Online NewsHour: International Conference on AIDS -- July 10, 1996

CAUTIOUS OPTIMISM

JULY 10, 1996

TRANSCRIPT

Doctors, scientists, and patients from around the globe have been meeting since Sunday at the 11th International Conference on AIDS in Vancouver, Canada. In the past few days, researchers released several reports detailing promising treatments to reduce the amount of HIV in people infected with the disease. Elizabeth Farnsworth discusses the conference with two participants.
Click for the Science special issue on AIDS

July 10, 1996: Fred De Sam Lazaro reports on the most recent findings in the fight against AIDS.
July 17, 1996: Dr. Helene Gayle, director of HIV Prevention at the Centers for Disease Control, participates in an Online NewsHour Forum on AIDS.
April 1, 1996: The NewsHour reports on the growing business of the AIDS epidemic.
Feb. 9, 1996: Two AIDS experts discuss the implications of a controversial bone marrow transplant.
Feb. 1, 1996: Elizabeth Farnsworth reports on the possibility of using protease inhibitors to slow the spread of HIV.

ELIZABETH FARNSWORTH: And now for more on the latest research and the Vancouver AIDS Conference we turn to two people who are there: Dr. Helene Gayle, director of HIV Prevention at the Federal Centers for Disease Control, and Dr. Roy Gullick, researcher at the New York University School of Medicine. He also treats HIV and AIDS patients. Thank you both for being with us. Starting with you, Dr. Gullick, what will the new results--we heard from this report that there has been treatment with the mixture of therapies, a mixture of drugs--what new results were announced that have been so--seem so promising at the conference?
DR. ROY GULLICK, NYU School of Medicine: (Vancouver) Well, I think that what you're seeing at this conference is a real optimism among people who've treated HIV for quite some time.
ELIZABETH FARNSWORTH: This is quite different, isn't it, from past conferences?
DR. ROY GULLICK: Yes, it's been two years since the last international AIDS conference, and, uh, the real feeling among people here is that we now have tools to begin to make a real difference in the treatment of this disease.
ELIZABETH FARNSWORTH: And what was announced that the conference, itself? There are some very recent tests, aren't there?
DR. ROY GULLICK: Right. We're now seeing the use and learning how to use a test called Viral Load. That's where you actually take a sample of blood from a patient infected with HIV, send it to a laboratory, who's able to count the number of viral gene particles and give that result back to a clinician. What we're learning about this test is what you might expect, that people with a lot of virus are going to ultimately not do as well as people who have very low levels of virus. That's been a useful tool in helping us to see how patients are going to do with this disease and equally importantly, it's letting us evaluate new therapies, particularly in combination, which are going to work together to really drive levels of virus to low or even undetectable levels.
ELIZABETH FARNSWORTH: And Dr. Gayle, how long a time span can you say now the virus can be kept low or undetectable? In other words, how long have they been able to test?
DR. HELENE GAYLE, Centers for Disease Control: (Vancouver) Well, I think that's not clear yet, and Dr. Gullick may have more to say about that, but this is still something in early stages. We do need to follow the results further out to see what the long-term effects are.
ELIZABETH FARNSWORTH: Excuse me for interrupting one second, but haven't there been tests that showed that the viral levels can be kept down for as much as a year or even a year and a half, is that as far as it's gone so far?
DR. HELENE GAYLE: That's about the length of time that people have been using these new therapies.
ELIZABETH FARNSWORTH: That's what I wondered. And if the viral level is kept so low that it's virtually undetectable, could it still be there? Does it hide somewhere?
DR. HELENE GAYLE: Well, it could, and I think that's why this is extremely, extremely encouraging, umm, news, extremely encouraging results, but we really do need to follow this for longer periods of time to make sure that we really understand, umm, what the long-term patterns are, what the patterns of resistance may be, and all of the things that you're asking, but, again this is extremely encouraging news coming out of the conference this year.
ELIZABETH FARNSWORTH: It's very expensive to get these drugs, is it not?
DR. HELENE GAYLE: Yes, it is, and I think that's one of the concerns and clearly one of the issues that will need to be looked into as we do develop a longer experience with these drugs. They are expensive, and we will have to look at the cost not only in this country, but clearly the cost of this new approach and these new therapies around the world.
