THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, June 19, 1995 TAG: 9506190028
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY KERRY DEROCHI, STAFF WRITER
LENGTH: Long : 207 lines
Three times a week, for more than a year, petty officer Timothy Nichols shoved a needle into his thigh and injected a protein that he hoped would ward off AIDS.
He knew the risks. Doctors had warned of the nausea and vomiting that could keep him awake at night, the possible high blood pressure, the permanent scarring of his heart.
Nichols didn't care.
At age 29, he had his death sentence. These shots, these needles filled with slightly more than a teaspoon of interferon, helped ease the fear and soothe the anger of contracting HIV.
The injections were part of a clinical trial operated out of the non-profit Henry M. Jackson Foundation for the Advancement of Military Medicine.
Though the therapy did not stop the disease, it offered Nichols and other service members with the virus access to a sophisticated new treatment and a shot at a longer life.
``It was a chance to fight back,'' Nichols said. ``It was a chance for me to personally fight back at the disease that was killing me and is still killing me. That was my hope.''
Today, three years after Nichols gave himself his first injection, the fire controlman is fighting more than the virus that creeps stealthily through his immune system.
He is struggling to keep the research alive.
Nichols, along with other active-duty and retired service members who are HIV-positive, are lobbying Congress to stop a Defense Department initiative that would end the military's clinical research on HIV, the virus that causes AIDS.
Unless they can convince Congress otherwise, money once used for cutting-edge research to, hopefully, slow the advance of AIDS will be spent instead on preventive therapies, including vaccine trials in Thailand.
The initiative stems from a growing belief among Pentagon planners that studying those with HIV is no longer the mission of military medicine.
In a memorandum earlier this year, the Army surgeon general urged the Pentagon to focus money and efforts on preventing the spread of AIDS to the uninfected troops.
``Therapeutic approaches to HIV disease do not make significant contributions to combat effectiveness,'' wrote Brig. Gen. Russ Zajtchuk, assistant surgeon general for research and development.
``If a soldier is already infected, that soldier is a casualty and is of limited use to the force.''
The shift in policy comes as Congress prepares to adopt a sweeping provision that would call for the immediate discharge of service members who test positive for HIV.
The House approved the measure Thursday as part of the 1996 Defense Authorization bill. If it is approved by the Senate, the provision will alter military policy that has allowed service members to remain on active duty until they become too ill to work.
Estimates vary widely on how many of the 1.4 million active duty military members have HIV. Roughly 9,400 service members have tested positive for the disease since the epidemic gained widespread recognition 10 years ago.
The development has angered active-duty and retired service members who say they have fallen prey to the prejudice that surrounds their disease. They argue they are an easy target because they cannot speak openly for fear of backlash from co-workers and friends.
``This is the first time we have picked one illness and treated people differently,'' said retired Navy Cmdr. Hank Carde, former executive officer of the frigate Francis Hammond, who now lobbies on behalf of people with AIDS.
``I'm ashamed of the Pentagon and Congress that they would turn their backs on the people that they have traditionally taken care of,'' Carde said. ``It's a road that is going to lead to pain and hardship. It's going to lower the moral fiber of the military.''
Nichols, like Carde, is afraid of what will happen if the research is ended.
A former instructor at the Navy's Fleet Combat Training Center at Dam Neck, Nichols was given a desk job in September 1991, after being told he was HIV-positive.
Barred from going to sea because of the condition, the petty officer first class works on the staff of the commander of training for the Alantic Fleet.
Once every six months, Nichols travels to a Jackson Foundation clinic at the National Naval Medical Center in Bethesda.
Nurses there take his blood and discuss his health. His skin is tested for tuberculosis and herpes. A doctor goes over his T-cell count, a critical assessment of the white blood cells killed off by HIV.
Nichols is one of some 7,500 service members enrolled in the 10 clinical trials that would end prematurely, be abridged or canceled if the Pentagon cuts off the money.
Though the service members can go to military hospitals for care, they rely on the Jackson Foundation for access to the cutting-edge experimental therapies.
``The research aspect is the most important part of the Jackson foundation,'' said one Navy officer who is HIV-positive. ``They're dedicated people. They're there because they want to be, not because they have to be.
``I would never have made it to my eight-year mark without them.''
For the patients, the Jackson Foundation offers solace from crowded military hospitals, a refuge where hopes and disappointments are shared with lab technicians and new treatment theories are discussed in the waiting room.
The foundation has controlled the lion's share of the military's clinical AIDS research since 1988, when it won a contract from the U.S. Army Medical Research and Development Command, the Pentagon's lead agency for infectious disease research.
With that money, the foundation started clinics at the National Naval Medical Center in Bethesda, the Walter Reed Army Medical Center in Washington, and the Wilford Hall Air Force Medical Center in San Antonio, Texas.
