Illustrated Daily; 5127; AIDS, Part 1

you . . . .. .. .. .. .. In the next two years, we are not going to find the answer. How to get rid of it, that we are not in spite of many efforts to do the education to change the risk factors,

that overall the pattern is going to stay the same of doubling every six months roughly. And if we take that estimate on a national average, assuming about 10,000 cases in the country now, we could expect in two years about 160,000. That's staggering, and I don't think our nation is prepared for that kind of a problem. The illustrated daylight, managing editor, how roads? Good evening, acquired immune deficiency syndrome, AIDS. It has been called the disease of the century, but it may in the long run turn out to be far worse than that.

Whatever history's ultimate judgment, AIDS is clearly already one of the greatest and most disquieting medical mysteries in the human experience. Tonight and tomorrow night, we pursue that awesome mystery, and to do justice to that pursuit. We need all to put our phobias in personal attitudes aside. For at the heart of the AIDS story is a disease which strips its victims of their protection from all other diseases, destroys their immune system. Is virtually always fatal, is international in scope, is epidemic, so much so that in the United States the number of its victims doubles every six months and is now approaching the 10,000 mark. In New Mexico, where the number of officially recognized AIDS victims is set at eight, the disease is currently increasing at a rate greater than the national pattern. Four in January, eight in April, the reasons are unclear, but all authorities agree there will be many more in the near future.

These are some of the facts at least, and in the words of one AIDS researcher, unless the virus that mutated to form this deadly equation reverses its course, we stand at the beginning of a worldwide epidemic scourge. But there are more facts. AIDS seems to attack what are called risk groups, notably male homosexuals. Indeed, in 1982, in its first major article on the disease, the New York Times called it grid, gay related immunodeficiency, and it was perhaps understandable. Originally, going back to 1980 when a handful of physicians first began to get a collective focus on the disease, the only known common denominator seemed to be that his victims were all gay men, and it came to be called the gay plague. Within three years, however, it was apparent that other groups were at risk, heterosexual hemophiliacs, intravenous drug users, prostitutes, and in time, whole African nations such as Zaire, where the disease knows no sexual preference and is epidemic.

Today, leading authorities characterize it as nothing less than a global general health threat to which all are vulnerable. Yet even now, less is known than remains unknown about the disease. There is a growing consensus among scientists, however, that AIDS is viral in nature. The United States, the virus identified about a year ago by Dr. Robert Gallo of the National Institute of Health, is known as HTLV3, the same virus known as LAV, discovered about a year and a half earlier by French scientist at the Pastor Institute in Paris. But the anatomy of AIDS remains a giant puzzle, the pieces of which do not always fit, and which has become a compelling preoccupation for physicians like Dr. Jim Waltner of Espignola, president of the recently formed organization, New Mexico AIDS Services, a key figure in the AIDS story in New Mexico. Jim, first things first, what is an immune system?

The immune system is a portion of the body that really might be looked at more as a function than as an organ. There are multiple organs involved, but it performs essentially three functions, surveillance, defense, and if you will, internal security. What we're saying is that this system looks at the normal body functioning and helps to maintain a steady state with regard to the body's internal functioning, not so much biochemically, but in terms of changes within cells that might make things potentially dangerous. It also looks at invasions from the outside, if you will, whether it be in the form of bacteria or virus or fungi, or perhaps at another level, those things that cause allergies, such as pollens or dust or foodstuffs or, in some circumstances, medications, and basically it is there to protect the body from insults both from within and from without. What then are T cells? What have they to do with the immune system? And, therefore, with the virus believed to cause AIDS, HTLV3, as is called the United States, or LAV, as is called in France.

T cells are one of a number of different types of white blood cells. They have essentially three functions and, by convention, have three names that go with them, helper cells, which tend to stimulate an immune response within the body. Suppress their cells, which usually come into play after the threat has been dealt with and sort of turned down the immune response. And cells that we call cytotoxic or killer cells, which are involved in the actual destruction of a bacterium or other cells that need to be gotten rid of. How they fit into AIDS is that HTLV3, the virus that we are assuming causes AIDS, is specifically a virus which affects the T cell function. And even more specifically, the T helper cell function, either by just destroying that population of cells in many patients, or decreasing its effectiveness to the point that they are really ineffective in their efforts.

All right. Let me ask you about the incubation period of this virus. When you look at the scientific literature, which has been published on this, at one time, it was argued that we're dealing with an incubation period of six months. In a relatively short time, it was said the incubation period is two years, and then it went to five years and some say it may even now be longer than that. I guess the question is, what's going on here? Well, I think part of the problem is that this disease is so new that we have no end point in terms of how long it can incubate. Certainly, the periods get longer and longer and longer as we go further into the studies. The issue basically is that from the best we can tell, from the time of first exposure to the virus, or maybe the only exposure to the virus until when disease actually develops, just seems to be longer and longer.

