Spread of AIDS Outpacing Progress Against Disease : Medicine: Researchers at conference in Italy will get bad news: The number of cases is rising rapidly.
FLORENCE, Italy — The seventh International Conference on AIDS, which opens here today, is expected to reflect the stark reality that the steady pace of scientific progress is far slower than the galloping pace of the worldwide AIDS epidemic.
The reports on new treatments and experimental AIDS vaccines are likely to be mildly encouraging. But the updates on the spread of the acquired immune deficiency syndrome in Africa, Asia and Latin America will be a painful reminder that the worst is yet to come.
“The world is going to be jolted by the extraordinary impact that human immunodeficiency virus infection is having on a global level,” said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. “There is going to be a lot of shock among people who read about this.”
“It can’t help but look worse,” said Dr. Paul Volberding of San Francisco General Hospital, who is also the president of the International AIDS Society. “Governments (in developing nations) are still barely able to cope with the sickest group of patients, much less do anything really effective in the area of prevention. Therapies that are available (in the United States) obviously are not available in most places.”
The cumulative global total of AIDS cases now stands at more than 1.5 million, according to the World Health Organization. In adults, there have been at least 8 million to 10 million infections with HIV, the virus that causes AIDS. An additional 1 million children may have been born infected.
Many Western nations, including the United States, show less drastic figures for the spread of AIDS than were predicted a few years ago. But the rate of new infections, particularly in sub-Saharan Africa and south and Southeast Asia, has risen steeply. As a result, the World Health Organization recently revised upward its projection of the cumulative number of HIV-infected individuals to 40 million by the end of the century.
Since the first international AIDS conference was held in Atlanta in 1985, the annual meeting has emerged as the most important forum for the exchange of new scientific information on the many aspects of the disease.
As in previous years, researchers downplay the possibility that major breakthroughs will be announced. But scientists are likely to present promising preliminary results with some of the dozens of experimental AIDS drugs that are under development.
One drug that will attract attention is 566C80, an experimental antibiotic being developed by Burroughs Wellcome Co. of Research Triangle Park, N.C. In preliminary human tests involving about 20 patients, this oral medication has been effective against two life-threatening complications of AIDS. These infections are Pneumocystis carcinii, which attacks the lungs, and toxoplasmosis, which attacks the brain.
The medication appears to have “a high degree of efficacy and a low degree of toxicity,” said Dr. Henry Masur of the National Institutes of Health. Masur, who spoke Saturday at a preconference symposium, said larger trials should be completed in about a year.
Some researchers, such as Dr. Daniel Hoth, the director of the AIDS program at the National Institute of Allergy and Infectious Diseases, are expected to advocate large-scale trials of experimental AIDS vaccines within the next several years. Such trials might involve 500 to 10,000 individuals and take two to five years to complete, according to Hoth.
The Florence conference itself is likely to be more of a scientific gathering, and less a political convention, than last year’s raucous meeting, which was held in San Francisco.
The theme of the conference is “Science Challenging AIDS.” The logo is the statue of David by Michelangelo. It symbolizes the small young man who won his battle against Goliath, the frightening giant. “I don’t think activism will be anything near what we saw last year or could expect next year” when the international AIDS meeting is to be held in Boston, said Dr. Mervyn F. Silverman, president of the American Foundation for AIDS Research.
Research presentations in San Francisco were often overshadowed by vocal frustration with the U. S. government’s response to AIDS. At the conference’s closing ceremony, activists drowned out remarks by Dr. Louis Sullivan, the U. S. secretary of Health and Human Services.
But the international AIDS community often has a different agenda than that of the activists at the San Francisco meeting.
“People from Africa and Thailand often find the American activists’ agenda highly irrelevant to their lives,” said Dr. Robert M. Wachter of San Francisco General Hospital, who served as program director of the San Francisco meeting.
For example, one focus of American AIDS activism is speeding access to promising experimental AIDS drugs. But health officials in many Third World nations cannot afford to buy the widely accepted yet expensive AIDS drug AZT, much less newer agents.
About 8,000 participants are expected at the Florence meeting, compared with about 12,000 in San Francisco. The percentage of Americans will be smaller, because of the distance and the expense of travel.
In addition, the AIDS activist community is not considered as strong or well organized in Italy as in some other European countries, such as Britain and France.
As of the end of March, Italy had reported 9,053 AIDS cases. Of European countries, only France, with about 14,500 AIDS cases, has reported more. But the total of about 50,000 reported AIDS cases for all of Europe seems small compared with the more than 179,000 AIDS cases that have been reported in the United States.
AIDS cases in Italy are concentrated in northern urban areas such as Milan and Bologna and in Rome. Two-thirds have occurred in intravenous drug users.
Last year, the Italian Parliament passed a law specifically allocating about $1.7 billion toward the care of AIDS patients and research programs. The law also ensures the rights of AIDS patients to privacy and protects them against discrimination.
But in Italy AIDS has only sporadically been the subject of public advertising campaigns, which are often an effective tool to help prevent the spread of the infection. Advertisements advocating the use of condoms to prevent the sexual transmission of AIDS have come under criticism from the Roman Catholic Church. The church opposes birth control, including the use of condoms.
Times researcher Janet Stobart in Rome contributed to this story.
