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Whatever theory may prove to be correct, the research has provided inspiration for fresh studies by epidemiologists. The levels of Tcells, the presence of HTLV and CMV viruses, and the swelling of lymph glands are regarded as possible "markers" that indicate the early stages of AIDS. At the New York Blood Center, Dr. Cladd Stevens and Friedman-Kien are examining the blood of homosexuals who do not have AIDS to see what factor might be unique to those who do develop the syndrome. By chance they have thousands of samples of blood, 1,500 of them from homosexuals now being studied, which were collected in 1979 for an unrelated hepatitis-B project. To date, 18 men in the survey have developed AIDS.
No cure is in sight. But the research already has benefited some patients. New knowledge about the immune system has inspired doctors to be more careful when treating Kaposi's to use therapies that do not lead to further suppression of the immune system. Fauci of NIH has conducted a bone marrow transplant that bolsters a patient's immune system. Along with many other researchers, he is testing the effects on AIDS patients of new forms of interferon, a component of the human immune system that can now be reproduced by genetic engineering.
Despite the concern about the death and suffering of its victims, and despite the lack of any solution so far, health officials are optimistic that science will eventually conquer AIDS. "We've beaten other diseases, and we're determined to beat this one too," says HHS Secretary Heckler.
Heckler's opinion, which is shared by many medical detectives, is rooted in a century of victories over diseases whose ravages once shaped the course of history. Only a few decades ago, fear of a polio outbreak could empty schools; victims in iron lungs would be put on exhibit in small towns to raise money for the March of Dimes. All that is history now.
Optimism about AIDS is bolstered by new weapons being added to the medical arsenal. Interferon holds the promise of retarding the growth of cancerous cells. Potentially as powerful is a process that creates new cells called hybridomas. Cells that build antibodies against specific diseases are fused with tumor cells to make hybrids, which have the durability of tumors and the power to create antibodies. These cells may eventually be used to develop vaccines that will protect humans against new diseases and can help the body fight certain cancers.
Nevertheless, optimism is tempered by knowledge that the struggle against disease never ends. Of the deadly African Ebola virus, Foege says: "What keeps it from spreading here? I don't know." Thus research work on Ebola at Atlanta's Maximum Containment Lab goes on. Another potential threat is a subviral particle that combines with the hepatitis-B virus to cause more severe infections and liver cancer. Discovered in 1977, this so-called Delta agent is starting to show up in high-risk groups, including some of the same ones who develop AIDS. Even the victory over smallpox permits no complacency. In its place, a disease called monkeypox has erupted in Africa. "It's probably a disease that's been around a long time but has been masked by smallpox," Foege says. "Once you get rid of one disease, a new one becomes visible."