San Francisco Chronicle - Monday August 21, 1989
Randy Shilts

Eminent experts patiently explained why treatments for AIDS would never be found. No viral disease, after all, had ever been cured; the cause was hopeless. Broder, then chief of clinical trials at the National Cancer Institute, bitterly replied, "If you declare the patient terminal, you'll always be right."

Broder, now director of NCI, received his full measure of vindication last week with the release of results from the world's largest AIDS study, showing that AZT is effective not only in treating AIDS, but in delaying the onset of the often-fatal AIDS-related diseases among HIV-infected people.

The importance of this study cannot be overstated, as it marks what could be the most important scientific watershed in the AIDS epidemic since the discovery of the human immunodeficiency virus six years ago.

The research, conducted by the National Institute of Allergy and Infectious Diseases (NIAID), gives scientific credence to the principle that has become increasingly accepted over the past two years: HIV infection need not be considered an invariably fatal condition but instead is a chronic medical problem that can one day be managed in the way that diabetics or people with high blood pressure manage and control their chronic maladies.

To be sure, the day when AIDS is such a manageable chronic disease has not yet arrived. But it is at hand.

This, ultimately, is the significance of both the new study on the use of AZT by asymptomatic HIV-infected people and another NIAID study, released just two weeks ago, which showed that AZT could stave off the development of serious health problems among people in the early stages of AIDS-related complex, another precursor to full-blown AIDS.

Not only was the heightened effectiveness of AZT demonstrated, but healthier patients suffered vastly fewer of the toxic side effects that have marked AZT use among sicker patients with AIDS.

The studies are less important for what they say about AZT than for what they demonstrate about the principle of anti-viral therapy.

A host of more sophisticated anti-HIV drugs - such as ddI, azdu, dda and beta interferon - are now being tested. At least in early tests, most show far less toxicity than AZT, and researchers hope that some will prove to be much more effective as long-term treatments.

Scientists anticipate that a combination of these drugs may ultimately turn the corner in making HIV infection a manageable chronic condition.

Still, for all the good news that the two recent AZT studies have heralded, the breakthroughs present profound public policy challenges that political leaders and AIDS organizers need to confront quickly.

Expecting the research to show the effectiveness of early intervention, NIAID director Dr. Anthony Fauci has spent much of this year privately warning AIDS opinion leaders that this new AIDS watershed would demand action to make these early treatments more widely available to HIV-infected people. Unfortunately, few in positions of power have listened.

Congress voted to authorize the creation of early intervention programs sponsored by Representative Nancy Pelosi, D-S.F., but then refused to allocate any funds to pay for them. The White House has similarly declined to put any money into programs to translate these scientific advances into life-saving interventions for the HIV-infected.

What's clear is that such programs are not only humane but cost-effective. Wider AZT distribution can keep people from needing the expensive hospital care that will be required if untreated HIV-infected people go on to get sick. Lethargy on this issue could cost the government literally billions of dollars in unnecessary Medicaid payments.

The new research also dictates that the policy of every AIDS group and health agency should be to aggressively advocate that all people at risk for AIDS take the HIV antibody test.

The goal is for HIV-infected people is to stay alive for the next few years until better treatments are developed. Advances in early treatment have made both short- and long-term survival far more likely - as long as HIV-infected people know their antibody status, monitor their immune systems and know when to intervene.

The public health message is plain: To refuse testing can no longer be considered an act of acceptable denial or understandable fear; it is an intolerable act of suicide.

For pioneers in AIDS treatment research, there's also a delicious message of hope in the new treatment breakthroughs, one that should be heard by scientists everywhere.

"I believe that we should have a big book, permanently inscribed somewhere for people who say that things cannot be done," Broder told a recent AIDS conference. "We should force them to notarize (their predictions) and sign their name next to it. And then when things are accomplished, let us bring out the book."

The lack of such a book for AIDS research allowed a number of eminent scientists last week to forgo a meal of crow.

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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