Subject: WHO Official to Seek $2.5 Billion a Year From Developed World for AIDS Fund 
Date: Published: 6/7/93 (98 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Technology & Health:
    WHO Official to Seek $2.5 Billion a Year
    From Developed World for AIDS Fund
    ----
    By Marilyn Chase
    Staff Reporter of The Wall Street Journal

    BERLIN -- An official of the World Health Organization will
 propose that developed countries invest a total of $2.5 billion a
 year in AIDS prevention in the developing world.  The move, he
 contends, would spare millions of lives and save about $90 billion
 in costs by the year 2000.
    "This is a return any company would be happy to achieve," Michael
 Merson, director of the World Health Organization's AIDS program,
 will argue in a speech here today at the opening session of the
 Ninth International Conference on acquired immune deficiency
 syndrome.
    In the past year alone, he said in his remarks, 500,000 people
 infected by HIV, the virus that causes AIDS, have gone on to develop
 the disease, swelling the epidemic's official toll to 2.5 million
 worldwide.  By 2000, Dr. Merson predicts those AIDS cases will
 triple, and the numbers of infected people -- now estimated at 14
 million -- will grow to 40 million.  (By contrast, Jonathan Mann of
 the Harvard University AIDS Institute, has predicted 110 million
 cases of HIV infection by 2000.)  
    Either way, Dr. Merson said in an interview that his prevention
 scheme -- if funded -- could cut the new HIV infection rate in half,
 and avert incalculable suffering during this decade.  "We can't
 afford to neglect this epidemic," he said, just because "the
 powerful lost interest, and the powerless had no choice."
    More than 12,000 scientists, journalists and people with AIDS
 poured into this city over the weekend for marathon debates and
 arguments pitting scientific hope against the grim and growing
 pandemic.  Battle fatigue is etched into many faces, and testiness
 was audible during debates that raged in preliminary sessions.
    Of all those debates, the fiercest fight is over the question of
 how soon to blast HIV with antiviral drugs.  It is a question
 troubling the fate of many thousands of patients, as well as the
 fortunes of Wellcome PLC. 
    For years, U. S. medical dogma has held that patients should begin
 taking Wellcome's antiviral drug AZT long before AIDS symptoms
 appear, indeed, as soon as white blood cells of the immune system
 decline to 500, or half the normal level.  At least two studies from
 the National Institutes of Health bolstered the practice.
    But leaders of a contrary European study took center stage here
 yesterday, asserting benefits of early AZT are at best "limited and
 transient," offering patients no real survival advantage.
    Seligmann of the University of Paris and his team of French and
 British researchers contend that the so-called Concorde study of
 1,700 patients invalidates the American standard of practice
 employing early AZT.  In the balance, thousands of patients'
 treatment plans are left hanging, along with millions of dollars in
 potential sales revenue for Wellcome.
    David Barry, who has headed Wellcome's AZT program since before
 the drug's 1987 approval, attacked what he called Dr. Seligmann's
 "leitmotif of limited and transient effects."  Even in the Concorde
 study, he noted, AZT maintained striking rises in immune cells.  Dr. 
 Seligmann countered such cells are an unreliable index of drug
 value.
    In the face of such challenges, some former champions of early
 treatment have at least temporarily yielded ground.  The American
 Medical Association, which was to have presented its updated guide
 for AIDS doctors here, has delayed publication.  Paul Volberding, an
 AIDS researcher at San Francisco General Hospital who heads the AMA
 committee on the guidelines, said that "following Concorde, the
 draft document will be revised" based on conclusions from summit
 meetings to be convened at NIH later this summer.
    Concorde's conclusions already have been attacked as outdated
 because the study kept patients on AZT for three years, long past
 the time experts counsel switching them to alternate drugs like
 BristolMyers Squibb Co. 's DDI, or Roche Holding Ltd.'s DDC.  Further,
 Concorde allowed hundreds of patients on placebo to switch to AZT
 during the study, yet counted their results as belonging to the
 control group.  Critics say this could cloud Concorde's real
 significance -- a charge Dr. Seligmann hotly denied.
    Diverse experts in WHO, the U. S. Centers for Disease Control and
 Prevention and AIDS clinics pounded home the theme that the
 epidemic-once the province of gay, white males-is changing course to
 attack more minorities, youth and women.
    "The new face of AIDS is a 15- to 19-year-old girl in Thailand,"
 said Karen Hein of New York's Montefiore Medical Center.  "It's a
 profile that has only begun to hit U. S. shores," she added.  But the
 forecast is hardly hypothetical.  With gay men having changed their
 risky behavior, most of new HIV infections are among poor and
 minority youth, especially adolescent girls.
    Dr. Hein praised the example of Finland, where the government
 mails every 16-year-old a brochure containing a condom and pictures
 of teens engaged in a safer form of intimacy -- without penetration
 or AIDS risk -- which Dr. Hein dubbed "outercourse."

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