San Francisco Chronicle, Wednesday, December 2, 1998
Sabin Russell, Chronicle Staff Writer

Dr. Neal Nathanson, a viral epidemiologist named last May as director of the National Institutes of Health's Office of AIDS Research, acknowledged that developing a vaccine was an uphill struggle, but he remained optimistic that scientists will succeed.

Nathanson, who oversees a $1.9 billion research budget, offered no guarantees that President Clinton's pledge of finding a vaccine within 10 years, made in May 1997, will be reached.

But he called a vaccine one of the "highest priorities" and the only way to make a dent in an epidemic that has infected 33 million people -- two-thirds of them in Africa. Each day, according to the United Nations Joint Programme on HIV/AIDS, an additional 8,500 people are infected by the virus.

"We have to think on a global basis," said Nathanson, during a panel session at San Francisco's Commonwealth Club. "It is truly exploding. It is out of control."

Nathanson later addressed a conference at the University of California at San Francisco, delivering a similar message of urgency mixed with cautious hope. Yet his assessment of vaccine work thus far dwelled on obstacles that have so far stymied researchers.

"This is not measles or polio revisited," he said.

Most successful childhood disease vaccines work by provoking blood cells to produce antibodies that, like a swarm of bees, will recognize and attack invading microbes.

But AIDS has the confounding ability to outwit a human's antibody defenses. Instead of stirring up antibodies, the AIDS virus has a shield of sugar proteins on its surface that antibody producing cells have difficulty recognizing. Blood cells just don't get excited about an AIDS virus in the neighborhood. In medical terms, the virus produces a "weak" antibody response.

That's why most researchers are skeptical that the one vaccine now being tested in the United States and Thailand -- developed by South San Francisco-based Vaxgen -- will prove effective. It is made up of pieces of the sugary surface proteins of the AIDS virus. It does stimulate antibodies, but the question that will be answered only by human testing is whether the response is enough to ward off infection by the real virus.

Nathanson outlined several new approaches in vaccine research that he believes may eventually yield a solution. The most promising avenue of research, he said, combines two types of vaccines -- one that produces antibodies and another that stimulates blood cells to attack and trigger the death of any cells that have been successfully invaded and therefore harbor the virus.

"I am convinced we will have an effective AIDS vaccine," he said. "I cannot predict when that will be."

Tom Coates, director of the UCSF AIDS Research Institute, declared vaccine research "the next major frontier in AIDS science."

But he said the 17-year contest between HIV and its scientific pursuers has reached a stage of equilibrium. "We will eventually win this tug of war," he said.

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