AIDS Conference Impressive--but Short on Science

The fifth international AIDS conference, which ended here Friday, attempted something never tried before: to include in a scientific meeting on AIDS the social, political and ethical dimensions of the epidemic, as well as the viewpoints of people with the disease.

Few who came to the six-day gathering would deny it was an impressive effort. But many left Montreal less than satisfied. Militant AIDS activists complained that their perspective had not gotten a fair hearing, while researchers grumbled that science had been given short shrift.

“Good can come out of it. It can bring people together,” Dr. Robert C. Gallo, a co-discoverer of the AIDS virus, said of the occasionally volatile intermingling of agendas. “But it can also be divisive.”

Adding to frustration at the conference, no dramatic advances in treatment were announced. For example, most of the new data on closely watched experimental drugs involved small preliminary trials. These trials are designed to determine the proper dose of medication and monitor for side effects, not to prove that the therapy is effective.

Nuclear Bomb Comparison

Both scientifically and politically, the conference made clear the enormous barriers to progress against AIDS, the disease Zambian President Kenneth Kaunda, the keynote speaker, called “a soft nuclear bomb on human life.” Unless those obstacles are overcome, there will be further delays in developing acceptable treatments for the disease.

The conference came eight years to the week after UCLA researchers reported the first cases of the disease that became known as acquired immune deficiency syndrome. It drew nearly 12,000 registered delegates and hundreds of reporters. Attendance was six times that of the first international conference on AIDS, held in Atlanta in 1985.

For the first time, the meeting included hundreds of presentations on the social, political, economic, and legal aspects of the epidemic. People with AIDS helped shape the program, were featured speakers and played an often vocal role in the audience.

The result was a much more diverse agenda than at previous meetings. Activists voiced views on everything from the slow pace of research and lack of access to experimental drugs to corporate profiteering from the disease and the neglect of lesbian issues at the conference.

Many delegates complained, however, that the occasional chaos combined with the sheer size of the turnout made it almost impossible to discuss science.

“On the one hand, I understand their urgency,” said Dr. Luc Montagnier, the French scientist who shares credit with Gallo for discovering the AIDS virus. “What I understand less is making intrusions into a scientific meeting.”

“Groups . . . can be expected to use this conference as an opportunity to push the system,” said Dr. Paul C. Volberding of San Francisco General Hospital. “My concern is that we not overreact to the discomfort that this process causes us.”

On the treatment front, both researchers and activists jammed meeting rooms to hear about the latest therapies for the human immunodeficiency virus, or HIV, the cause of AIDS.

AZT, or azidothymidine, is still the only drug shown to prolong the lives of AIDS patients. Dr. Margaret Fischl of the University of Miami reported studies confirming the benefits of AZT. Fischl and others discussed the benefits of combining AZT with drugs that prevent pneumocystis carinii pneumonia, a common cause of death for AIDS patients.

Fischl acknowledged, however, that AZT has its greatest benefits during the first year of therapy and that, during the second year, many patients developed “advancing” disease.

Nearly four-fifths of a group of AIDS patients who began AZT therapy in early 1986 were alive after one year, Fischl said. But the percentage of patients surviving decreased to 31% after two years of therapy and 21% after 30 months. By comparison, about 50% would probably have died within a year if they had not received AZT.

New AIDS Treatments

The new treatments attracting the most interest included dideoxyinosine and dideoxycytidine, compounds chemically related to AZT that interfere with the ability of the virus to reproduce. Also drawing attention was CD4, a genetically engineered drug that interferes with the ability of HIV to infect immune-system cells.

Many researchers expect that larger trials of dideoxyinosine and dideoxycytidine, including comparisons with AZT, will begin soon. Both compounds appear to have significant anti-viral effects in humans.

Trials of CD4 are not as far along. Researchers need to learn more about the best dose of CD4 and possible side effects. They also need to determine that it works against the virus in humans.

Disappointing results were also presented for oral dextran sulfate, a popular underground AIDS remedy. A research team led by Dr. Donald I. Abrams of San Francisco General Hospital said that a trial of oral dextran in 60 patients showed very little absorption of the drug into the bloodstream. They said it was of no help to the immune system and had no effect against the virus. The researchers concluded that trials of oral dextran should be abandoned.

Significant news about treatments could emerge by the time the sixth international conference on AIDS convenes in San Francisco next June. In particular, San Francisco General’s Volberding said he hoped that results would be available from the crucial study of the role of AZT in preventing disease in asymptomatic HIV-infected individuals. Volberding is the co-chairman of that conference and the principal investigator of the AZT trial.

Politically Charged Climate

But already the meeting’s organizers are worried. More than 15,000 registrants are expected. Because of the location of the conference and its timing--immediately before the annual Gay Freedom Day parade--the political climate may be even more charged than it has been in Montreal.

“The activism is the expression of the community’s fear,” Volberding said. It is necessary “to work with these groups, because in the long run we share the same goals.”

The final word in Montreal went not to a scientist but to a journalist--Randy Shilts of the San Francisco Chronicle, the author of “And The Band Played On,” the best-selling history of the epidemic. In his conference-closing speech, Shilts chided the “dissenters” for frittering away their energies on sometimes ill-focused protests. He also scolded scientists for their seeming lack of urgency.

Shilts said he dreamed of a time when there would be an acceptable treatment for HIV disease. But he said his recurring nightmare is that it will come in 1996--when most of the people now infected with the virus will already be dead.

“One of the most momentous days in science will come and it will be utterly irrelevant,” Shilts said.