Medicine: Furor Over an AIDS Announcement

The hubbub began last week with an unusual announcement. According to Georgina Dufoix, France’s Minister of Social Affairs, an important discovery had been made that offered “reasonable hope” in the treatment of acquired immunodeficiency syndrome. At a jam-packed press conference later the same day, three scientists from Laennec Hospital in Paris reported that they had found a drug treatment that produced “a spectacular biological response” in AIDS patients. Such a response, said Dr. Philippe Even, who headed the team, “has never been observed before.” The name of this magical potion was unexpectedly familiar: cyclosporine.

The drug, which is responsible for much of the recent progress in organ transplantation, is a potent suppressor of the immune system and is particularly effective at inhibiting the rejection of foreign organs. On the surface, cyclosporine (trade name: Sandimmun) would seem to be the last drug one would prescribe for AIDS patients, whose immune systems are already critically depressed. Indeed, an early theory about the cause of AIDS held that it was triggered by a cyclosporine-like substance produced by an infectious fungus.

To medical researchers, it was no less surprising that Even and his colleagues, Jean-Marie Andrieu and Alain Venet, had based their sensational report on tests with only two patients, one of whom had been treated for less than a week. “To draw conclusions with just a week’s time frame is really a majestic leap,” said Anthony Fauci, a leading AIDS investigator at the U.S. National Institutes of Health (NIH). AIDS researchers in both the U.S. and France also censured the Paris team for holding a press conference before they had presented their findings in a scientific forum. “I’m very disturbed by their method of announcing their work,” said Dr. Paul Volberding, head of the AIDS clinic at San Francisco General Hospital. “They’re approaching it in the most irresponsible way possible.”

The Laennec group acknowledged that it would be premature to draw any firm conclusions about cyclosporine. But they argued that it was “ethically necessary” to share what could be an important finding. They reported that the drug had produced a dramatic rise in the number of T-4 cells–specialized white blood cells essential to the immune system–in both of the test patients. (An abnormally low level of these cells is a hallmark of AIDS.) One of the patients, a 38-year-old man described as having been “near death” before treatment, had a hundredfold increase in his T-4 level.

The Laennec scientists speculated that cyclosporine produced this effect by depriving the AIDS virus of its favorite target, “activated” T-4 cells that are primed to defend the body. The virus reproduces inside these cells, destroying them in the process. Cyclosporine is known to prevent activation of T-4 cells, apparently making them less susceptible to the virus’ assault. The T cells survive, and their number increases as the body continues to produce them.

Currently not enough data are available to begin evaluating this theory. But as the French researchers admit, even if cyclosporine treatment should prove effective, it would not represent a cure for AIDS; the virus would still be present, ready to strike again when treatment stopped. Moreover, giving an immunosuppressant to patients whose immune systems are already weakened is clearly risky. Says Dr. Donald Abrams of San Francisco General Hospital: “Cyclosporine might be quite lethal in AIDS patients for all we know.”

Though inconclusive, the French tests prompted the U.S. subsidiary of Sandoz, Ltd., the Swiss-based manufacturer of cyclosporine, to announce that it would soon begin tests of the drug in American AIDS patients. Said Max Link, who heads the subsidiary: “Only well-controlled, long-term investigations will answer the question of whether Sandimmun could play a role in the treatment of AIDS.”

The French announcement and the resulting furor underscore the frenetic pace of AIDS research. At the NIH in Bethesda, Md., calls come in virtually every day from drug manufacturers claiming to have a new treatment for the disease. About half a dozen drugs are currently under serious study. Several, including ribavirin, suramin and one called compound S, have shown promise in blocking the replication of the AIDS virus. But few, if any, have demonstrated the potential to rebuild the devastated immune systems of AIDS patients.

With no other way to turn, desperate AIDS patients may be led by the premature French report to try potentially dangerous experiments with cyclosporine. Says Laurie McBride, president of San Francisco’s Lesbian and Gay Chamber of Commerce: “This feeds into what we’re calling the second epidemic–the epidemic of fear.”

When the world learned that Rock Hudson had AIDS, a question arose in the minds of Dynasty fans: “What about Linda Evans?” She had played a passionate kissing scene with Hudson on the popular TV series. Though no case of AIDS has ever been traced to kissing, the virus is sometimes present in saliva. This has prompted some actors to express concern about playing love scenes. Last week the Screen Actors Guild addressed the touchy matter by asking that movie producers notify performers in advance if their roles call for open-mouth kisses. Any actor not so advised before signing a contract may refuse to play the scene, without financial penalty. “We are not saying kissing is dangerous,” stressed SAG Executive Dean Santora. “This is not a medical bulletin. It’s a labor matter.”