The Deadly Spread of AIDS

By Claudia Wallis

Homosexuals, Haitians and hemophiliacs fall victim

It began suddenly, in the autumn of 1979. Young homosexual men with a history of promiscuity started showing up at the medical clinics of New York City, Los Angeles and San Francisco with a bizarre array of ailments. Some had Pneumocystis carinii pneumonia, a deadly disease rarely seen except in drug-weakened cancer and transplant patients. Others bore the purplish skin lesions of Kaposi's sarcoma, a cancer that is usually confined to elderly men of Mediterranean extraction and young males in Equatorial Africa. Still others had developed strange fungal infections or other rare cancers. All had one thing in common: an immune system so severely impaired that they were living playgrounds for infectious agents. As soon as one bug could be brought under control, these patients would fall prey to another, gradually wasting away.

It has been 16 months since the Centers for Disease Control in Atlanta began compiling statistics on acquired immunodeficiency syndrome, or AIDS, as the disease is now known. During that period, AIDS has struck 547 people in the U.S. and at least 21 abroad, killing 232, more than toxic shock syndrome and the Philadelphia outbreak of Legionnaire's disease combined. "This is a very, very dramatic illness," says Dr. James Curran, head of the 120-member CDC task force on AIDS. "I think we can say quite assuredly that it is new." What makes AIDS especially alarming, says Curran, is that its incidence is rising, from one case a day in the first six months, to two or three cases a day in the past three months. What is more, the epidemic has spread beyond the homosexual community into several other segments of the U.S. population.

AIDS victims fall into four general groups (with some overlapping):

> 75% are homosexual men. Most are Caucasians in their 30s and 40s with a college education, incomes averaging $20,000, a history of prior infection with mononucleosis and venereal disease, and a sex life that has included many partners, more than 500 in several cases.

> 25% are intravenous-drug abusers, also in their 30s, but usually black or Hispanic, heterosexual, and with a high school education at most. Of this group, 19 are women.

> 6% are Haitian immigrants, three of them female, most of them heterosexuals and nonaddicts. All are believed to have been infected before coming to the U.S.

> .5% (three in all) are hemophiliacs who are not gay, Haitian or drug addicted.

The search for a common thread among these widely diverse groups has confounded researchers from coast to coast. When AIDS was confined to the gay community, says Curran, "our efforts were concentrated on trying to dissect out life-style differences." Various sexual practices and the use of amyl nitrite "poppers," inhalants widely used by homosexuals to enhance orgasm, were among the subjects investigated. The life-style theory does not, however, explain the emergence of AIDS in nongay populations. Most researchers now believe that an infectious agent is involved in AIDS. This agent is probably transmissible in a variety of ways, through lesions caused by anogenital sex, for example, or by dirty hypodermic needles. The hemophiliac cases raise the frightening possibility that it can also be transferred through blood transfusions. One model for such an agent is the hepatitis B virus, which commonly infects homosexuals, drug addicts, donor-blood recipients and, partly because of poor sanitary conditions, most Haitians. A few researchers speculate that the AIDS agent may have originated in Haiti and been sexually transmitted to American homosexuals vacationing there.

The narrow geographic distribution of AIDS further supports the transmissible-agent theory. Half the cases occurred in New York, 20% in California. More to the point, AIDS has been traced from sexual partner to partner. In one Los Angeles study, nine out of 13 patients had had sexual contact with one another. In San Francisco, six pairs of "roommates" have been stricken with Kaposi's sarcoma.

So far, efforts to isolate an AIDS bug have come to nothing. The CDC has cultured specimens from lymph nodes, urine, feces and blood of AIDS victims and then inoculated them into specially bred marmosets, at a cost of $25,000 for testing on each animal. Unfortunately, as Curran points out, "it is not known whether there is a transmissible agent, whether the patients we're studying harbor it, which body secretion may contain it, and whether marmosets are an appropriate species."

While some investigators delve into the question of AIDS transmission, others are exploring the nature of the disease. The type of immunosuppression found in AIDS patients appears to be unique, affecting white blood cells called T lymphocytes (T for thymus, which plays a role in their development). Certain of these cells help defend the body against viruses, foreign tissue (like organ transplants) and the growth of cancer cells. There are several types, including helper T cells, which promote the production of antibodies against foreign invaders, and suppressor T cells, which reduce antibody output. Healthy individuals have twice as many helpers as suppressors. In AIDS victims, the ratio is reversed; helper cells are depleted. No one knows what happens to these cells, but New York Immunologist Roger Enlow has a theory: "Just as hepatitis B virus preferentially attacks liver cells, it is probable and even likely to have a virus that at tacks helper T cells."

Theories are, of course, of little use for those now suffering or at high risk of contracting AIDS. Panic has set in on Greenwich Village streets and in "the Castro," San Francisco's gay quarter. Local AIDS hot lines are receiving 30 calls a day. There is evidence that at least some gays are curbing their night life out of fear.

Because of the widespread concern over AIDS, more victims are seeking medical attention at the first signs of the disease. Often these include low-grade fever, swollen glands and general malaise. Early detection makes it easier to control infections with antibiotics and to treat Kaposi's by surgical excision of lesions, chemotherapy and, more recently, the experimental use of interferon. The discovery that Kaposi's is more likely to strike a certain genetic type has made high-risk individuals easier to identify.

It is hard to find anything positive in a deadly plague, but immunologists, virologists and cancer experts agree that AIDS represents a remarkable experiment of nature. The new scourge, says New York Immunobiologist Pablo Rubinstein, "may teach us more about cancer and old, familiar diseases than we are able to fathom at this time."

--By Claudia Wallis.

Reported by Richard Bruns/New York and Joyce Leviton/Atlanta

With reporting by Richard Bruns, Joyce Leviton

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