The time we have and the longer period of follow-up that we have to actually get us information as to when the disease actually starts. I think what we're really saying is that one may harbor the virus in the body for many years before it actually starts to do its work. Well, why is that? At this point, we don't know. Well, what does it mean when they say people do not die of AIDS, they die of AIDS-related diseases? Very simply, the best way to explain that is that the virus itself does not kill anyone. It wipes out the immune system leaving you open to any number of infections and without an intact immune system to fight those infections, what might be a relatively mild disease in a person with a healthy immune system can be devastating and fatal. There's this catalog of diseases that seem to be the so-called opportunistic diseases. Why are individuals who are victimized by the AIDS virus, victimized particularly by these killer diseases and not other killer diseases, or do I not understand?

I think you're right at the point, but the problem is that, again, all of the things that become opportunistic infections, and they're about 14 that we know of at this point, are diseases which everyone is exposed to on a day-to-day basis. They are not rare, they are not unique. The situation is though that they are problems which, within an intact immune system, they are immediately fought off, and there may be no perceptible illness when one has been exposed to these infectious agents. What happens though is that when the immune system is gone, these agents, in a sense, take the opportunity to attack the body very viciously because the body's immune system can't fight them back off. The presumption now is that there is a single virus at work here, or that seems to be the consensus, although there are those who argue that we may be dealing with multiple viruses here.

How comfortable are you with the part, the single virus theory? At this point, fairly comfortable in the sense that when we look at infections not just in this country, but around the world, what seems to fit here in the people in the highest risk groups are often victims of many multiple infections before they develop AIDS. This is not the case in many of the foreign countries where there are significant numbers of patients with AIDS, and because of that, it seems that the single virus theory is probably the one that best fits what we're seeing in a world wide scope. In your opinion, the search for a vaccine. Where are we today in relation to that objective? There are several things going on right now, seven universities in this country are working on vaccine in the collaborative fashion.

The problems are several. One is that when we're going to make a vaccine for something like this, usually the attempt is made to create an immune response to parts of the wall of the virus. We are finding over time that there seems to be genetic drift, which means there are changes happening in the genetic material of the virus. The causes change in the antigenicity, the ability to make an antibody of that virus wall. Because of that, if we develop a vaccine with one particular portion of this whole wall, it may be that six months or six years from now, that part of the wall will have changed sufficiently that it no longer is an effective vaccine. To get around that, we may very well have to go to some of the what we would call core antigens parts of the virus deeper within the virus and go for something that is less likely to change on a rapid basis. So what are you saying this is a dynamic virus? Absolutely. It's changing from what we can tell at this point on a very slow but steady basis.

Years ago, if anybody had suggested that such a creature existed, you probably would have looked at me and said, no, it does not. And now today, people in your profession, scientists all over the world, absolutely horrified before they've gone on their hands. That's exactly what my first response was when I heard the one virus theory was, no, that just doesn't seem possible. I think we're learning more and more about where it did come from, though, how. Recent research really published within the last three to four months indicates that looking retrospectively at blood samples, which had been in a freezer left over from other studies in Central Africa, indicates that there are a number of pools of people with antibody to the HTLV3 virus. And uniquely to that virus, not the HTLV1 or two viruses, which indicates that probably even as much as four to five years before anyone recognized this problem and even was aware that this was developing.

There were people in that part of the world who had antibodies to that virus. Looking in this country, it's much more clear that in stored blood specimens, there were no antibodies to that virus before sometime in the late 70s to early 80s. So something in that process had changed. So it would be your presumption that is a mutant virus that appeared in Africa and subsequently spread elsewhere. Yes, I think that's where the research is taking us at this point. So, could we call it the evolution of a virus? Exactly. That's a good word for it. Because this evolving AIDS virus is believed transmitted through the exchange of body fluids, those who monitor our blood and plasma supplies here and elsewhere have become vigilant. And a good deal of difficulty has been occasioned by false alarms and bad news reporting on this matter.

Dr. Toby Simon of United Blood Services in Albuquerque. I think this has been the flow of information and the rapidity with which information has flown about this disease is really remarkable and something I think most of us have never seen before. And it has created problems because the news reports are so far ahead of the scientific reports that those of us who are used to getting our information from scientific reports and making careful judgments about what we read find ourselves in somewhat of a disadvantage. Well, no matter how rapidly the story develops, this much we know, hemophiliacs and those in need of transfusions require healthy blood and plasma supplies. And we've been adding to our annual examination of the patient's additional examination to look for problems, fortunately haven't found these significant ones.

And the physicians around the state to see the patients on a regular basis are calling to our attention if they see mysterious problems. So we're keeping a very close watch on it. If the virus is in the blood, it seems to me easy to understand how hemophiliacs, intravenous drug users should be able to come in contact with it, acquire it, and become victims of it. But in this country, at least for a period of time, and I gather even now, the largest single block of victims of AIDS are gay men. And the supposition is it has to do with sexual contact.