It's at these clinics - where service members come twice a year to meet with private nurses, attend group therapy sessions and have their blood drawn - that the threat of budget cuts is felt most strongly.
More than 90 percent of the foundation's money comes out of the Defense Department budget. The rest is raised through private donations.
In the past, clinical research has received about one-third of the money earmarked by Congress and the president for military AIDS and HIV programs. The rest goes to preventive measures such as vaccine programs and behavioral modification.
In 1995, the total money allocated for military AIDS research was about $40 million.
A tug of war over that money surfaced last February when the Pentagon opted to switch the funds to the preventive programs and informed the foundation that its services were no longer needed.
The move sparked a controversy within the HIV research community, prompting White House Chief of Staff Leon Panetta to write a memo in protest. The Pentagon backed down.
But later this spring, Pentagon leaders advised the foundation that reductions will be necessary to meet the constraints of a tighter 1996 budget.
Money from the 1995 allocation will be used to close out the ongoing studies at the Jackson Foundation.
In a May 30 memo, Assistant Secretary of Defense Dr. Stephen C. Joseph outlined the shift in policy, stating that the Defense Department believed preventive measures ``to protect the uninfected fighting force'' to be militarily unique research.
Clinical studies of infected patients were not, and should no longer be paid for by Pentagon dollars, the memo stated. They are often duplicated by civilian agency studies and fall under the purview of the Department of Health and Human Services.
Active-duty and retired service members who were HIV-positive would still receive care through the military and veteran's hospitals.
But scientists who operate the clinical trials at the Jackson Foundation warn that much will be lost if the cuts are made.
They are lobbying Congress to write legislation requiring the Pentagon spend one-third of any AIDS research money on clinical trials.
If not, they warn, the medical community will lose a valuable resource.
Since the foundation was awarded its first contract, it has maintained an exhaustive catalog of more than 2,000 service members with HIV, from the time of first detection to illness and eventual death.
The patients represent every state in the country and come from every racial and socio-economic background.
Key data from the first stages of infection are available because of the mandatory HIV testing given periodically in each of the service branches. Through that information, the researchers are able to track the disease as it progresses through the immune system - a process that can take more than 10 years.
``The reason we're different is we emphasize early-stage disease vs. late-stage disease,'' said Dr. Kenneth F. Wagner, senior research physician at the foundation.
``We test everybody. We catch people early on. We have incredible clinical studies that have national and international importance.''
Wagner, director of clinical research at the Bethesda center, said the data base has given the foundation the ability to test aspects of the disease such as its resistance to certain drugs being used.
At an international meeting on infectious diseases held in Orlando last year, for example, foundation scientists reported that one-tenth of their clients were contracting a strain of the virus that was resistant to Zidovudine and Retrovir, or AZT, the drug most commonly used to fight HIV.
``What does that mean? People are now spreading HIV that is resistant to AZT,'' Wagner said. ``That's what we were able to determine through our constant testing. That's what's on the line. That's what could be lost.''
Earlier this year, the foundation won approval to test a procedure that would remove the T-cells from a patient, allow them to be grown outside the body and then be injected back into the bloodstream to boost immune levels.
``The military patients will lose access to cutting-edge clinical trials,'' Wagner said. ``Why is that? Because active-duty patients will have great difficulty entering into civilian trials due to their duty status. They can't just pick up and go to another state or city.''
Carde, 48, barely has the energy to walk across the Capitol.
He was diagnosed as HIV-positive in 1988, while working for the Joint Chiefs of Staff. He had just finished running 1.5 miles as part of his annual physical tests. It took him nine minutes.
Carde, who now has cancer, said he didn't get sick from the virus until 1992.
``I'm a long-term AIDS survivor,'' Carde said. ``I would not be talking to you today if I had not been able to get AZT and DDI (dideoxyinosine), while they were still experimental.
``Survival with this illness depends on that kind of access.''
Nichols, 32, is counting on it, too.
Divorced and the father of two children, Nichols said has no plans to leave the military while he is able to do his job.
After completing the interferon drug trial, Nichols participated in other studies. He is counting on experimental drug therapies that combine AZT with other drugs to keep him alive.
``Realistically, I will be dead when my children are 18 or 19 years old, but that research could be an opportunity for me to save my children's lives,'' Nichols said. ``We could find a vaccine or we could find a way to save them, if God forbid, they got infected.
``That's why I do it.'' ILLUSTRATION: Color staff photo by TAMARA VONINSKI
Petty Officer 1st Class Timothy Nichols is fighting more than the
HIV virus creeping through his system. He is struggling to keep the
military's clinical research on AIDS alive by lobbying Congress to
stop the Defense Department's latest budget intiative.
KEYWORDS: AIDS MILITARY EXPERIMENTAL DRUG DRUG THERAPY U.S. NAVY
by CNB