Expectation at Research Conference : No Breakthroughs in AIDS War Likely
WASHINGTON — In tranquil times, Dr. George J. Galasso is an agreeable, affable man. But these are not ordinary times, and the associate director of extramural affairs for the National Institutes of Health has become very hard-nosed.
“I’ve learned how to say no. And I’ve had to say it a lot,†Galasso said.
As chief organizer for the third annual International AIDS Conference, which begins here Monday, Galasso has had to make some tough decisions. Among them:
- How to cram 6,000 people into space planned for only 3,500? (Leave it to the fire marshals.)
- How to accommodate 2,000 scientific abstracts when you expected only 1,300? (Ask a scientific review panel to say no 700 times.)
- What to say to industry and trade associations that want to take advantage of the presence of so many acquired immune deficiency syndrome experts by having “satellite†meetings? (Just say no.)
The expected attendance is a huge jump over 1985, when 2,000 attended the first international AIDS conference in Atlanta and last year when 2,500 showed up for the second in Paris.
‘Parallels the Epidemic’
“In a sense, this conference--in its size and increasing number of topics covered and increasing number of countries participating--parallels the epidemic itself,†said Dr. Gary Noble, the AIDS coordinator for the federal Public Health Service who organized the first international AIDS meeting.
This third conference, sponsored by the U.S. Department of Health and Human Services and the World Health Organization, will have more non-science sessions than previous ones. “We’ve tried to cover everything--how to handle AIDS patients, the perspectives of AIDS patients themselves, AIDS and the media, ethics,†Galasso said. “There will be considerably more on the legal and ethical aspects of AIDS.â€
But few expect announcements of major import in the fight against the epidemic.
“It’s likely there will be no breakthroughs,†said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases .
“I think you can expect reports of steady progress and advances,†added Dr. Sam Broder, director of clinical oncology for the National Cancer Institute who is conducting drug trials on AIDS patients. “I think it’s appropriate to have a cautious sense of optimism. There is at least one drug available for prescription, and its development occurred as rapidly as any drug. And I think you’ll see other drugs emerging shortly.â€
What conference organizers expect are lots of small pieces of new information that scientists and physicians can take home as building blocks for tomorrow’s breakthroughs.
Fauci and others note that the identification in 1983 of the AIDS virus is apt to remain the major breakthrough in AIDS research for some time to come. That identification put researchers on the road to the many important developments and findings that have ensued, such as a blood test for exposure to the virus, experimental drugs and several candidate vaccines.
Drugs’ Test Results
Of great interest at the meeting will be the latest test results of experimental drugs against the disease.
There are three test drugs involving 470 patients that have been under way at 19 government-funded AIDS treatment evaluation centers. In addition, separate trials, involving other test medications, are being sponsored by pharmaceutical companies. (The precise number of drugs and patients in these trials are considered proprietary information by the industry.)
Two of the drugs in the government studies are DHPG, an antiviral medication for treating cytomegalovirus infection and hepatitis, and doxorubicin, a drug for the treatment of Kaposi’s sarcoma, a type of cancer that afflicts AIDS patients.
The third drug, AZT, or azidothymidine, is undergoing three separate studies--in children with AIDS, in patients with Kaposi’s sarcoma and in patients who have recently had pneumocystis pneumonia.
Four other compounds--foscarnet, AL-721, ribavirin and alpha interferon--soon are to be tested in more than 400 people with AIDS or AIDS-related complex (ARC) at the government-sponsored centers.
Foscarnet is said to have the advantage of inhibiting not only the AIDS virus but also infection by cytomegalovirus, the organism responsible for causing blindness in AIDS patients.
Some researchers believe that AL-721 may be capable of preventing the AIDS virus from infecting immune system cells.
Ribavirin may delay the progression of AIDS from an early stage, called lymphadenopathy, to more advanced stages of the disease, according to its maker, ICN Pharmaceuticals Inc. But in April, the FDA rejected a request by ICN to distribute the drug to many lymphadenopathy patients, saying there was insufficient evidence to justify doing so. The FDA also said it is investigating allegations that ICN presented it with misleading test data that may have cast the test drug in a better light than the true results.
Scientists also hope that alpha interferon may be useful in treating Kaposi’s sarcoma.
New Antiviral Drug Test
In a separate government study involving about 60 AIDS patients, researchers are trying to learn how well humans tolerate a new antiviral drug called dideoxycytidine, or DDC. According to Broder, the drug may have less toxicity than AZT, the most widely used antiviral AIDS drug.
AIDS researchers may also hear about new and improved treatments of so-called opportunistic diseases, such as pneumocystis pneumonia, which, together with Kaposi’s sarcoma, are the chief cause of death of AIDS patients. Researchers recently presented promising preliminary reports on several therapies for these two diseases.
In one study, AIDS patients have been inhaling tiny droplets of aerosolized pentamidine, a drug normally given intravenously, every two weeks to see whether it delays the occurrence of pneumocystis pneumonia. After about five months of treatment, according to the investigators from Memorial Sloan-Kettering Cancer Center in New York, only eight cases of pneumocystis had occurred, although 18 could have been expected by that time among the 130 patients in the study.
Scientists may also update preliminary reports that AZT appears to allay some of the dementia and other neurological effects that affect perhaps half of all AIDS patients. AZT previously has been shown to delay the onset of pneumocystis pneumonia, a finding that prompted the U.S. Food and Drug Administration to quickly license it so it can be given to all appropriate AIDS patients.
Updates are also likely on the development of vaccines. According to Fauci, at least half a dozen candidate vaccines are in various stages of testing on goats, monkeys and other animals. And in at least two such tests, the vaccines caused the animals to produce antibodies that were shown to be capable of inactivating the AIDS virus--an indication that the scientists may have selected the proper substances with which to make the vaccines.
It is “likely,†Fauci said, that early stage safety trials on humans will begin late this year or early 1988.
Vaccine Not Expected Till 1995
“Even if a safe vaccine is developed, it will be 1995 at the earliest before it could become generally available,†he cautioned, however. One reason for the delay is the need to be certain that any vaccine is safe and effective against the various strains of the AIDS virus; another is that the virus may not produce symptoms for five or more years.
It is also possible that several vaccines may have to be developed--and used together--in order to confer complete protection.
Earlier this year, a French scientist, Dr. Daniel Zagury, reported that he had immunized himself and a small group of volunteers in Zaire with a live-virus vaccine made with recombinant DNA technology. Zagury is scheduled to report on his findings at the conference.
Another topic that may come up is whether genetic makeup makes a person especially susceptible to infection by the AIDS virus. A recent report by British scientists indicated that people who possess a certain protein located on the surface of their cells are at a much higher risk of being infected than individuals who have a related, but different, protein.
