and some researchers report hopeful results with gene therapy approaches aimed at helping the immune system battle the virus.

But while hospital beds are emptying of AIDS patients who are helped back to health by new drugs, most experts say a vaccine offers the best hope.

"The real solution to the international problem probably will depend on a vaccine," said Dr. David Ho of the f of their AIDS research into vaccine-related efforts.

But there have been setbacks here, as well. More than 40 vaccines are in the works, and none has been effective in people.

One vaccine, using a live but genetically weakened form of the HIV virus, has shown promise in monkeys. A group of doctors loosely organized by the Chicago-based International Association of Physicians in AIDS Care was so impressed that dozens of members volunteered to try it on themselves.

But the National Institutes of Health, which must approve any such move, says it is too dangerous and too soon to do that.

Pressure to do something, however, is building. Prevention is not working and the epidemic has shifted from gay men to drug users and to women. In Africa and Asia, the two hottest spots, transmission is mostly heterosexual.

Earlier this week the United Nations announced the alarming news that 30 million people were now infected with HIV, up considerably from fewer than 23 million in 1996. By 2000, they predict 40 million could be infected.

U.N. officials predict another explosion is building in Asia, and they predict the generation of orphans that will be left behind by the epidemic will be left poor and malnourished, uneducated and likely to contribute to unrest and economic decline.

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