ELIZABETH FARNSWORTH: So, Dr. Gullick, is it too early to say that AIDS is no longer an incurable, inevitably fatal disease?
DR. ROY GULLICK: Well, I think that what we've shown is using combinations of drugs which can actually lower the virus to very low or undetectable levels for periods as long as months, that what we're really saying is that that's an important first step toward making HIV a chronic, treatable illness. I think it would be misleading to say that we have the answer. Certainly I would not use the word cure to describe these therapies, but we're making a positive step in the long-term treatment of this disease.
ELIZABETH FARNSWORTH: Dr. Gayle, what about prevention, have there been gains in methods of prevention?
DR. HELENE GAYLE: Well, I think on that front too there's cause for optimism. For instance, in our country, if you look at the rate of increase in new AIDS cases reported annually, we've gone from about an 85 percent annual increase in AIDS cases per year, uh, back in the, the mid and late 80's to under 5 percent increase in AIDS cases per year. That's a dramatic change in the rate of growth of this epidemic, so we really do feel that there's cause for optimism not only in our country but we're seeing around the world in developing countries like Uganda and Thailand a real effect and an impact of our prevention efforts worldwide.
ELIZABETH FARNSWORTH: So some countries the prevention efforts are really making a difference, but is it true that in some countries like India, for example, the rate of growth is very high?
DR. HELENE GAYLE: The rate of growth in India is still very high. Umm, it looks that HIV began probably later. The epidemic probably began later in India than in other countries. They're beginning to mount a serious prevention campaign, but, as we know, prevention takes time. It takes a sustained effort, and so we expect that around the world we'll continue to see an impact of our prevention efforts, but, again, it's--prevention is something that takes time. We also clearly need to make sure that we continue our, our search for prevention modalities that can help us as we continue our existing prevention efforts, for instance, things like finding a virus that can really have an impact on decreasing transmission, finding a cream--
ELIZABETH FARNSWORTH: Excuse me. What did you say--
DR. HELENE GAYLE: --or a gel that women can use to prevent themselves from getting HIV, so there are a lot of things that we continue to need to develop in order to continue our impact on prevention.
ELIZABETH FARNSWORTH: And, Dr. Gullick, is that research going on, for example, among researchers that you know and are in contact with to find a gel that would prevent HIV transmission during intercourse?
DR. ROY GULLICK: Well, I think we've seen some encouraging results from animal studies at this point, and I believe that we'll have to wait and see how those results transmit to human infection.
ELIZABETH FARNSWORTH: And Dr. Gullick, who is getting AIDS right now? Who is the most likely to get it in this country?
DR. ROY GULLICK: Well, I believe that the people at highest risk in this country are inner-city dwellers, people of color, women, partners of injection drug users and injection drug users, themselves.
ELIZABETH FARNSWORTH: And among the homosexual population, is the incidence of spread down?
DR. ROY GULLICK: Well, it's down in certain communities, and overall, the risk for a young gay man appears to be less now than it was at the beginning of the epidemic, but I think that the types of encouraging results we're hearing may I would urge a lot of caution for people to not become complacent about the practices that can avoid HIV infection. That's one of the worries I think that we all share here at this meeting, was that some good news may actually be taken to mean that it's okay to go ahead and do some of the high risk behaviors that people have done in the past.
ELIZABETH FARNSWORTH: But, Dr. Gayle, it's hitting poor communities the hardest, isn't it?
DR. HELENE GAYLE: Well, it has been hitting poor communities very hard. What we've seen in the trends over the years is that in gay men and particularly older gay men, the men who were part of the first wave of the epidemic, if you will, did take note, started changing behaviors, and that's being interpreted in decreasing--decreases in AIDS cases; however, we're seeing an increase in the proportion of our AIDS cases that are attributable to injecting drug use. We're seeing growth in AIDS cases due to heterosexual contact. And we're seeing major increases in, in the proportion of women who are developing AIDS as well. So we're seeing slowing in gay men and particularly older, gay men, increases in injecting drug users, women, and, and through heterosexual contact, and in all of those categories minorities particularly, African-Americans and Hispanics, are disproportionately affected.
