Subject: AIDS Vaccine Study Offers Hope Amid Reports Illness Has Spread Date: Published: 6/13/91 (143 lines) Source: Wall Street Journal. Copyright Dow Jones & Co. Inc. Health: AIDS Vaccine Study Offers Hope Amid Reports Illness Has Spread ---- By Marilyn Chase Staff Reporter of The Wall Street Journal On the eve of the Seventh International Conference on AIDS, new research on vaccines and treatments is stirring hope even as other studies point to the growing size of the epidemic. The conference, which opens Sunday in Florence, Italy, will draw 8,000 scientists from around the world and include thousands of reports and scores of lectures on AIDS prevention, care and education. The epidemic's devastating inroads in Africa and, more recently, Asia will be a prime focus. Another study, already released, indicates risky sexual practices among young gay men in the U. S. are leading to a new wave of AIDS cases. Even before the conference opens, a new AIDS vaccine study is buoying spirits. The study found that in people already infected with the virus, repeated vaccinations may bolster the body's defenses and forestall a deadly decline in infection-fighting immune cells. The vaccine study by Robert R. Redfield of Walter Reed Army Medical Center in Washington, D. C., used a vaccine made by MicroGeneSys Inc. of West Haven, Conn. Created by gene-splicing technology, the vaccine uses a synthetic version of a viral protein called gp160. In a report published in today's edition of the New England Journal of Medicine, Dr. Redfield and his co-workers say they vaccinated and observed 30 people with asymptomatic HIV, or human immunodeficiency virus, which causes AIDS, for 10 months. Volunteers received a series of either three or six shots. The report says 19 of the patients, or 63%, showed an increase in antibodies against the virus and a rise in infection-fighting killer cells. Most intriguingly, Dr. Redfield reported that the 19 showed no decline in their levels of T-cells -- certain white blood cells that are normally depleted over time by AIDS. The other 11 patients, whose systems didn't respond to the vaccine, experienced a 7% decline in their T-cell counts. A major drawback of the study is that it lacked a "control group," or group of patients who weren't treated but were monitored simultaneously. Instead, Dr. Redfield did an historical analysis of untreated individuals and found that they suffered a nearly 9% drop in T-cells over a 10-month period. AIDS experts reacted to Dr. Redfield's report with restrained praise, saying it is encouraging but needs to be confirmed. "You certainly need to do a controlled study in a larger number of people," said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. But he was pleased by the apparent safety of the vaccine. "There was concern that if you vaccinate people who are already infected, you could make them worse. But there was no increase in viremia," or virus levels in the blood. "The most important thing," said Dr. Redfield, "is that we document the feasibility of using a vaccine to modify the body's immune response in a chronic disease." He said he is already doing a controlled trial of the MicroGeneSys vaccine in 138 people and plans to add 170 this summer. He is also starting to test another gene-spliced vaccine made by Genentech Inc. of South San Francisco, Calif. Dr. Redfield added that patients in the original study continue to show strengthened immunity for as long as one to two years. "But it's a small group," he warned, "so interpret that with caution." It still isn't clear whether the vaccine can slow the course of AIDS. Those who responded to the vaccine tended to be those who received more shots and those whose immune systems were stronger to begin with. Still, Dr. Fauci said, "It is worthy of active pursuit." Another study released before the start of the conference raises the possibility of a second wave of AIDS among homosexuals who were children when the epidemic began 10 years ago. Lulled by denial, they engage in risky behavior now largely avoided by older gay men in their 30s and 40s, says George Lemp, an epidemiologist with the San Francisco Department of Public Health. Dr. Lemp deployed teams of health interviewers in gay dance clubs and bars in San Francisco to survey 258 men aged 17 to 25 about their sexual practices and to test them for AIDS. Dr. Lemp found that 12% of the men tested positive for the AIDS virus. While that's far less than the 50% rate of infection among all San Francisco homosexuals, it is sobering because many of the young men in the study began having unsafe sex long after the risk of AIDS was known. Within the survey group, it was the youngest men -- aged 17 to 19 years -- who showed the highest prevalence of AIDS infection at 14.3%. That compared with 10.4% of men aged 23 to 25 who tested positive for AIDS. Risky behavior was also highest among the youngest men. More than 40% of 17 to 19 year olds said they engaged in intercourse without a condom, compared with 25% to 30% of men aged 20 to 25 years. "A lot of these young guys think that if they have sex with each other, they're safe. We wanted to blow that myth out of the water," said Giuliano Nieri, a health worker who helped conduct the interviews. "I believe evidence from this study is that there is a second wave of AIDS infection among young gay and bisexual men," Dr. Lemp concluded. "We assumed the change in behavior would carry on through the generations, but there is a generation gap." Dr. Lemp and Mr. Nieri urged revamping education programs. Messages should "personalize the risk" to teen-agers, they said, by increasing one-on-one counseling, putting more young faces on AIDS prevention billboards, and emphasizing that condom use is not only safer behavior but socially attractive and desirable. In the field of drug research, many AIDS doctors and advocates hope the Florence meeting will provide ideas for improved treatment of AIDS patients. One hot area is combination therapy, which involves giving two or more drugs together to increase the drugs' effectiveness while limiting drug toxicity and curbing the rise of drug-resistent viruses. Intense interest surrounds the presentation in Florence of data from unpublished studies on the combination of Wellcome PLC's AZT, the only approved antiviral drug, with experimental drugs such as DDC from Roche Holding Ltd. and DDI from Bristol-Myers Squibb Co. Investigators like Douglas Richman of the University of California at San Diego have criticized earlier leaks of study results as premature and error-filled, but other experts are enthusiastic about what they have seen so far. "This is the next step in AIDS treatment. Initial data indicate that combination therapy will be superior to single agents," said Jerome Groopman, a researcher at New England Deaconess Hospital and Harvard Medical School in Boston. And Dr. Fauci, who oversees AIDS drug research for the infectious disease institute and its parent body, the National Institutes of Health, concurred. "Combination therapies will be the therapies of the future," he said. [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]