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AIDS Researchers Optimistic over New Drug Development

By Marlene Cimons and Thomas H. Maugh II
Los Angeles Times
WASHINGTON

After a long, cold winter of disappointment, disillusion and discontent, a warmer, more optimistic wind is wafting through the AIDS research community.

Despite a drumbeat of recent reports indicating that AIDS is a more dangerous and aggressive foe than most had believed, many researchers are now increasingly optimistic about the chances of fighting the disease than at any time since the discovery of AZT, the mainstay drug of current AIDS treatment programs.

That optimism - clearly present in Washington earlier this month at a national AIDS meeting - arises, in part, from the discovery that the virus is surprisingly vulnerable to combinations of antiviral agents and to a new class of drugs called protease inhibitors.

But perhaps even more important is a fundamental and dramatic change in researchers' ideas about how the HIV infection should be attacked - what scientists call a paradigm shift.

Clinicians are abandoning the standard model of HIV as a simple infection that can be treated with a single drug in the same way that a bacterial infection is cleared up with an antibiotic.

Instead, they are seeking inspiration in the field of cancer therapy, where a single tumor is aggressively attacked with a "cocktail" of different drugs that each exploit a unique vulnerability of the cancer cells.

Clinicians couldn't adopt this shotgun approach to AIDS before now because they had only rifle bullets - AZT and two other drugs, all targeting the same viral weakness. But the new discoveries reported at the Second National Conference on Human Retroviruses and Related Infections have suddenly stocked their armory.

The Washington meeting was "clearly a much more upbeat meeting than the last several international meetings have been," said Dr. David Ho, director of the Aaron Diamond AIDS Research Center in New York City. "Now we have more tools, better drugs, better assay development - the field has matured a lot. A lot of hard work that before didn't translate into anything meaningful is now (paying off)."

"I think there is genuinely more optimism," added Dr. Jack Killen, director of the division of AIDS at the National Institute of Allergy and Infectious Diseases. "There were a lot of loose ends coming together (at the meeting). It's beginning to make some sense, and to provide a rational framework for (therapy)."

"I think the investigators are more encouraged than ever before," said Dr. David Feigal, director of the division of antiviral drug products at the Food and Drug Administration. "Some are so excited that they would just as soon skip clinical trials and start using these new drugs immediately" - something, he added, that is prohibited by federal law.

Critics cautioned, however, that the promising studies have not been in progress long enough to determine if the new drugs actually prolong life, and they warned that most of the new drugs are very expensive. Others said that researchers may be overly optimistic simply because there was so little good news in the past.

"I don't think that things are any different than they were six months or a year ago," said Dr. Irvin S.Y. Chen, director of the AIDS Institute at the University of California, Los Angeles. "There has been steady progress on a number of fronts, (but) if there has been change, it is psychological."

Dr. Robert T. Schooley, an AIDS specialist at the University of Colorado Health Sciences Center - who organized the Washington meeting - agrees that "psychologically we definitely have turned a corner," but believes a substantive corner may have been turned as well.