Valley Interview : AIDS Research Pioneer Gottlieb Offers Patience and Confidence
There is a greater awareness of the killer disease known as AIDS since it was discovered in 1981, but the number of people infected with the virus that causes acquired immune deficiency syndrome continues to grow. According to the World Health Organization, in the last 12 months 3 million more people worldwide have become infected with HIV. To date, more than 17 million people are infected, setting a pace for as many as 40 million by the year 2000.
Earlier this month, at the 10th annual International AIDS Conference in Yokohama, Japan, many scientists used the word “crisis” to describe the state of AIDS research. Many researchers have concluded that 10 years after finding the “bug” that causes AIDS--but no cure--it is time to put more emphasis on basic research.
Federal officials have announced plans to revamp the $1.3-billion annual AIDS budget to devote more time to laboratory studies and less to clinical research to test new treatments.
Still, there has been some progress. The drug AZT has been found to reduce the transmission of HIV from infected mothers to their children by two-thirds. Antiviral drugs called protease inhibitors have also been found to block an enzyme that is intimately linked to viral replication.
Dr. Michael S. Gottlieb, who reported the first known cases of AIDS in 1981, remains optimistic that progress has been made and will continue to be made in the fight against AIDS. Gottlieb, who has offices in Sherman Oaks, Pasadena and Century City, spoke with Times staff writer Julio Moran.
Question: Do you think that some scientists have concluded that we are back to square one in AIDS research because 10 years later we still do not have a vaccine for HIV?
Answer: I think that people are frustrated and disappointed, and it is natural for them to feel that way. After all, 250,000 people in the United States have died of AIDS; 150,000 people today in the U.S. are living with AIDS. Another 100,000 test positive for HIV every year. I think people care a lot more today about better treatments because they know or have known people with AIDS. People are frightened and frustrated and disappointed and expect faster progress. But in medical research, 10 to 15 years is a relatively short time frame.
Q: So you personally are not surprised that there have not been more developments in AIDS research?
A: No, there have been a lot of developments. None have been home runs. On the other hand, it hasn’t been a no-hitter. Even at the Japan conference there were a number of developments that could be called singles or even doubles. The ability of AZT to cut down on the transmission of HIV from mother to baby is a very significant development. It raises a whole lot of additional ethical questions about the lack of availability of AZT in many countries around the world where mother-to-child transmissions are occurring.
But on a purely medical level, our ability to affect something as important as mother-to-child transmission, while admittedly a very focused and limited application of technology, to me it is an indicator that we are not at a research standstill.
Q: Has research up to now been limited to finding a vaccine, or is that merely a public misperception?
A: I think it is natural for people to anticipate something dramatic like the Salk vaccine for polio, which was a very dramatic event in world history. That event has set up an expectation which in this case hasn’t been fulfilled because the virus has been so elusive.
Q: More elusive that when you first saw the disease in 1981?
A: When the virus was first described, we did not appreciate just how complex and evasive and formidable it was. With every year, the new information we have gathered about it continues to add to its reputation as a bad actor. We did not anticipate how tough and adaptable HIV is.
Q: Do you see the Japan conference as a starting-over point?
A: There is some of that, and I think that’s healthy in any endeavor, especially science, to revamp a strategic plan. I don’t entirely agree with the new strategy of the Office of AIDS Research to put a much greater emphasis on basic biology research, in some cases on viruses other than HIV, in order to try to understand HIV much better. The study of other viruses is important, but HIV is the one that should be most intensely under the microscope.
I’m also concerned that the strategy is a reversion to the business-as-usual modus operandi of the National Institutes of Health before HIV. It is based on the idea in science that breakthroughs come about when scientists are totally free to choose what to work on without being directed to work on specific problems by someone else.
Q: You don’t agree with that?
A: In principle I agree. However, when it comes to a global emergency that threatens the survival of the species, I favor a more focused approach. It may not require bringing together scientists from all over the country to a Los Alamos, but I support scientists working together in a more focused, goal-oriented way on AIDS.
Q: Have there been factors that have hampered finding an HIV vaccine by now?
A: The absence of a good animal model has been a very big issue. HIV has a preference for human beings. It has very specifically evolved to become a parasite of humans. There are related viruses with some similarities, but specifically vaccine trials for HIV must be tested on an animal that is susceptible to HIV. That’s why there are so many ethical dilemmas about HIV vaccine trials because the human being is the most suitable experimental animal.
Q: Do you think the public still believes that AIDS is only a gay disease?
A: I think there is still some of that. But most people becoming infected with HIV outside Western Europe and the United States are not gay men. By the year 2000, the gender difference will disappear worldwide. In this country, in the last 18 months 8% of new cases reported were heterosexuals who acquired HIV through sexual activity.
Q: Do you think that the growing number of women with HIV will bring more attention for AIDS?
A: Women with HIV are becoming more organized and vocal with respect to needs for services for themselves and their children. They have become more politically active. That seems to be taking off around the globe. That is a very welcome development. A lot of the spread of HIV around the world has to do with the second-class citizenship of women. In many countries, woman are treated as property and have very little choice in deciding whether they have sex or not, and whether their partner uses a condom.
Q: Are you surprised that the number of people infected with HIV continues to grow?
A: It has grown in relationship to poverty and prostitution and apathy. And it’s growing because we are late in getting serious about curbing it. For example, given the social mores in Thailand, it was highly predictable it would become a hot spot. Yet, preventive efforts were insufficiently intensive to prevent a catastrophe. On another level, it relates to HIV itself. Just as it exploits weaknesses of the immune system, its spread globally depends on weaknesses in social structures and human behavior.
Q: Some people have compared HIV to cancer, in that both are fatal and a vaccine has not been found for either one. Is that a fair comparison?
A: I think it is a little unfair to compare the two. Most cancers do not have anything as specific as a virus as the cause. HIV depletes the immune cells, where you usually think of cancer as a multiplication of cells. Since we know that HIV is the instigator, we have a leg up in finding an effective therapy. I believe that we have a better chance of finding treatments for HIV than in the case of cancers.
Q: What about your patients? Has their outlook changed in the last 14 years?
A: I’ve seen it go from hopelessness to hope, and now hopelessness again. A misreading of the current state of care is leading to hopelessness. We have news reports that reinforce to a person that they are going to die from HIV. Doctors are seeing a relapse toward quackery and therapies that offer false hope.
Q: Do you see an increase in HIV patients turning away from traditional doctors?
A: Patients always have sought alternative therapy. I think now there is more disenchantment with the approved antiviral drugs and a misreading of the new information coming out of the international meeting in Yokohama.
Q: So some of your treatment is not just for the body, but for the mind?
A: Sometimes I do feel like a cheerleader. For patients to come away from a conference resigned to the fact that there is no hope is very damaging.
But to say we are back to square one--that we have made no progress and that research is at a standstill, or that the problems are insurmountable or that we will never solve these problems--is just plain wrong.