The Changing Face of AIDS
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PHIL PONCE: The 12th World AIDS Conference came to a close today in Geneva, offering a mixed picture of progress in the 17-year battle against AIDS. The biennial meeting brought together more than 12,000 scientists, health officials, and activists.
An estimated 11.7 million people have died of AIDS since the epidemic began. According to a new UN report, more than 30 million people are living with HIV, the virus that causes AIDS, or with AIDS itself. More than 90 percent of them live in developing countries, many in Sub-Saharan Africa. The report estimated close to six million new infections last year, with the fastest growth coming from Africa, Asia, and the former Soviet republics.
DR. PETER PIOT: We even found two countries, Zimbabwe and Botswana, in Southern Africa, where as many as one adult out of every four adults is HIV positive.
PHIL PONCE: This year’s conference focused on patients in developing countries who cannot afford the expensive new drugs that extend life. Toward that end, several pharmaceutical companies announced that AIDS medicines will be sold at a discount in poorer countries. The UN also announced a pilot program to treat 30,000 pregnant women who have HIV women in Africa. Women in Africa countries will be given the drug, AZT, which can help reduce the transmission of the virus from mothers to babies.
DR. PETER PIOT: For the first time, we have a strategy to help prevent transmission to children that becomes affordable and feasible for countries such as ours and for those women, it really does provide some hope.
PHIL PONCE: There was other promising news: Researchers said patients may not have to take as many pills a day because of two new medicines. They block an essential enzyme that HIV needs in order to take over cells and replicate itself. And a new study showed that a person’s immune system can recover even after AIDS has weakened it.
But there was also some bad news. Scientists reported two cases in which HIV became resistant to most AIDS drugs available. Other research found that even when drug combinations do work in fighting off aids, HIV could not be eliminated entirely from the bloodstream. Another study showed that up to 15 percent of patients taking protease inhibitor drugs — which suppress the growth of Aids –suffered a change in the distribution of their body fat. And yesterday came the news that an AIDS vaccine tested on monkeys had not worked. Researchers had hoped to use it as a model for a human vaccine.
PHIL PONCE: With us now are two experts just back from the conference: Dr. David Ho is director of the Aaron Diamond Research Center in New York. He’s one of the researchers credited with pioneering the drug combinations now being used by AIDS patients. Dr. Anthony Fauci is director of the National Institute of Allergy & Infectious Diseases at the National Institutes of Health. He oversees funding for government-sponsored AIDS research throughout the country. Gentlemen, welcome to you both.
Dr. Fauci, how would you assess where you are in the fight against AIDS?
DR. ANTHONY FAUCI: I think we’ve come along way, and as was manifested at the meeting, there have been a number of important advances. The tone of the meeting was one I would say of some sober reality testing in which we are realizing that we’ve come a long way. We’ve seen some obstacles appear that we need to overcome, but there are pretty good directions and plans on how to overcome them. So I think the meeting was a positive meeting and the mood was one that we have a lot of work to do but we’ve also come a very long way.
PHIL PONCE: Dr. Ho, your big picture assessment.
DR. DAVID HO: I agree with what Dr. Fauci just discussed. I think we heard both good news and bad news. The enormity of the epidemic, as was mentioned, was certainly impressive. And obviously the situation in the developing countries cannot be treated with the current medications. On the other hand, we heard about the impressive record of combination of therapy, resulting in substantial decrease in mortality in this country and in Europe. In addition we heard about several new drugs and several new promising drug combinations.
PHIL PONCE: Before we get to some of those, some of those promising new drugs, your assessment on the attempt to bridge the gap between the countries that are experiencing the growth in AIDS and the resources that they have to fight AIDS, Dr. Ho.
DR. DAVID HO: Well, I think the gap is huge. These combination therapies we have in the states are so expensive they’re simply out of the question for the developing countries, many of which have only a few dollars per year per citizen. So the gap is certainly too large at this point.
PHIL PONCE: Dr. Fauci, what is your assessment of prospects for a cure for people who already are infected?
DR. ANTHONY FAUCI: I think for the purposes of clarity we shouldn’t at this point use the word “cure” but use the word of effective control of the virus, because when you talk about cure, you generally think of completely eliminating each and every viral infected cell from the body. And we know from recent work that that’s going to be difficult but doesn’t mean that we shouldn’t strive to do that because that’s a goal that we should strive for. But, nonetheless, it’s going to be difficult, and it’s going to take many years of people being on therapy to do that. So I think we have a good chance of very good control of the virus in individuals now and particularly as new drugs come along. Whether or not we’re going to effectively cure, as it were, individuals, I’m not so sure about that. But that may not be so bad. We may be able to have a major, major impact, as we already are having, on the lives of individuals, the morbidity and mortality, short of a cure.
PHIL PONCE: Dr. Ho, what is the — in lay terms — what is the big hurdle in finding a cure?
DR. DAVID HO: Well, the major obstacle in the road to eradicating HIV is really the persistence of the virus in the dormant state in certain T-cells. And in this form the virus is protected from the drugs that we use, and since these T-cells can live for a long period of time, it’s extremely difficult to stop the medications, because this reservoir would rekindle the whole infection if we were to stop the medications.
