TURNING THE TIDE

By Philip Elmer-De Witt

Some ages are defined by their epidemics. In 1347 rats and fleas stirred up by Tatar traders cutting caravan routes through Central Asia brought bubonic plague to Sicily. In the space of four years, the Black Death killed up to 30 million people. In 1520, Cortes' army carried smallpox to Mexico, wiping out half the native population. In 1918 a particularly virulent strain of flu swept through troops in the trenches of France. By the time it had worked its way through the civilian population, 21 million men, women and children around the world had perished--more than were killed in World War I.

Today we live in the shadow of AIDS--the terrifyingly modern epidemic that travels by jet and zeros in on the body's own disease-fighting immune system. More than 15 years after the first rumors of "gay plague" spread through the bathhouses of New York City and San Francisco, nearly 30 million people--gays and straights alike--have been infected by HIV, the virus that causes what has been, until now, an almost invariably fatal disease.

This year, for the first time, there is something that looks like hope. Early this summer AIDS patients taking therapeutic "cocktails" that combine protease inhibitors with other antiviral drugs began experiencing remarkable recoveries. Their viral loads fell. Their T-cell counts climbed. Their health improved--perhaps temporarily, but often dramatically. Hospices and AIDS clinics across the U.S. began to empty.

Then in July, at an international AIDS conference in Vancouver, a virologist named David Ho reported on a most promising experiment. By administering the protease-inhibitor cocktails to patients in the earliest stages of infection, his team seems to have come tantalizingly close to eliminating the virus from the blood and other body tissues. Mathematical models suggest that patients caught early enough might be virus-free within two or three years.

This is, as an AIDS expert puts it, hope with an asterisk. Even if Ho's treatment works, there is still no magic bullet for patients in late stages of the disease and no vaccine that will inoculate against HIV infection. The cost of the cocktails (up to $20,000 a year) puts them beyond the reach of all but the best-insured patients--and out of the question for the 90% who live in the developing world.

Nevertheless, we have learned this year what may be the most important fact about AIDS: it is not invincible.

This was not the work of one scientist alone. There is no Louis Pasteur of AIDS. Science today is too costly and too complex for that. Modern research, and especially AIDS research, is a richly collaborative effort. But in the shared achievement of the thousands of scientists and physicians who have helped bring AIDS this year to what seems to be a historic turning point, one name stands out.

Dr. David Ho was one of a small group of researchers who recognized from the start that AIDS was probably an infectious disease. He performed or collaborated on much of the basic virology work that showed HIV does not lie dormant, as most scientists thought, but multiplies in vast numbers right from the start. His insights helped shift the focus of AIDS treatment from the late stages of illness to the first weeks of infection. And it was his team's pioneering work with combination therapy, reported in Vancouver, that first raised hope that the virus might someday be eliminated.

Ho is not, to be sure, a household name--like Bill Clinton, who dominated the front page this year with his masterful comeback victory, or Bill Gates, who deftly extended the scope of his software empire into news, television and the Internet. But some people make headlines while others make history. And when the history of this era is written, it is likely that the men and women who turned the tide on AIDS will be seen as true heroes of the age.

For helping lift a death sentence--for a few years at least, and perhaps longer--on tens of thousands of AIDS sufferers, and for pioneering the treatment that might, just might, lead to a cure, David Da-i Ho, M.D., is TIME's Man of the Year for 1996.