HIV – Latest Medical Developments
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ELIZABETH FARNSWORTH: Now, for more information about the latest medical developments in HIV and AIDS, we turn to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, and Dr. Wafaa El-Sadr, director of infectious diseases at Harlem Hospital in New York. Thank you both for being with us. We hear about new discoveries in science of HIV and AIDS, and I guess the new medicines are a result of new discoveries, and I guess there’s a new discovery, or the announcement in “Scientific Magazines” of new discoveries today that helped explain why some people get HIV but don’t develop full-blown AIDS. Can you catch us up in lay terms, in terms we lay people can understand about these new developments?
DR. ANTHONY FAUCI, National Institutes of Health: Well, the recent ones that came out today were reports of natural substances of the body, which we call cytokynes, because they’re made by cells which when you put them in a test tube, they can very effectively block the ability of the virus to multiply or replicate itself. Since they come from the body and are natural products, obviously, that’s something that’s very interesting and potentially important. The hope will be that we may be able to extrapolate that to the people who are HIV-infected and maybe use that as a therapeutic modality. However, we must caution, we’ve been with AIDS a long time, and it’s very difficult to have any assurances that what’s going to work in the test tube is also going to work in the body. But the concept of cells making natural products and now the papers that came out today identifying at least some of those factors very precisely I think are very important.
ELIZABETH FARNSWORTH: But are we getting an understanding of the mechanism of the disease?
DR. ANTHONY FAUCI: Absolutely.
ELIZABETH FARNSWORTH: I understand it’s very complex. Has there been a lot of progress lately?
DR. ANTHONY FAUCI: I think over the last year or so we’ve learned more about what we call a big word, pathogenesis, which really means how the body responds to the virus and how the virus destroys the defense mechanisms of the body. And as you understand that more, you could use that as the basis for some intelligent, hopefully, strategies for the development of therapies, as well as for the development of vaccines. So that understanding of the basic science really is the underpinning of all strategies that get spelled out in practicalities for the patients.
ELIZABETH FARNSWORTH: Do you think, Dr. Sadr, that we’re talking about major breakthroughs here, or are these just small movements in this very complex mystery that the virus is?
DR. WAFAA EL-SADR, Harlem Hospital: I think today’s reports that are just recently announced are one more step amongst many steps that have happened over the past several years, and I think the steps have been incremental and additive, and they’ve added to our knowledge and have added to our understanding of the virus and have also really helped in developing treatment strategies for the patients. I think I would agree with Dr. Fauci, over the past couple of years there has been a faster pace of development of new treatment and potentially new ideas that can help us in developing new treatment strategies in the future.
ELIZABETH FARNSWORTH: And the combination of medications really are allowing, the combination is allowing people to live many more years than they had lived before?
DR. WAFAA EL-SADR: The combination of new treatments is very promising. They can add more years and better years for many of the patients; however, we should not, though, forget that still this disease is responsible for significant death, numbers of deaths in this country. And it will take time for us to understand in a broader arena how these combinations work, how long can patients stay on these combinations, how will they be able to live longer with them and so on and so forth, so I think the news is very encouraging, but I think there’s a long road ahead.
ELIZABETH FARNSWORTH: Okay. Let’s talk more generally for a minute. Dr. Fauci, AIDS is now the leading killer of Americans between the ages of 25 and 44. Does that mean that the efforts at prevention have failed?
DR. ANTHONY FAUCI: Yes and no. I don’t think they’ve failed, because you’re looking at the whole picture. There are certain obviously subsets of people in which the, the message has gotten through better, and there have been changes in behavioral patterns.
ELIZABETH FARNSWORTH: What subsets, for example?
DR. ANTHONY FAUCI: Well, for example, gay men clearly have altered their behavior. We’ve known that. Unfortunately, we’re starting to see a little return of the blip in infection among younger gay men who don’t have the perspective of seeing so many of, of their friends and loved ones who get infected and die. What we really need to do is focus more on individual groups in which there is a lot of high-risk behavior, particularly younger people, adolescents, people in the inner city, people who are exposed to the drug culture.
ELIZABETH FARNSWORTH: Tell me, why adolescents?
DR. ANTHONY FAUCI: Well, for the obvious reasons that–many of which that people begin to experiment sexually. They’re beginning to be aware of the sexuality.
ELIZABETH FARNSWORTH: And AIDS is spreading most quickly among adolescents, is that right?
DR. ANTHONY FAUCI: Well, yes, it is spreading among younger people, it’s spreading among women, and if you look at the statistics, the number of new cases per year of HIV infection and AIDS are leaning much more now towards the heterosexuals. Still, when you look at the total numbers, there are still more gay men and IV drug users, but when you look at the relative proportion among heterosexual transmissibility, each year it gets more and more. There was less than 2 percent in the mid 80’s. At the end of 1994, it was greater than 10 percent of the new cases were among heterosexuals. That’s where we’ve got a target place.
