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Scientific VIEW

AIDS Vaccine May Present New Woes

May 28, 1986|BETTY ANN KEVLES

Although AIDS (Acquired Immune Deficiency Syndrome) seems to have appeared full-blown early in this decade, it is not without analogies in the medical world. In spite of its sudden appearance and lethal nature, it is a virus. Like other viral diseases, including small pox and polio, AlDS may disappear from the scene with the development of a vaccine.

Such a vaccine may be on its way. The May 30 issue of Science reports that Viral Technologies Inc., a Washington corporation, has managed to prevent the AIDS virus from invading human cells inside a test tube. Because this method aims at a gene in the core of the virus, and not on the coating (which differs according to the particular mutations of this many-faced virus), the new approach would protect individuals against all forms of the disease.

With the exception of the discovery of a cure, a vaccine is the best bet in the medical rush to stop AIDS from spreading. Yet the possibility of a vaccine presents a new set of problems. As Dr. Lawrence K. Altman wondered earlier this year, who will test such a vaccine?

Many Have Stopped

In the United States, the affected population is largely comprised of male homosexuals and intravenous drug users. Many people in these groups have already stopped practicing the kinds of behavior that made them especially susceptible to AIDS. It would be unethical, then, to suggest that they return to a style of life that is life-threatening.

Yet it does not appear likely that AIDS will disappear as soon as those infected with it now succumb. Indeed, there is reason to fear it will spread to the rest of the population. In central Africa, AIDS is endemic among young heterosexuals. In Uganda, where statistics are available, it appears that at least 10% of the population is infected.

AIDS is a peculiarly human disease. Although the virus has been found among the green monkeys of Africa (from which some speculate it was transferred to humans via a monkey bite), the monkeys thrive despite it. It is not dangerous to them. Even though researchers have managed to infect a chimpanzee (I will leave aside here the many questions that arise concerning the morality of infecting a highly intelligent animal like a chimp with a lethal virus), the vaccine may function differently inside a chimp's body from the way it works inside a human being. No, the vaccine must be tested with people.

Must Include Volunteers

But whom? The test group must include volunteers from a group of people who are at risk and who remain at risk. It would be useless, for instance, to vaccinate a group of novitiates for the convent.

A likely set of candidates has come to light in a new study in San Francisco for the AIDS Behavioral Research Project. Dr. Leon McKusick, a psychologist with the University of California at San Francisco, has surveyed 644 homosexual men about their willingness to participate in a test of an AIDS vaccine. Forty-three percent said they would do so. These are individuals, moreover, who now engage in high-risk behavior and who do not intend to change their behavior in the next year.

Many of those surveyed by McKusick have not taken the antibody test--a blood test that indicates if the subject has been exposed to AIDS. These are individuals who prefer not to know. It is interesting to note that those in the sample group who are unwilling to take the test are the same people most unwilling to consider volunteering as guinea pigs. However, more than a third of those surveyed, 273 men in all, responded that they are willing both to be tested and to volunteer if they are determined not to be carrying antibodies to the AIDS virus.

Those most likely to volunteer are men who are both highly active sexually and are involved in long-term, stable partnerships. These men are an appropriate group to undergo the first round of vaccine testings. If the vaccine proves successful in preventing the spread of the disease among them and does not cause serious side effects, it can then be tested among a more general population.

With AIDS spreading among heterosexuals in other parts of the world, we cannot assume that it will remain limited to specialized populations here.

There has been such widespread homophobia in the wake of the AIDS epidemic that it is important for the general population to appreciate that among a substantial number of homosexuals there is a strong sense of compassion and responsibility. At the moment AIDS is the scourge of their community. McKusick's study reveals that a good portion of those not infected are willing to place themselves at risk to protect other men and--in the light of what we know about the spread of the disease--to protect women and children too.

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