When Dr. Michael Gottlieb showed up to register for the Third International Conference on AIDS last week, he learned the hard way that fame is fleeting--perhaps even non-existent.
The Los Angeles immunologist, who in 1981 identified the first cases of AIDS in the world, had neglected to register in advance, assuming that he could sign up on the first day. But the conference was overbooked, and he was informed politely that registration was closed.
"I told the lady at the desk that I had discovered AIDS--wouldn't she please let me in?" Gottlieb recalled, laughing. "She said no."
The story, however, has a happy--if slightly dishonest--ending. Gottlieb managed to secure a fake badge bearing the name of a non-existent person from a government scientist who had obtained it for just this very possibility.
This year's annual international AIDS conference, which ended Friday, was notable for many things--not the least of which was its gargantuan size. More than 7,000 participants attended, nearly three times the number who gathered in Paris last year. Among them were scientists, public health officials, educators, representatives from biotechnology and drug companies, AIDS service organizations and AIDS patients--dogged by nearly 1,000 journalists from around the world.
Warm, Steamy Weather
The already claustrophobic atmosphere was compounded by banks of television lights circulating throughout the meeting, and a stubborn spell of warm, steamy weather outside that wrapped itself like a clammy blanket around the capital all week.
While no startling scientific breakthroughs were announced, researchers reported slow but steady progress against the deadly disease.
There also were moments of poignancy that recalled the words of one health official as the conference opened. Referring to the grim AIDS death toll, he reminded everyone that "each of these numbers we talk about represents a person."
During a "Living With AIDS" panel discussion, patients insisted they were not "dying of AIDS," but "living with AIDS."
One woman, Tema Luft of Baltimore, who had contracted AIDS Related Complex (ARC) from an infected man, said her upbeat attitude came from lessons learned from her parents, both of whom had been imprisoned in concentration camps during World War II.
"When I told my father, he said: 'Now you know how I felt when I was 22 and knew I could die at any moment,' " she said. "That did it for me--I could choose to live or choose to die. I choose to live. He survived the Holocaust--and I'll survive this."
Another woman, identified only as Matilda, was a professional dancer from Miami who contracted ARC through the use of intravenous drugs. She said she had infected her 2-year-old son, Angel. In broken English, tears running down her face, she spoke of her heartbreak and guilt. By the time she had finished, many in the audience were weeping too.
"He's only a child, and we're still human, you know. This virus can kill us, but not our feelings. In the end, my child is just a child. He is my life," the woman said.
"What makes me sad--I'm afraid he gonna say: 'Mama gave me this problem,' and hate me. Or do you think he gonna love me?"
Several in the room shouted back: "He'll love you--you're wonderful."
One of the more surprising reports during the conference was one saying that carriers of the AIDS virus become more infectious with time--contrary to earlier thinking.
This may be one explanation why there have been far fewer AIDS cases among women. Also, it may point to an increased number of heterosexual cases in the coming years.
Until now, medical researchers believed that individuals were most infectious immediately after exposure to the virus, and that it was much less unlikely for women to transmit the virus to men through vaginal intercourse.
"There are some very unpleasant implications of these findings for heterosexual transmission," said Dr. H. Hunter Handsfield, a Seattle health official. "It might just be that women (have not been infected long) enough to pass the virus on."
In another study involving women and AIDS, University of California, Berkeley, researchers said that the more sexual contacts a woman has with an AIDS-infected man or men, the greater her risk of becoming infected; but even so, her risk of contracting the virus from each contact is still lower than are her chances of acquiring other sexually transmitted diseases.
High Infection Rates
The investigators tested 96 women partners of infected men and found that 22 women, or 23%, were infected. The women with the highest infection rates were those who had several hundred sexual contacts with an infected partner, and those who had had any sexual contact with infected intravenous drug users.
The highest rate of infection, 36%, was found among women who had had more than 600 sexual contacts with an infected man, or men. Forty-two percent of the women who had had sexual contact with infected intravenous drug users became infected, and 22% of the women who had had sexual contact with infected bisexuals had become infected.
On average, the women in the study faced only a "one-in-a-thousand" chance of infection each time they had sexual contact with an infected man, the researchers said, calling the risk "surprisingly low."
However, the scientists said, this "does not mean women can beat the odds against AIDS infection simply by reducing their total number of sexual contacts, or avoiding contact with men from high-risk groups."
As the infection spreads among heterosexuals, they said, "even women who practice serial monogamy" could face risk of infection from partners who were exposed earlier to the virus.
Cases in Newborn Babies
The rising number of cases of AIDS among females--either through sexual contact with an infected male or through drug abuse--is the reason the number of cases in newborn babies continues to rise, according to Dr. James Curran, director of the AIDS program at the national Centers for Disease Control. To date, 503 children nationwide have contracted AIDS, 396 from their mothers.
Meanwhile, another study has found a five-fold increase in celibacy among gay and bisexual men. In a survey of 4,955 such men, Johns Hopkins School of Public Health researchers found that the percentage choosing celibacy has increased from 2% to 12% and monogamy from 12% to 28% since April, 1984. The researchers also found a decrease in the number of sexual partners as well as in the number of those still engaging in unsafe practices such as anal receptive intercourse.
Occasional units of contaminated blood are still slipping into the blood supply because infected individuals who had not yet developed detectable antibodies were continuing to donate blood, according to Steven Kleinman of the American Red Cross in Los Angeles.
