Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.

Reuters NewMedia - Friday December 1, 2000
Maggie Fox, Health and Science Correspondent

But Coffin's two-day-a-week job running the National Cancer Institute's HIV drug resistance program is serious business. Its very existence shows that the U.S. government realizes a cure for AIDS is a very long way away.

World Health Organization figures released ahead of World AIDS Day this week showed that more than 21 million people have died from AIDS since it was identified two decades ago. Thirty-six million people are infected with the virus.

There is still no cure, and no vaccine. And the lucky few people who can get the cocktails of drugs that suppress HIV are finding that they stop working after a time.

Coffin's job was created to face up to that stark fact and to try to find ways to identify and fight HIV's resistance to drugs.

"We've got six research groups doing different things," Coffin said in an interview. "We have a clinical program, doing studies on the virus's genetic variation, new approaches to salvage therapy in patients that have failed all kinds of other drugs."

Coffin, a molecular biologist and virus expert at Tufts University in Boston, travels to the converted Army base at Fort Detrick in Maryland -- ironically once a site for research into biological weapons -- to oversee the research.

While his lab tests the effects of existing drugs, hundreds of labs around the country and around the world are racing to come up with new and better drugs. 103 New Drugs And Vaccines In Development

More than 100 such drugs and vaccines are in the research pipeline, the Pharmaceutical Research and Manufacturers of America (PhRMA), a drug company industry group, says in its latest report on AIDS drugs.

Most are aimed against the diseases that take root after HIV has ravaged a patient's immune system -- cancer, fungal infections, pneumonia. The industry group says 30 anti-viral drugs are being developed, most of them improvements on existing drugs such as the protease inhibitors.

"A lot of it is really second and third generations of that which is out there, which is not surprising because almost all drugs go through that evolutionary process," PhRMA executive John Siegfried said in a telephone interview.

"Working toward better dosing schedules, working toward fewer pills is also a part of it." HIV patients currently have to take dozens of pills a day, at different times and often with or without certain foods.

New approaches include the fusion inhibitors -- such as AnorMED of Canada's's AMD-3100 and T-20, being developed by Hoffman-La Roche and Trimeris of Durham, North Carolina. These drugs prevent HIV from attaching to the immune cells it attacks.

"If you can really interfere with its ability to enter a cell, that would be fantastic," Siegfried said.

The survey also finds 13 vaccines being tested in people, the furthest along of which is VaxGen's AIDSVAX, and immune system modulators meant to help the body fight off the virus with its own ammunition.

Siegfried joins other experts who fear that news about the available drugs is making people complacent and lulling them into risky behaviors.

"The fact that the death rate dropped 80 percent (in the United States) and the fact that people are living much longer is misinterpreted by many, many people as meaning AIDS is no longer a threat in the United States," he said.

"What really disturbs me as private citizen is that AIDS is preventable and we have known how to prevent it for over a decade now and yet still the rate of infection is high. Condom use and safe sex practices will prevent the spread of AIDS."
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