How can sexual contact involve contact with the virus? Very simply, the virus is certainly present in the blood of people who are carrying it, but it can also be found in other bodily fluids. Specifically, it's been found in saliva, in urine, and in semen. And in some people, in some research, it is felt that it might also be present in stool, although at this point we don't know that for sure. It has not been definitely proven. But in the presence of those other bodily fluids, in particular saliva and semen, it's very clear that it can then very easily be transmitted. Why, if it's communicable in semen exchange between males, is it not an equal proportion since there seems to be a larger number of gay males with the virus than heterosexual persons either male or female? Is it not equally, easily communicated amongst heterosexual males and heterosexual females? Did I ask that question right?

Yes. We're finding now that it can be transmitted between heterosexual males and females through regular normal heterosexual contact. And we are finding out in very current and very new research that indeed the virus can be isolated in vaginal secretions as well, so that it can be transmitted female to male, as well as male to female. In other parts of the world, in particularly in Central Africa, the ratios are nearly one to one male to female, and for all intents and purposes, it's primarily in that part of the world, a heterosexual disease. The reporting of AIDS is based upon a rather strict definition of the disease as laid down by the Center for Disease Control in Atlanta. What can you tell us about that definition? What does it include? What does it not include? I think the definition in and of itself is part of the reason that there's controversy about diagnosis. It is fairly restrictive in one sense and yet fairly open in another sense.

Particularly what it says is that a person is considered to have AIDS if he has a reliably diagnosed opportunistic infection, a list of about 13 or 14, or the campuses are coma. Generally speaking, that has come to mean pneumocystis, crinoline, pneumonia, or campuses, or both, or some combination of the other things as well. The reason that the CDC has been so strict about that is very appropriate. What we don't want to be doing right now is counting apples and oranges as the same thing, and by making it fairly tight in its definition, we can be reasonably assured that we have been counting the same disease. The so-called AIDS-related complex arc pre-AIDS, where do they fit into the AIDS story and where do they fit in ultimately to the CDC definition of AIDS?

A wonderful question and a difficult one to answer. The problem is that these are people who have perhaps symptoms compatible with AIDS, but are lacking the presence of that opportunistic infection or the campuses sarcoma, which will put them into the definite AIDS category. All of the opportunistic infections and campuses sarcoma when they are present give indication that there is a defect in immunity. In those who fall into the pre-AIDS or the AIDS-related complex, we are seeing people who have the symptoms, but who do not have the identifiable opportunistic infections. One another matter Jim, why is the rate of AIDS in New Mexico increasing more rapidly than the national average?

A little better because when there were still only one or two cases, I think the physician in health care awareness was at a level that we may not have been making the diagnosis. But I think more importantly, we are also in a position where because we have had such a low rate of new cases in the past, people from other parts of the country who are perhaps feeling the same. Perhaps feeling that by leaving where they live, California, Florida, New York are moving to New Mexico because there is such a low rate. If these people had contracted the virus at some point before they got here, they may get here and then be diagnosed in our state and be counted as one of our cases. The other issue that we can't positively answer at this point is whether or not we really are seeing a real increase in the rate and that this is really inaccurate reflection of what's going on here.

Well, what is going on here? State health secretary Fitzhue Mullen expects many more AIDS cases in New Mexico and his state epidemiologist Harry Hall acknowledges that other cases are presently being monitored. We're following up on two other individuals who may have AIDS, full blown AIDS, and please remember we're talking about a spectrum of disease here where many people are infected with the virus but have not developed the full blown AIDS. I don't think that we can conclude that New Mexico is increasing at twice the national average. The figures are as follows, 1981 there was one case diagnosed, 1984 there were four cases and to date in 1985 there have been three cases. You can put that on a graph in a number of different ways and conclude from what you'd like. The fact is, in New Mexico as everywhere in the country, the number of cases is increasing and the rate is increasing as well, the rate at which they're diagnosed.

And this is a disease on the rise as a susceptible population and the American and New Mexican population is by and large susceptible. Nobody has natural immunity. So it can be spread female to male as well and it needs to be pointed out that in some parts which is what worries New Mexico AIDS services, President Dr. Jim Walt and Waltner is willing to hazard some projections. See that we have to state what assumptions we're making and I think the main assumption in both instances in making that kind of an estimate is that in the next two years we are not going to find the answer to how to get rid of it that we are not in spite of many efforts to do the education to change the risk factors that overall the pattern is going to stay the same of doubling every six months roughly. And if we take that estimate on a national average, assuming about 10,000 cases in the country now, we could expect in two years about 160,000.

That's staggering and I don't think our nation is prepared for that kind of a problem. When we look in New Mexico with only eight cases now and make the assumption that we are going to double every six months following the national average, we're going to see roughly 160 to 200 cases over the next two years. The anatomy of an epidemic disease, or at least what we currently know of that anatomy and its unique configurations in New Mexico. Tomorrow the human story of AIDS, living in the shadows of the disease, the fear in the anguish, controversy over AIDS antibody testing and difficulties in responding to the challenge. Thank you for joining us. I'm Hal Rose. Good night.

Thank you. Thank you.