Hope at last?

If press reports coming from Vancouver, Canada, are correct, the 11th International Conference on AIDS can rightly be called a milestone in medical history. For the first time, researchers present at the meeting dared to speak openly about the hope that the feared and baffling disease which demolishes the human immune system can now be treated. AIDS, the acquired immune deficiency syndrome, may no longer be a death sentence.

What triggered the hope is the discovery that multiplication of the human immunodeficiency virus, HIV, can apparently be checked and even reversed by using a combination of drugs including newly-developed pharmaceuticals known in the medical profession as protease inhibitors. These reportedly block a certain enzyme which is needed for the multiplication of HIV, which causes AIDS.

In a report made public at the conference by Abbott Laboratories Inc, which developed the protease-inhibiting drug Norvir, it is said that in a study conducted in France 17 patients with advanced, previously untreated, HIV infections saw their condition dramatically improve after 60 weeks of the therapy. The count of the disease-fighting CD4 cells in their blood rose dramatically and the virus levels in their blood dropped by around 99 percent.

The same therapy approach made in a separate study involving 1,000 patients at the University of Ottawa brought a similar dramatic drop in virus levels and considerable rises in the patients' CD4 cell counts after just the first two weeks of treatment. In other studies the virus levels dropped in a number of cases to undetectable levels. Obviously, for the layman in particular, such startling results are reason for euphoria. In the words of Dr. Scott Hammer, of Boston's Deaconess Hospital and Harvard's Medical School, "Just six months ago, this ... would have been seen as far-fetched or even ludicrous."

Obviously, too, the words of caution that have been spoken by the same researchers who described the breakthrough at the Vancouver conference are easily overlooked amid all the excitement. From the medical point of view, researchers warn that the search for a cure for AIDS is far from over. To quote the pioneering AIDS researcher and co-discoverer of the HIV, Dr. Robert Gallo, "These are major advances .. but we haven't reached the goal yet." That goal presumably includes the development of a safe and powerful vaccine as well as other, more effective and affordable drugs and cures.

There are also many questions that still have to be answered. For instance, what will the longer-term effects of this new "cocktail" approach be? Will the virus once again outsmart the researchers by mutating into drug-resistant strains, as it has done before? And in those cases where the virus levels have dropped so dramatically, has the virus been wiped out by the drugs or has it simply gone into hiding in places in the patients' bodies where it cannot so easily be detected?

For AIDS patients in developing countries there is another major obstacle. The drug "cocktails" that include the protease inhibitors can cost as much as US$15,000 a year. Clearly, that puts the therapy out of reach of by far the majority of patients in countries, where, according to World Heath Organization estimates, some 90 percent of HIV-infected people live.

The message, as far as we in Indonesia are concerned, is clear. There is reason for hope. AIDS, the previously-incurable disease, may not necessarily be a terminal disease after all. Researchers may eventually come up with a drug or a vaccine that is truly effective and affordable. But given the cost involved, the tricky nature of the virus and the host of questions which the researchers still have to answer, prevention is still the only effective way to stem the spread of the disease.