Hope and the Fight Against AIDS
[Sorry, the video for this story has expired, but you can still read the transcript below. ]
ELIZABETH FARNSWORTH: Scientists in Washington this week for a conference on retroviruses reported some promising developments in HIV and AIDS research. Here to bring us up to date on the latest developments are Dr. William Paul, the director of the Office of AIDS Research at the National Institutes of Health, and Dr. Lawrence Altman, medical correspondent for the “New York Times.” Welcome, gentlemen. Dr. Paul, what kind of findings were announced that you think were very important at this conference this week?
DR. WILLIAM PAUL, National Institutes of Health: I think the most striking finding were the results announced by two of the large drug companies in the United States, Merck and Abbott, describing two new drugs that are members of a new class of drugs. These drugs are called protease inhibitors. They’re called protease inhibitors. They inhibit a key step in the virus’s development, the step in which the virus chops part–its parts into small pieces that can be used. Without protease, no virus can be made that is infectious, so the inhibitors have a potentially very powerful role, but what was exciting that we heard today and early in the meeting was that these drugs when used together with AZT and another drug very much like AZT have the capacity to reduce the amount of virus in an individual by a hundred to a thousand fold or more.
Quite remarkable in comparison to what we have seen before. In a much smaller study, a so-called efficacy study, aimed at determining whether this drug, one in particular, Retonovir, could actually aid or help patients, this study admittedly small, was able to demonstrate that in very late-phase patients one could reduce the risk of death by about twofold over a relatively short period of time. So we need to caution people though that it’s still early days, that the results are very promising, but we also have to look to see how they will play out.
ELIZABETH FARNSWORTH: One of the protease inhibitors was okayed by the FDA at the end of last year, but these are two new ones that are more powerful?
DR. PAUL: Yes, these are–the drug you’re referring to, Sequinovir, from Roche, was previously approved by FDA for use in combination. These two drugs, Indinovir and Retonovir, which I believe will be considered by FDA in the very near future, although equally potent in the test tube, appear, at least as we have seen them to be, somewhat more active, or possibly even considerably even more active in people and it will remain to be seen how the three agents that are coming on to the scene will be used which will prove in the long run to be the most effective, but it certainly a day that we feel that we should greet with optimism.
ELIZABETH FARNSWORTH: You reported in the “Times” that one person who took Indinovir had no detectable HIV for a hundred and twelve weeks?
DR. LAWRENCE ALTMAN: Yes. But that was one patient out of four.
ELIZABETH FARNSWORTH: Uh-huh.
DR. ALTMAN: And–
ELIZABETH FARNSWORTH: So give us caveats and the worries that–why shouldn’t we be very excited about this?
DR. ALTMAN: Well, you should be very excited particularly for that patient and looking at that as a model for what might be done, but it’s still one out of four. We don’t know what will happen in the one hundred and fourteenth or fifteenth week or thereafter, and we don’t know what the long-term toxicity will prove to be even if it is effective in checking the virus, so that’s the reason why Dr. Paul said we need caution.
ELIZABETH FARNSWORTH: I want to talk about the toxicity in a minute but you’ve been to many of these conferences. You’ve been covering this a long time. Is there a–was there a different feeling at this conference, is there more optimism than you’ve seen before?
DR. ALTMAN: Yes. I think this meeting ended on an upbeat note, and this meeting was different from certainly in the last couple of similar meetings here and elsewhere. There is usually one meeting a year up until last year, the international AIDS meetings, and I think if you went back and looked at that, you would find a real roller coaster in terms of scientist enthusiasm and pessimism and scientists are human, and everyone has got their moments of frustration and their moments of enthusiasm, and there’s no difference between the scientist and anyone else when you’re in a very tough situation.
ELIZABETH FARNSWORTH: This–
DR. ALTMAN: Trying to fight the wiliest virus that we know.
ELIZABETH FARNSWORTH: And this was a more enthusiastic moment.
DR. ALTMAN: Yes. Some people weren’t cautious; others were; and I think you just have to tease out why those who were enthusiastic were and why those who weren’t and we got a different reaction from a lot of people.
ELIZABETH FARNSWORTH: What about possible side effects?
