Wars are usually launched with the promise of a quick victory, with trumpets primed never to sound retreat. And the campaign against AIDS was no exception. Soon after researchers announced in the mid-1980s that they had discovered the virus that causes AIDS, U.S. health officials confidently crowed that a vaccine would be ready in two years. The most frightening scourge of the late 20th century would succumb to a swift counterattack of human ingenuity and high technology.
But no one was making any victory speeches last week in Amsterdam, where more than 11,000 scientists and other experts gathered for the Eighth International AIDS Conference. The mood was somber, reflecting a decade of frustration, failure and mounting tragedy. After billions of dollars of scattershot albeit intensive research and halfhearted prevention efforts, humanity may not be any closer to conquering AIDS than when the quest began.
There is no vaccine, no cure and not even an indisputably effective treatment. While AIDS education has slowed the epidemic in developed countries, the disease continues to spread rapidly in many poorer nations. The World Health Organization says at least 30 million people around the world could be infected with the AIDS virus by the year 2000. Other experts think the number could reach 110 million.
Despite dogged detective work by the world's best researchers, AIDS (acquired immunodeficiency syndrome) remains one of the most mysterious maladies ever to confront medical science. The more researchers learn about the disease, the more questions they have. Human immunodeficiency virus (HIV), proclaimed to be the cause of AIDS, has proved to be a fiendishly fast-moving target, able to mutate its structure to elude detection, drugs and vaccines. No one knows for sure how HIV destroys the human immune system, and puzzled experts have debated whether the virus is the only culprit at work.
Bewilderment reached a new level in Amsterdam, where scientists reported cases of people who have an AIDS-like condition but have not been found to be infected with HIV. That frightening revelation raised the possibility that a new AIDS virus is emerging. Another theory, suggested by France's Dr. Luc Montagnier, who first discovered HIV, is that the strange cases were caused by one or more mutant forms of HIV that were altered too radically to be detected by standard blood tests.
Hardly any of the news at the conference was good. As groups of protesters staged daily demonstrations demanding more action against the epidemic, Dr. Jonas Salk suggested that vaccine researchers were on the wrong track, and the actress Elizabeth Taylor blasted President Bush for not doing enough about AIDS. Delegates heard reports on the surging costs of treatment, warnings about the threat of AIDS-associated infections such as multidrug-resistant tuberculosis, and alarming projections that AIDS will become more of a heterosexual disease. The infection rate among women is rising and will pass the rate in men by the year 2000.
"We're dealing with something that's expanding out of control," said Dr. June Osborn, chair of America's National Commission on AIDS. Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, noted that "the science is going as fast as it has with any disease," but he admitted that "the advances over the last several years are clouded and dwarfed by the size of the growing epidemic." Mark Harrington, a member of the New York City-based Treatment Action Group, summed up the situation more simply and grimly: "It's clear we're losing the battle. We have one class of drugs that slows AIDS down by two or three years, and then people go on and die."
THE MYSTERY OF NON-HIV CASES
The biggest surprise in Amsterdam was the talk about a new kind of AIDS. Dr. Jeffrey Laurence of the New York Hospital-Cornell Medical Center described five instances of people who suffer from an AIDS-like illness and yet bear no trace of HIV anywhere in their body. When a similar case was reported at last year's AIDS conference in Florence, it was dismissed as a fluke. This year several scientists in the audience stood up to tell of other cases of non-HIV AIDS, bringing the total to about 30 -- a number that is small but impossible to ignore.
Is a deadly new microbe on the loose? Speaking in the U.S. last week, Dr. Sudhir Gupta of the University of California at Irvine claimed to have found ! one in patients with AIDS-like symptoms. But there is no proof yet that the virus caused the symptoms. It is possible that the patients don't have AIDS but have some other problem with their immune system that mimics the disease. "It's just very premature to talk, because we don't know if it's real," says Fauci. "We should know something in a matter of months."
Even if there turns out to be a new virus, people should have no reason to panic or refuse blood transfusions. Researchers think they can isolate the pathogen within months and develop a blood test. In the meantime, this unusual type of AIDS, whatever causes it, is very rare. Said Laurence: "Every major AIDS researcher is here in one place in one room, and still we're talking about only a handful of cases."
The bad news, if a new virus does exist, is that AIDS will become even harder to prevent or cure. Pharmaceutical manufacturers have already been hampered by HIV's talent as a quick-change artist. Only last year a group of promising anti-AIDS drugs had to be shelved because HIV adapted too easily to the medication. And drugs that prove effective against all forms of HIV will not necessarily knock out an entirely novel virus.
HIV is a formidable enough opponent, mainly because researchers still don't understand the method to its madness. Like all viruses, HIV is simply a strand of genetic material (in this case the nucleic acid RNA) surrounded by a protein coat. A virus lacks the tools to reproduce unless it invades a living cell and takes over the host's molecular machinery. The intruder can then produce many copies of itself, eventually killing the cell. One of HIV's favorite targets is the CD4 T-cell, an important player in the human immune system.