PHIL PONCE: So are you saying that it’s the dormancy in the cells that, in a sense, protects them from the drugs that seek them out?
DR. DAVID HO: That’s correct. The virus in those cells lie dormant and, therefore, the drugs cannot get at them.
PHIL PONCE: Dr. Ho, President Clinton has made it a stated goal of his to come up with a vaccine in nine years. Is that doable, do you think?
DR. DAVID HO: I think it’s a reasonable objective. Obviously it’s a tall order. The research in the vaccine field has not progressed as fast as the situation for drug development; however, we do know from certain animal experiment that vaccine protection is achievable, and, therefore, it holds promise for the future.
PHIL PONCE: Certain animal experiments relating to AIDS?
DR. DAVID HO: Relating to SIV, which is a relative of HIV in monkeys.
PHIL PONCE: What is your assessment of where the government is as far as finding a vaccine?
DR. ANTHONY FAUCI: I think that the 10-year goal that the President set last year is a reasonable goal that I believe we have a good chance of accomplishing. When you have something like a vaccine that’s such an elusive, difficult thing, particularly because of the special nature of HIV vaccine, you can never say for sure. You can predict that we will likely have one in ten years, but science moves in such a way because it’s a discovery process, that you can never guarantee it. But as a scientist, I feel — and I’m sure that Dr. Ho also feels — that it’s totally within reason to feel that we can do it within 10 years.
PHIL PONCE: What do you say to people who look at other government attempts to “cure cancer” and that sort of thing in a specified amount of time and that hasn’t necessarily happened?
DR. ANTHONY FAUCI: Well, that’s the reason why you set a goal. You set a goal. You don’t guarantee anything, and setting a goal of 10 years is reasonable. But don’t forget that there’s a big difference between HIV, which is a single infectious agent, and cancer as a field. So when you talk about curing cancer, you’re talking about a very complicated, complex process. When you talk about developing a vaccine, as difficult as it may be, at least you can sharply focus on that goal.
PHIL PONCE: Dr. Ho, there have been a couple of cases where patients have responded — have not responded at all to some of the drugs that have been effective in everyone else. Do these cases — is it something that people should be extremely worried about?
DR. DAVID HO: I think in Geneva we heard about certain cases of new HIV infection from viruses that have become resistant to the currently available drugs. I think this is certainly alarming to some extent in that those individuals who are infected with resistant viruses will not respond in the same way to our current drugs. However, we should not blow them out of proportion in that this is a situation that’s still occurring in low numbers, low frequency, and certainly does not speak of a doomsday scenario. Nevertheless, these few cases serve nicely to remind people that we have to work on prevention. There’s still too many new infections occurring each year in the US, as well as everywhere else.
PHIL PONCE: Dr. Fauci, do you think people have been lulled into a sense of complacency by some of the successes, and how do these new cases sort of fit into that?
DR. ANTHONY FAUCI: Well, I’m certainly certain individuals have. We hope it hasn’t been widespread, but we know from our interaction with the community that there has been a feeling among individuals that if you get infected in 1998, because we have such effective drugs, that that’s not so bad, because you can very adequately treat these infections. The cases that we heard about in Geneva, particularly the one from San Francisco, about the sexual transmission of a multiple drug-resistant virus, you know, is sort of like a wake-up call to people that if you happen to be unfortunate enough to get infected from an individual who has the multiple drug-resistant virus, that’s sort of like turning the clock back and getting infected back in the early 80’s, when we had no drugs at all. So hopefully, something like this, if anything good comes to it, it will underscore the need to continue to emphasize prevention, because this is a clearly preventable disease. And we need to do everything we can to get people to be aware of what they need to do to prevent infection.
PHIL PONCE: And Dr. Fauci, how about the issue of new drugs and new treatments, what’s in the pipeline?
DR. ANTHONY FAUCI: Well, there are several that we heard about in Geneva, drugs that were in the pipeline, drugs that are second and third generation drugs, particularly drugs that not only are as powerful or appear to be as powerful as some of the standard drugs we have now, but that are more user-friendly, and that they can be given in less dosages; you don’t have to take four or five times a day of a particular dose. Some of them, for example, you need to take one or at the most two times a day. Whether or not they’re going to be totally effective against a virus that has already developed resistance against the standard first generation of drugs is not clear, but at least in their present form they appear to be at least as powerful as the ones that we have now. So it’s good news about the pipeline.
PHIL PONCE: Dr. Fauci, in the past, notwithstanding the scope of the problem as you described it and as you learn more about in Geneva, you’ve expressed optimism about the fight against AIDS. Why is that? I’m sorry. Dr. Ho.
DR. DAVID HO: Well, we have learned so much about this virus in the past decade and a half, so many drugs have been developed for one single virus, and as we just heard, there are several more in the pipeline. And physicians and scientists have learned how to combine these drugs to effectively control HIV replication, resulting in meaningful differences for patients in the US and in Europe. All these have been rather impressive developments and certainly is the cause of my optimism.
PHIL PONCE: Dr. Ho, Dr. Fauci, thank you both.
DR. ANTHONY FAUCI: Good to be here.