DR. PAUL: Well, we’ve heard that there are side effects of course, any powerful drug does. The protease inhibitors, on the other hand, seem to be relatively well tolerated. The drugs are metabolized in the liver; that’s where they’re broken down, and indeed, it appears that there are some individuals who develop some liver toxicity relatively mild. One of the two drugs tends to cause kidney stones but patients seem to be able to continue to take the drug while on them. So far they’re–as I said–relatively well tolerated, probably the toxicity seemed to be less than those in the previous class of drugs, the AZT class.
ELIZABETH FARNSWORTH: How available are they?
DR. PAUL: Well, now they’re just coming on to line. It’s an interesting story. These are very complex drugs to manufacture, and the amounts patients will need to take quite large. The companies have had basically to build new factories to bring these drugs in the market; they’ve actually shown tremendous confidence by building these manufacturing facilities before they’ve received FDA approval, indicating their commitment, in this instance, to bringing these drugs or making these drugs available, but they have not been widely available until now. The amounts had been limited. In the near future, we hope that will turn around.
ELIZABETH FARNSWORTH: They’re very expensive, aren’t they? How will people get these drugs? How will they pay for them?
DR. ALTMAN: That’s a big question. Very few people will have the insurance or personal fortune to be able to pay for them, but the vast majority of people are going to have a very hard time, and that’s going to be an issue for the government and you certainly can expect activists to be speaking up and wanting–but we’re in age now where we have health maintenance organizations and there are a lot of places that have limits on the amount that doctors can spend for drugs in the pharmacy and there are going to be some very difficult issues.
ELIZABETH FARNSWORTH: Even with the caveat and with the problems, there is a kind of change in that people are living much longer and you can–I mean, it’s quite amazing but you can get the virus down to such very low levels for a while, is there–do you think, a scientist, a change as a scientist, do you see a change in the way people around the country and around the world are seeing AIDS? I thought about this with Magic Johnson’s return to the Lakers.
DR. PAUL: Well, I think it’s a very good point, and I think we need to think of two situations. Here in North America and Western Europe you’re quite right; people are living longer; they have better quality of life; they have the prospects of better drugs coming on; we now know that during the period of time when people are not symptomatic, they can lead normal lives, and I think Magic Johnson is a perfect example of an individual doing exactly that. I think it’s a wonderful illustration what patients with HIV infection can do, and it also illustrates how far we have gone in beginning to understand this. But there is another face to this epidemic in the poor parts of this world in sub-saharan Africa, in Southeast Asia, in India, possibly in China, we can look forward to almost an explosive epidemic where these drugs no matter how effective they may be may not be available because of cost. And this is in a sense the other face of the epidemic and one that I think we here need to spend much more effort and energy thinking about how we are going to respond to that.
ELIZABETH FARNSWORTH: What does recent data show about how much the virus is spreading both here and abroad?
DR. PAUL: In the United States, it appears the epidemic has reached an overall stabilization although the new groups are coming in, new groups being affected so the dynamics have changed, and numbers of new infections are stabilized but stabilized I would say at an unacceptably high level. However, in the rest of the world, in sub-saharan Africa, of course, it’s been estimated that death rates or I should say rather life expectancy in individual countries may fall from 58 to 30 because of this one disease. For the first time this year, there appear to have been more new cases in Southeast Asia or in Asia as a whole than in Africa. So we’re looking in the rest of the world to an entirely different issue, an issue which we really need to give great, great attention to.
ELIZABETH FARNSWORTH: And I noticed that there wasn’t a lot of talk about a vaccine at this conference, am I right about that?
DR. PAUL: Yes, that’s–there was some discussion of course and some of the scientific sessions dealt with various approaches to vaccines, but it is clear that we need a substantially greater investment in the vaccine area. There are vaccines in the pipeline; we’ll know much more about them I hope in the next year, but there is no doubt that a greater creativity, a greater energy has to be put into the vaccine program.
ELIZABETH FARNSWORTH: It’s partly the structure of the virus; it’s a very difficult kind of virus to find a vaccine for because of many factors, right? Just what are a couple of those factors?
DR. ALTMAN: The virus mutates and that makes it very difficult and there has not been a good animal model. The news from this meeting is that for the first time a chimpanzee did develop AIDS but it took over 10 years for the chimpanzee to develop AIDS, and chimpanzees in the wild are endangered species, so there’s a question of how practical they would be as a laboratory animal; nevertheless, they are important because they do show that the HIV virus can cause AIDS, and this further strengthens the arguments against the critics who say HIV doesn’t cause AIDS.
ELIZABETH FARNSWORTH: Well, thank you both very much for being with us.