"We can't afford to wait for the biomedical community to come to our rescue," Department of Health and Human Services Secretary Otis R. Bowen said on Jan. 15 as a way to underscore the importance of preventing the spread of the virus that causes AIDS. Yet for a disease first identified only seven years ago, the biomedical community has made a great deal of progress in developing drugs that may one day be used to treat patients with AIDS.
The U.S. Public Health Service, which includes the National Institutes of Health, will spend nearly $1 billion to fight the virus this year, a 92 percent increase over last year's budget. Next year, the Reagan administration will ask for $1.3 billion to be spent on AIDS -- an amount that rivals the budget of the National Cancer Institute.
A third of the AIDS dollars are earmarked for community education efforts. About a quarter will go for basic research and population studies to track how the virus is spreading.
Nearly 20 percent of that budget, about $184.3 million, will be spent to develop and test new drugs and other therapies for those already infected.
Across the country are 19 AIDS Treatment Evaluation Units at university-associated research centers. Some 2,600 people infected with the AIDS virus are participating in nearly 40 drug-testing studies to evaluate various treatments.
An estimated 1.5 million Americans already are infected, and although scientists do not know how many of them will develop the disease, they suspect that at least a third -- and perhaps many more -- will become sick and need treatment. Officials at the Centers for Disease Control report that 50,820 Americans have been diagnosed with AIDS as of Jan. 11; 28,437 have died.
So far, only one drug, AZT, has been shown to slow the virus. But AZT is costly, frequently has severe side effects and does not eliminate the virus from the body.
Researchers now believe that no single drug will completely stop the virus once a person is infected. Like cancer, AIDS is most likely to be controlled by a combination of agents.
In one experiment, the immune-boosting drug interferon is being tested with a protein called tumor necrosis factor, which has been used to kill cancer cells and has shown some effectiveness against the AIDS virus in laboratory experiments. Other studies with human patients are testing combinations of AZT with biological agents, such as interferon and interleukin-2, a protein shown to stimulate the cell-killing ability of certain white blood cells.
One of the newest AIDS drugs to be tested in human trials is Peptide T. Developed by Dr. Candace Pert and her colleagues at the National Institute of Mental Health, the drug may block entry of the AIDS virus into cells, but its action is the source of great debate among the scientific community.
Last month, two AIDS patients became the first Americans to receive the drug.
In earlier experiments, Peptide T was given to four Swedish AIDS patients who were in the final stages of the disease. Three have died.
"We had only a very limited amount of Peptide T at that time, only enough to give the drug for one month," said Dr. Lennart Wetterberg, who conducted the study in October, 1986 at the Karolinska Institute in Stockholm. Karolinska study, in a telephone interview.
More recently, Wetterberg has begun a more extensive study of Peptide T with 36 AIDS patients. Results are expected in March.
Some of the most novel approaches to fighting AIDS are a long way from being tested in humans. One promising agent is the CD4 molecule -- the "gateway" molecule on the surface of a cell that controls the virus's entry into immune cells. By injecting large amounts of CD4 into the bloodstream as a decoy, scientists hope to trick the AIDS virus into latching on to the decoy and overlooking the cells it now attacks.
As work progresses on finding treatments for AIDS patients, scientists are also using human volunteers to evaluate potential vaccines to prevent AIDS. Two candidate vaccines are being tested. The first study began in August when NIH researchers started testing a vaccine made from a protein on the surface of the AIDS virus, which was then produced in large quantity in insect cells by Microgenesys Inc. of West Haven, Conn. Last week, NIH announced it would expand the trial to more research centers.
A second vaccine, only recently approved by the FDA, will be tested in 30 to 60 healthy homosexual men at the Pacific Medical Center in Seattle. This vaccine, developed by a Bristol-Myers Co. subsidiary, is made using genetic engineering techniques to combine the vaccinia virus, used to prevent smallpox, with a portion of AIDS virus protein.
French AIDS researcher Dr. Daniel Zagury of the Pierre and Marie Curie University in Paris is also working on a candidate vaccine. Last year, he injected himself and other volunteers in Zaire with a vaccinia-AIDS vaccine, similar to the Bristol-Myers preparation. He has reported that the experimental vaccine induced his body to produce antibodies to the virus that appeared, he said, as though they might protect him from being infected with one strain of the AIDS virus.
Because the AIDS virus mutates so quickly, researchers believe that making an effective vaccine will be complicated and may require a preparation that generates immunity to several strains of the virus or several different AIDS viruses. No vaccine is expected to be available for widespread use before the mid-1990s.