AIDS Meeting Ends With Sobering Appraisals : Health: Experts say that progress is slow in coming. The Berlin conference stressed prevention, not cure.
BERLIN — Acknowledging that science is progressing at a snail’s pace and that prevention is the only immediate hope for stemming the global AIDS epidemic, more than 14,000 medical researchers, doctors, community workers and patients bid adieu Friday to the Ninth International Conference on AIDS.
“It’s best to be frank,” said Dr. Michael Merson, head of the World Health Organization’s Global Programme on AIDS. “There have been disappointments in (the development of new drugs). And we cannot report the big breakthroughs on preventive vaccines for which the world is waiting.
“We must accept that our scientific advances today are coming in small steps, not leaps and bounds. . . . At times, our progress seems desperately slow.”
Among those small, albeit significant, steps:
* U.S. researchers studying long-term survivors of acquired immune deficiency syndrome reported new insights into the immune systems of those who are infected but do not get sick. The work reveals the importance of certain killer immune cells that are capable of directly destroying other cells infected with the human immunodeficiency virus and may prove useful for the development of an eventual vaccine.
* Dutch scientists provided compelling evidence for the hypothesis that syncitia--the clumping, and eventual death, of immune cells--hastens the onset of AIDS. One of their findings was that the drug AZT appears to accelerate this process of syncitia; if correct, this could mean that existing antiviral drugs could do some patients more harm than good.
* British researchers reported that, contrary to previous U.S. studies, their findings show that AZT does not work better when given to patients in the early stages of the disease. The controversial study may prompt the U.S. government to revise guidelines about the use of the drug.
If anything, AIDS experts said, this year’s gathering demonstrated the need for new antiviral drugs. Only three are now on the market.
Vaccines captured a lot of attention as well, although experts concluded that even if a successful preventive vaccine is developed--and that remains a big if--it would by no means wipe out AIDS. Moreover, as some vaccine candidates move closer to large-scale clinical trials, public health experts spent the week grappling with the ethical concerns that are bound to plague such testing.
For instance, they asked, how will vaccine volunteers, who would presumably develop antibodies to HIV after vaccination and therefore test positive for the virus, be protected from discrimination by employers and insurance companies? And how can researchers adequately ensure that the people who receive the experimental vaccinations do not practice unsafe sex under the false belief that they are protected?
One of the major themes during the weeklong meeting in Berlin was the dramatic spread of the epidemic in developing nations. In Thailand, more than 450,000 are infected--nine times as many as three years ago. A study in rural Uganda, meanwhile, showed that more than 80% of deaths in young adults were associated with HIV.
Women are increasingly affected; around the world, women account for five out of every 11 new cases of HIV infection. The issue of women and HIV took center stage this year, with experts across the board calling loudly and repeatedly for development of a vaginal microbicide--a virus-killing agent that a woman could use to prevent herself from getting infected.
In the arena of sexual transmission of AIDS, experts gathered in Berlin said biological research now confirms what epidemiologists have believed for eight years: Sexually transmitted diseases put people at increased risk for becoming infected with HIV.
Studies now show that genital ulcers, which often appear in connection with sexually transmitted diseases, assist in the transmission of HIV, according to Marie Laga of the Institute of Tropical Medicine in Antwerp. Laga also said sexually transmitted diseases can increase the number of HIV-infected cells in vaginal fluids and semen, thus making transmission more likely.
If there was any overarching message the experts sought to drive home this year, it was that prevention, rather than science, is the way to stop the spread of AIDS. The WHO’s Merson reiterated his call, issued on the opening day of the conference, for an additional $2.5 billion per year to be spent on prevention--money that he said could save 10 million lives by the end of the century.
“For now and for the foreseeable future, unfortunately the only way we can slow the AIDS epidemic is through the prevention of sexual transmission of HIV,” said Yamil H. Kouri, a conference organizer.
The international AIDS conferences have always been as much about politics as they are about science and public health, and this year was no exception.
U.S. Surgeon General Antonia Coello Novello took the occasion to release her office’s newest report on AIDS. The report covers recent trends, including the disproportionate impact that AIDS is having on minorities and the increasing toll the epidemic is taking on children.
Activists protested the incarceration of HIV-infected Haitian refugees at Guantanamo Bay, Cuba, and then celebrated their release under a federal court order. And the conference delegates gave a collective groan when they learned that President Clinton had signed legislation reauthorizing a ban on HIV-infected people traveling and immigrating to the United States.
“He said it was not his choice,” Cindy Robins-Shapely, leader of a worldwide coalition of AIDS patients, said during Friday’s closing ceremonies. “But as far as I’m concerned, if he’s not making the decisions, who is?”
