The Long Fight Ahead

By early 1984, the Reagan administration had spent three years being accused of inaction on AIDS–ever since the Centers for Disease Control first began tracking cases. Now the administration was keen to trumpet its progress.

To have heard Margaret Heckler tell it at her April 23 news conference, it was all over but the shouting. Only a year earlier, said the secretary of health and human services, she had “made the conquest of AIDS the federal government’s number-one priority.” And now not only had the “probable cause” of acquired immune deficiency syndrome been found; it had also become possible–thanks to a newly developed blood test–to identify AIDS victims and AIDS-tainted blood “with essentially 100 percent certainty.” And to top this dazzling array of accomplishments, Heckler announced that a preventive vaccine should be “ready for testing in approximately two years.”

Science journalist Judith Randal, in a column for TR, had her doubts:

Not so fast, madam secretary. The truth is that the cause of AIDS may or may not have been found. And there is no evidence that anything discovered to date will make a dime’s worth of difference to people who already have AIDS or get it in the next few years. Even the blood test is not yet a fait accompli. And as for the vaccine, only the wildest of optimists expect it to be a reality before the end of the decade.

Heckler was right about researchers’ having identified the cause of AIDS, but that was far from clear at the time. National Institutes of Health researcher Robert Gallo had identified a virus that he called HTLV-III, and a French group led by Luc Montagnier had found one dubbed LAV a year earlier. They were the same virus (it was renamed HIV in 1986), but the competing claims would not be sorted out until 1987, when the researchers grudgingly shared credit–and royalties on the patent for the blood test, which the U.S. Food and Drug Administration approved in 1985.

Meanwhile, as Randal pointed out, Heckler’s predictions about a vaccine were wildly overoptimistic, mostly because of the nature of the viruses that researchers were focusing on.

Although we don’t know precisely which virus is responsible for AIDS, scientists are fairly certain that the disease involves a special class of viruses, known as retroviruses (to which both HTLV-III and LAV belong). The genes of most viruses are made of DNA, which then makes RNA. But in retroviruses the reverse occurs, and the genes are made of RNA, which then makes DNA.

Making a vaccine for a virus–let alone a retrovirus–is difficult and time consuming. The virus must be grown in laboratory culture and used intact to make a product that will generate antibodies, the molecules in the body’s immune system that attack foreign substances. To make sure the vaccine won’t cause the disease, weakened or dead strains of the virus must be developed. …

Once (and if) that is accomplished, animal tests must then be conducted to show that the AIDS virus actually causes the disease, and that the vaccine is capable of safely neutralizing it. Human field trials are also required before the vaccine can be widely used. All this suggests that an AIDS vaccine is probably six to eight years away … .

Obviously, Randal was being overly optimistic about a vaccine herself. But she advocated trying to help those already affected, an approach that many researchers take today (see “Can AIDS Be Cured?” ).

In the meantime, no one is known to have recovered from AIDS, and the problem is not going away. The number of cases continues to double about every six months, and because the incubation period is so long, a lot more cases are certainly in the pipeline. Since more than 4,600 AIDS patients have been diagnosed in the United States alone, that means there could well be 100,000 or more in this country before the end of the decade.

Granted, treatment may very well have improved by that time. But this, too, is unpredictable. A year ago researchers held great hope for one type of interferon as well as a drug called interleukin two. However, neither medication is panning out. With a disease as complex as this one, the light at the end of the tunnel has a nasty habit of flickering brightly and then going dim.