Battle Fatigue

The setting was new. Never before had the annual International AIDS Conference, now convening for the 10th time, taken place in Asia. And yet the 10,000 researchers and others gathered in Yokohama, Japan, found it hard to shake a terrible sense of deja vu. Once again, despite their efforts, the epidemic is galloping ahead: from 14 million people infected worldwide in 1993 to 17 million today. Once again, disappointing results have led U.S. researchers to postpone large-scale trials of experimental vaccines. Once again, a cure is nowhere in sight.

Equally disturbing were reports that efforts to contain the epidemic in Asia, a particular focus of last week's session, were being crippled by shame and denial, the same forces that hindered efforts in the U.S. and Europe 10 years ago. Experts fear that overcrowding and other factors in Asia could make the epidemic there even more devastating than it is in Africa.

In paper after paper, scientists tried to chip away at the strange workings of the AIDS virus. New research suggests that in the early stages of infection, the immune system is not suppressed but overactive, churning out white blood cells. The virus appears to take advantage of this charged-up state by multiplying within the abundant white cells. The implication is that doctors may have to alternate between dampening and boosting the immune system in order to fight AIDS.

Some HIV carriers seem to do this naturally. Scientists are studying a handful of people who are still healthy a decade or more after first being infected with the virus. A possible clue to their good fortune lies in the high levels of white blood cells, called CD-8 cells, whose job is to turn down the immune system before it careers out of control. Perhaps these people possess just the right balance between an overly aggressive immune system that produces more virus particles and a dangerously passive one that cannot resist infections.

For less fortunate AIDS patients, researchers are beginning to explore the possibility of using gene therapy to fortify white blood cells against the virus. One team of researchers expects to test such a treatment for AIDS- infected babies in the next year. But it could take years to determine if such a strategy will work. Alas, by then, doctors will have many new patients on whom to try it.