ELIZABETH FARNSWORTH: Worldwide you said there has been some success. And yet the number of AIDS cases grows--it'll be what, 44 million by the year 2000, is that the figure that I've seen, 21.8 million now worldwide?
DR. HELENE GAYLE: Right. And it's, obviously, it's hard to project exactly, but if you look at the way things are growing, we definitely think there will be upwards of 30 million people affected by HIV globally.
ELIZABETH FARNSWORTH: Can you give us some comparison. Give us a sense of how that compares to say TB or malaria.
DR. HELENE GAYLE: Well, that varies a lot from continent to continent. Clearly, there are more people affected by tuberculosis worldwide than there are by HIV, and the growth in TB has been very much linked to the growth of HIV, and so when we look at HIV, particularly in developing words, we see HIV and TB as twin epidemics that we have to make sure that we are looking at both of those. Tuberculosis is the most common opportunistic infection associated with HIV in developing countries, so we have a serious problem, both with the TB and HIV, and they're very related.
ELIZABETH FARNSWORTH: So, Dr. Gullick, we have a paradox here, don't we, all good news, even though you both are very cautionary about the good news coming out of the conference, and yet a worldwide epidemic, I think, 90 percent of the AIDS cases are still not in the United States, outside the United States. How will these expensive drugs get to those people?
DR. ROY GULLICK: Well, I think that's a very important question, one that we've heard time and time again that this conference. It's, it's encouraging to see such a breakthrough, and perhaps many patients in the developed countries will get some benefit from these drugs, but how can we apply expensive drugs like this to countries where food is an issue, or even the simplest medicines are not available? I don't think we have answers to those questions.
ELIZABETH FARNSWORTH: Do you have any suggestions? Have you heard some suggestions for how this might be done?
DR. ROY GULLICK: Well--
ELIZABETH FARNSWORTH: I mean, after all, polio and, I mean, there have been other--other mass inoculations. I know there's no inoculation, but there has been a way of getting things to people, getting drugs to people.
DR. ROY GULLICK: I think the success of vaccine programs in the past has made people hope and wish for further developments for a vaccine in HIV.
ELIZABETH FARNSWORTH: Mm-hmm.
DR. ROY GULLICK: I think a lot of people feel that that is going to ultimately be the best approach in the developing world.
ELIZABETH FARNSWORTH: Because the drugs have to be taken, so many pills, day after day after day after day, as opposed to a vaccine?
DR. ROY GULLICK: Yes.
ELIZABETH FARNSWORTH: Uh-huh.
DR. ROY GULLICK: Certainly.
ELIZABETH FARNSWORTH: And, Dr. Gayle, do you have anything to add to that? How can these, these treatments be brought to people in very poor places?
DR. HELENE GAYLE: Well, I think, as Dr. Gullick said, clearly, a vaccine is going to be a very important part of making an impact on the epidemic globally. I think we have to have more experience with the new drugs and the new approaches. Hopefully at some point, as we know how to use them best in our country, we may be able to look at ways in which they can be used in other countries, perhaps shorter courses or taken in different combinations. It could make a difference.
I think one of the important themes coming out of this conference besides a sense of cautious optimism is the sense of global solidarity and the fact that we have a real obligation as we develop better and better therapies and technologies in the developed world that we do look for ways of providing those advances to the parts of the world that are really sharing the, the real--the largest burden of this epidemic. So I think we're coming out of this conference with a much greater sense of global solidarity, much greater sense of responsibility that we have to make a difference for this whole epidemic and particularly in developing countries that are really sharing the largest burden of this epidemic.
ELIZABETH FARNSWORTH: Finally, Dr. Gullick, is it likely the price of these drugs will go down?
DR. ROY GULLICK: Well, I think that would be hard to predict. These are expensive drugs, and the question we're going to have to ask ourselves is: Are we ready to pay for these kind of medications for people who are infected with HIV who may actually require taking these drugs for years at a time? It's unclear at this point how we're going to do that.
ELIZABETH FARNSWORTH: So good news, but lots of questions?
DR. ROY GULLICK: Yes.
ELIZABETH FARNSWORTH: Thank you both. Thank you for being with us.

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