Based on studies of blood in Southern California, he estimated the risk at one contaminated unit in 48,000--higher than the federal government's estimate of one in 80,000.
During the two-year period beginning in May, 1985, the Los Angeles/Orange County Red Cross tested 780,574 units of blood donations, and found 361 of them were infected with the AIDS virus. Of these, 21 individuals had previously donated 26 units of blood that had earlier tested negative, he said.
These were believed to be infected individuals who had not yet developed antibodies to the virus at the time of their earlier donation.
He emphasized that "while we have a good screening test, it is not perfect--and it will continue to be not perfect. There are always going to be cases that are going to be missed."
Programs should continue to emphasize "that people with risk behaviors should not donate," he said.
Dr. Don Desjarlais, a New York drug abuse expert, said that if the definition of AIDS was changed to include tuberculosis and certain other infections among HIV-infected drug users, the number of AIDS cases among that group would increase 50% to 100%. At present, intravenous drug users account for 17% of the 36,000 AIDS cases to date.
Drug users, through sexual intercourse, have become a significant route of the virus into the heterosexual population. As a result, many researchers called for more drug-abuse clinics and educational programs aimed at that group.
"We will not stop AIDS unless we get a handle on drug abuse," said Dr. Edward N. Brandt Jr., chancellor of the University of Maryland and former assistant secretary for health at the U.S. Department of Health and Human Services. "All persons concerned about AIDS must be equally concerned about drug abuse."
Regardless of prevention and control measures, according to Dr. Jonathan Mann, head of the World Health Organization's AIDS program, the world can expect to see 3 million new cases of AIDS by 1991.
"AIDS has created a worldwide emergency," he said. "Global AIDS control will require billions of dollars over the next five years. . . . AIDS threatens all countries--there are no geographic 'safe zones' and no racial exemptions."
He estimated that the current total number of AIDS cases worldwide is in excess of 100,000 and said WHO believes that between 5 million and 10 million people are currently infected.
For AIDS patients, there were glimmers of hope last week as researchers reported on many continuing experiments.
Several recently completed clinical trials of experimental drugs intended to improve the treatment of cytomegalovirus infections and pneumocystis pneumonia, the chief cause of death of AIDS patients, revealed that small but steady progress is being made.
In one trial of a drug called eflornithine conducted on 345 patients with pneumocysti s pneumonia--151 of whom were sick enough to be on respirators--36% recovered enough to be discharged from the hospital. Dr. B. D. MacLees of the Merrell Dow Research Institute in Cincinnati recommended that all patients on a respirator who are not responding to standard treatment receive the drug.
A second pneumocystis study involved 49 acutely ill patients who were treated with trimetrexate, another experimental drug, after they had failed to benefit any longer from standard drugs. Eighty-eight percent responded by having reduced fever and cough and improved breathing, according to Dr. Carmen J. Allegra of the National Institutes of Health.
In the cytomegalovirus study, 122 patients with life-threatening infections in the eyes, colon, brain or esophagus were treated with DHPG. Although all the patients had been given only three months to live when the study began, 66 of the patients lived at least twice that long, according to Dr. Douglas Dieterich of the Kaplan Cancer Center in New York. He did not elaborate.
The role of genetic susceptibility to AIDS is increasingly being studied, and last week there were two reports that concluded that genetic factors may determine whether an individual is susceptible to Kaposi's sarcoma, a cancer that afflicts AIDS patients, as well as pneumocystis and other infections.
One study suggested that persons with certain tissue types--an inherited characteristic--tended to develop those illnesses, while those with a different tissue type seemed to be protected from them. The other study, involving hemophilic families in whom two brothers were infected with the AIDS virus, showed that the chances of the younger brother developing serious complications of AIDS are much higher if the older brother had suffered such complications.
A new explanation of how Kaposi's sarcoma arises in AIDS patients came from Dr. Robert Gallo, the National Cancer Institute researcher who is a co-discoverer of the AIDS virus. Kaposi's sarcoma, the second leading cause of death in AIDS patients, generally is regarded as an exceptionally malignant form of cancer in such patients.
Not True Malignancy
But Gallo said he has laboratory evidence suggesting that Kaposi's is not a true malignancy after all but, rather, the result of the effect that natural body chemicals called growth factors have on cells. Interleukin-2, a growth factor that speeds the replication of the AIDS virus, is one example of the large number of growth factors identified in recent years.
If this observation holds up, it may provide a new line of research into Kaposi's. For instance, it might be possible to reverse the onslaught that Kaposi's has on cells by developing a drug that blocks the growth factor, Gallo said.
Although human trials of several AIDS vaccines are scheduled to begin in the United States early next year, there were no reports last week to indicate that a useful vaccine will be available before the mid-1990s. In fact, one report said that a promising vaccine that had been developed at the National Cancer Institute has failed to protect chimpanzees against infection by the AIDS virus. All six vaccinated chimps in the study died weeks after being exposed to the virus.
Elizabeth Taylor may be the entertainment industry's most visible star heading the war on AIDS. But there are many others.
An upcoming TV campaign sponsored by the American Red Cross will feature, among others, Meryl Streep, Robert De Niro, Elizabeth McGovern, Jose Feliciano and Johnny Carson, Glenn Close, Sam Waterston and Wayne Rogers.
They all have made nine 30-second, educational TV spots scheduled to start running June 16.
One of the messages tells viewers, "You are sleeping with everyone your partner slept with in the past 10 years."