ELIZABETH FARNSWORTH: And especially in minority communities I know, in your hospital in the minority area, the rates are up. Why is that? Is the message not going out to minority communities?
DR. WAFAA EL-SADR: I think there are two issues. I think in order to really effectively have a good prevention policy, you have to obviously protect the person who’s not infected from getting the infection, and that means being able to provide the message that individuals can really use, not just the knowledge, but the skills that they can use in their daily life, and the methods to protect themselves from getting HIV. I think, on the other hand, there has to be an equal effort done at the same time to include those with HIV infection. They’re very crucial to our prevention methods, because it is from HIV-infected individuals that the infection spreads to others.
ELIZABETH FARNSWORTH: And you talked a lot about the necessity for trust between researcher and patient in that. Can you talk about that a little bit?
DR. WAFAA EL-SADR: I do believe that in order for us to reach the population that can be very valuable in our prevention efforts, as well as to improve obviously the life of those with HIV, we do have to develop trust between the medical community and those with HIV and the communities at large. We can–if we can reach those with HIV infection from any community and then engage them in the care system, in the medical system, in a trusting relationship with providers, I think then we can be probably much more effective at having them also participate in our prevention message, and, therefore, they, themselves, will be conscious of assisting us in not transmitting HIV to others. So I think it’s a two-pronged approach that needs to happen.
ELIZABETH FARNSWORTH: Does the research show that in the minority communities the disease is spreading because of drug use, because of unsafe sex, or both?
DR. WAFAA EL-SADR: I think it’s spreading for multiple reasons. As Dr. Fauci just mentioned, heterosexual transmission is quite prominent with a major group that’s now–a major group that’s acquiring HIV infection are women from minority communities. Substance use is an issue as well. We also have significant proportion of new infections occurring amongst minority men, gay minority men also from these communities, so I think it’s happening in a variety of different ways in minority communities, and, therefore, our message really has to be tailored to each of those groups specifically.
ELIZABETH FARNSWORTH: And what about the cost of these drugs? First you, Dr. Fauci. These drugs, the new drugs in particular are very, very expensive, aren’t they? How do people with AIDS, and especially poor people, afford them?
DR. ANTHONY FAUCI: That’s a problem, and I think that that transcends AIDS. That gets back to the unfortunate dichotomy in our society that individuals who have access and have the resources to get good health care versus others and AIDS is no exception. And that’s something we really need to deal with as a society when we look at how we distribute our resources and how we make available for people who don’t have the wherewithal to get drugs, it’s a problem I don’t have the solution to, but it’s not the problem that just started, nor will it end with AIDS.
ELIZABETH FARNSWORTH: But there are plenty of people who can’t use these drugs at all, I would imagine, who have no health care–
DR. ANTHONY FAUCI: Indeed.
DR. WAFAA EL-SADR: I think the tragedy is that all the advances that have occurred, are they going to be able to reach the new populations with HIV, and in order to do that, we really have to sustain and build a foundation, an infrastructure of care for these individuals when they’re acutely ill, as well as when they’re feeling well. So within that frame work, then you can do the research and then you can also provide the treatments that are very promising now.
DR. ANTHONY FAUCI: This point was made by the President, himself, at the White House conference today actually, and he underscored that, and there’s a lot of discussion about that.
ELIZABETH FARNSWORTH: What has been the purpose of the White House conference?
DR. ANTHONY FAUCI: Well, I think the purpose of the White House conference was several. Most importantly, it was to focus and highlight the importance of this problem, and it was an extraordinary signal. The President was really outstanding at the conference. It was really something to behold. He was very much involved. He invested a lot of time, and we had a wide diversity of people talking about the problems of different segments, scientific problems, societal problems, public health problems, health care cost problems, and the President was involved deeply in the discussion of all of them. He was really quite something.
ELIZABETH FARNSWORTH: Do you think that AIDS has fallen–just briefly, we only have a little time left–has fallen off the radar screen and the national radar screen right now partly because it is moving more and more into the minority community?
DR. WAFAA EL-SADR: Well, I do believe that that message has been a little bit confusing to the American public. They hear that the epidemic is plateaued. They really, on the other hand, the subtle–what’s happening in the spread to other communities has been lost, and I think in many ways the message today for the President was that HIV and AIDS are here, they affect every community in this country, it is the leading cause of death in people with their most productive years, and that this country can mobilize to do something about the HIV epidemic.
ELIZABETH FARNSWORTH: Well, thank you both for being with us.
DR. ANTHONY FAUCI: Good to be here.