Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, September 7, 1993 TAG: 9309070096
SECTION: NATIONAL/INTERNATIONAL PAGE: A1 EDITION: STATE
SOURCE: Newsday
DATELINE: LENGTH: Medium
"It's like St. Paul seeing the light on the road to Damascus," declared a happily agitated Cecil Fox, a cellular biologist who is president of Molecular Histology Laboratories Inc. in Gaithersburg, Md.
"The history of this disease is a history of doorways never opened," said Dr. Joseph Sonnabend of the Manhattan-based Community Research Initiative on AIDS. "Finally, we are beginning to open the right doors."
Until recently, most research has focused on the human immunodeficiency virus, or HIV, and its ability to harm a component of the human immune system, called CD4 cells. But now a consensus is emerging that, from the earliest moments of infection, HIV tricks the immune system, setting it on a path of self-destruction that may continue even if the virus is later eliminated. The actual damage, many scientists say, is done not directly by the virus but by an immune system that goes haywire, attacking itself and other parts of the body.
"It's clear you need the virus at some point to kick off the pathological events," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, "but even if you knocked off the virus early you could still have damage to the immune system."
Even Dr. Robert Gallo, a top researcher at the National Cancer Institute whose own work has focused on the virus, now thinks most damage isn't directly done by HIV.
"The molecular mimicry in which HIV imitates components of the immune system sets events into motion that may be able to proceed in the absence of further whole virus," Gallo said.
Many pieces of the puzzle remain obscure, many details of the process are hotly disputed, and many scientists, like Fauci, are far more guarded in their optimism than Fox and Sonnabend. But at a recent meeting of 500 AIDS scientists from around the world, it was clear that researchers separated by seas and languages are reaching new and strikingly similar conclusions about the way HIV causes disease and about the possible new directions for treatments.
Jacques Leibowitch, of the Raymond Poincare Hospital in Garches, France, was among the most enthusiastic of those who gathered for the eight-day annual AIDS meeting, convened by Gallo in Bethesda, Md.
"It's bizarre, no? But at last we are getting some place. We started all our work on the wrong foot, because we were all focused on the bias of the discovery of the virus."
But now, he said, scientists are focused on how the immune system gets burned out.
"That's AIDS," he said. "The virus is benign in comparison to the enormous destructive activity of the immune system itself. Now the whole strategy is different."
Up to now, most research into AIDS treatment has had one of two goals: trying to block reproduction of the AIDS virus, as with the antiviral drugs AZT, ddI and ddC; or preventing and treating the opportunistic infections, such as pneumonia, that kill most people with AIDS once their immune systems are weakened.
But if immune system self-destruction does turn out to be the key to AIDS, it seems logical that a severe jolt to the immune system early in HIV infection might set the system back on proper course before the first opportunistic infections occur, many scientists now say.
Fox, Fauci and microbiologist Ashley Haase of the University of Minnesota all say the most exciting thing about this juncture in the fight against AIDS is that every aspect of the new theory could be easily proved or disproved.
In the months to come, many aspects of the pathogenesis hypothesis will be examined in animals and test-tube studies. If results continue to support the basic tenet of immune system chaos, human clinical trials can't be far off, the scientists concluded.
"Every aspect of this is testable," Fox says. "All we need is a mean son of a bitch in charge [of coordinating AIDS research efforts]. Somebody who has the guts to do what needs to be done to get an answer. And we could have an answer within two years."
But such procedures would require biopsies and painful invasive procedures.
Haase is not quite as sanguine as Fox.
"We've spoken a little too enthusiastically in the past without a good understanding of the disease process," Haase said. "But it's true that if you're interested in testing whether manipulation of the immune system can make a difference, those things you could do tomorrow."
Memo: shorter version ran in the Metro edition.