San Francisco Chronicle - November 30, 2004

Tomorrow is World AIDS Day, a benchmark in progress against the incurable disease. In wealthy countries, AIDS death rates have fallen sharply, thanks to widely distributed life-prolonging drugs. In many cases, those infected can find care, return to work and look forward to years of stable health. Then, there's everywhere else.

In scores of countries in Asia and Africa, health care is a long bus ride to a crowded clinic. Drugs can cost more than a month's wages. The virus has moved into the entire population, infecting as many women as men and leaving millions of children orphaned as their parents die off. Education, support and counseling for these families are nearly nonexistent.

In the developing world, the AIDS battle is being lost. A total of 39.4 million people are infected -- a new high. Though worldwide spending has climbed to $6.1 billion, much more will be needed.

In fighting AIDS, one dream has endured: a silver-bullet vaccine that could prevent infection. Typhoid, tetanus and polio were all controlled by such science. Why not AIDS?

Because the HIV virus that causes AIDS has been hard to crack, it's evolved into different forms, outwitting scientists. Several promising vaccine candidates fell flat in human trials when lab theories and animal experiments didn't work.

Yet, despite this failed record, any success grabs attention. The latest example is a French team who have a costly and complicated drug that shows astonishing promise. It's not a true vaccine that wards off infection but is, instead, a therapeutic that lowers HIV levels by 80 percent in the blood of those already infected.

Thus, sick people are made less sick -- but there are significant drawbacks. A single injection can cost $4,000 to $8,000. A tiny pool of 18 volunteers was tested, with different dosage levels. Also, a new shot may be needed annually. Despite its promising outlines, it's not a major breakthrough.

Other big drug firms -- Merck and GlaxoSmithKline, to name two -- are on the case, too. But promising paths have turned into dead ends, such as one highly touted vaccine candidate that failed to deliver in tests in Africa last summer.

Time is running out. In Southern Africa, the effects of AIDS are worse than any war or famine. In nine countries, life expectancy is less than 40 years, a level not reached in decades. In the Caribbean, AIDS is leading cause of death among adults and youth. India and China have yet to wake up to the threat, which health experts fear will jeopardize tens of millions more.

A vaccine could stop this runaway threat, but it isn't likely to arrive soon. That's why expanded programs and continued spending are the only hope in stemming AIDS.

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