AIDS: A Spreading Scourge

By Claudia Wallis

The rumors, fed by his wan and wasted appearance, had circulated for days. Rock Hudson, it was said, was suffering from liver cancer and slipping in and out of a coma at the American Hospital in the Paris suburb of Neuilly. Reality was more shocking than rumor. At the hospital last week, a spokeswoman for the actor bluntly announced, "Mr. Rock Hudson has acquired immune deficiency syndrome."

For most Americans, whose lives have not been touched by the epidemic, the announcement brought home for the first time the grim reality that AIDS is spreading unabated, inevitably striking the famous and the familiar. As of July 22, the Centers for Disease Control (CDC) in Atlanta had recorded 11,871 U.S. cases, including 5,917 deaths. Most alarming, the total number of cases continues to double every ten months. So far, 73% of those stricken by the disease have been homosexual or bisexual men, 17% intravenous drug users and 1% hemophiliacs. But the rest of the victims are people from all walks of life, contaminated perhaps through blood transfusions or through sexual contact with infected prostitutes, addicts and others. "This is not really a disease of homosexuality at all," says Dr. Alexandra Levine of the University of Southern California. "It is spread by sexual contact of any kind--homosexual or heterosexual. This is a disease of all of us."

Not everyone exposed to the AIDS virus has contracted the disease. Some have developed a flu-like condition known as ARC (AIDS-related complex), which may or may not progress to the more lethal syndrome. Others have so far displayed no symptoms at all but remain capable of spreading the contagion.

For anyone stricken with a full-blown case of AIDS, the prospects are grim. The virus directly attacks a group of white blood cells called helper T cells, which serve as one of the main coordinators of the immune system. As the disease progresses, these defensive cells are almost entirely destroyed. The immune system collapses, and victims fall prey to one infection after another. Ordinarily mild diseases become dangerous, even fatal, and many patients develop rare cancers, severe neurological disorders and brain damage.

Treatment for AIDS patients is for the most part a matter of damage control. Doctors use antibiotics and other drugs to battle against each successive infection, but overall the war is slowly lost as each illness takes its toll and the immune system continues to deteriorate. "We know of no patient who has regained the total strength of his depleted immune system," says Charles Fallis of the CDC. "We've observed that AIDS is almost always fatal."

In a desperate search for something, anything, to arrest the disease, AIDS patients are traveling the world. Hudson had reportedly gone to Paris to seek treatment with an experimental antiviral preparation called HPA-23, which was discovered at the city's famed Pasteur Institute. French experiments with this and other new drugs have made Paris something of a Lourdes, attracting dozens of AIDS patients from the U.S. and elsewhere. Some patients have flown to Mexico to be treated with other drugs supposedly effective against AIDS but not approved for use in the U.S. Some sufferers have spent small fortunes on obscure rejuvenating treatments in Switzerland and sheep-gland injections in Rumania, or have turned to holistic healers, megavitamin therapists, even voodoo doctors and spiritualists. Doctors caution AIDS patients about quackery but understand why their advice is often ignored. Says Dr. Michael Lange, an infectious-disease specialist at St. Lukes-Roosevelt Hospital in Manhattan: "If I were told that I was going to die from AIDS in two years, I would seek help wherever I could find it."

The greatest and perhaps the only real hope for AIDS patients lies in half a dozen experimental drugs now being tested in the U.S. and abroad. In general, the drugs fall into two categories: those that attack the AIDS virus directly, generally by interfering with its replication, and those that are aimed at rebuilding the immune system. The Pasteur Institute's HPA-23, which may be available for study in the U.S. this fall, prevents the virus from reproducing by blocking the transcription of its genetic code. In limited studies, HPA-23 has indeed been shown to reduce the amount of virus present in some patients' blood. But it is by no means clear that it alleviates their illness. What is more, the drug can have potentially serious side effects, including blood-clotting problems. Acknowledges Dr. Willy Rozenbaum, a leading French investigator: "This is not a miracle drug."

U.S. researchers at a handful of medical centers around the country are testing another antiviral preparation, called Suramin, which was originally used to combat African sleeping sickness. Like HPA-23, the drug appears to stop the proliferation of the AIDS virus, but it does not necessarily improve the patient's condition. Other antiviral substances, including Ribavirin and Foscarnet, now being studied in Sweden and Canada, are in even earlier stages of investigation.

To revitalize the weakened immune systems of AIDS patients, researchers have in some cases tried bone-marrow transplants and infusions of interferons and interleukin-2, another substance produced naturally by white blood cells. But such efforts, like those aimed at arresting the virus, have failed to influence the course of the disease. The answer, says Dr. Anthony Fauci, an immunologist at the National Institute of Allergy and Infectious Diseases, "may lie in a two-pronged approach to suppress the replication of the virus at the same time that we are enhancing the immune response." This strategy, Fauci and other researchers think, will probably involve the use of several drugs in combination.

Doctors are eager to go ahead with multidrug experiments and more extensive tests of existing drugs. "It's terrible going into room upon room of patients who ask what we can do, and to have to tell them we have nothing to offer," says Dr. Donald Abrams, assistant director of the AIDS clinic at San Francisco General Hospital. One major obstacle, researchers agree, is a lack of federal funds. "The Administration is giving lip service to this disease but not the funding," complains Immunologist Allan Goldstein of George Washington University. Federal allocations for AIDS research have risen steadily from $5.5 million in 1982 to $106.5 million this year, but much of the money has come at the expense of other health programs and much of the initiative has come from Congress, not the Administration. Says Congressman Henry Waxman of California, who has been leading a drive for more generous support: "The amount being spent on AIDS is a drop in the bucket compared with what we need for this emergency."

In addition to money, researchers say, the drive against AIDS needs more direction and better coordination, which only federal agencies like the National Institutes of Health can provide. The NIH has an established nationwide program for the testing of new anticancer agents. Says William Haseltine of Harvard's Dana-Farber Cancer Institute: "What we need to do is apply that know-how and organization to AIDS." Current U.S. trials of antiviral drugs are being conducted in a piecemeal way, often with each research group setting its own standards and protocols. Dr. Martin Hirsch, a Harvard immunologist, complains that it is difficult to learn much from these uncoordinated studies. "My great fear," he says, "is that two years from now, instead of having only half a dozen drugs to consider, we'll have a dozen, all with data that are no more useful than what we have today."

Last week, as the news of Rock Hudson's illness spread, AIDS researchers and patients alike were hopeful that his plight, and his decision to reveal it, might finally dramatize the threat of the growing epidemic and bring calls for a more effective medical counterattack. Says Dr. Alvin Friedman-Kien, who has treated hundreds of AIDS patients at New York University Medical Center: "It takes something like this to make the public aware that not enough is being done." --By Claudia Wallis. Reported by Melissa Ludtke/Los Angeles, with other bureaus

With reporting by Reported by Melissa Ludtke/Los Angeles, with other bureaus