Can AIDS be cured?
The question could only be imagined a few months ago. But participants at an international meeting on AIDS here last week were jolted when some scientists said that continued use for a few years of new drug combinations, which already drive the AIDS virus to undetectable levels in the blood, might eradicate the virus from patients' bodies. Drug treatment could then be stopped forever for such people. A cure.
For now, there is only the hope of such a result. But Dr. David D. Ho and Dr. Martin Markowitz take the hypothesis that a cure is possible seriously enough that they plan to test it at some point by stopping treatment of a very small number of infected individuals at the Aaron Diamond AIDS Research Center in New York City and possibly elsewhere. Definitive proof of a cure probably could not come for years. Failure could come sooner.
News that some scientists are seriously considering the possibility that new drug treatments might not only control, but cure AIDS has caused widespread excitement, and intense controversy.
To critics, merely raising the possibility of curing what has been a generally fatal disease is far too premature and perilous. In doing so, some critics have warned that scientists could create a false sense of security, leading many to drop their guard against unsafe sex and other risky behavior, and negate gains in prevention if people assume that they could be cured if they did become infected. Another fear is that medical science could get a huge black eye if a widely publicized effort to cure AIDS fails.
In speaking of cure, eradication and elimination, proponents are borrowing words from other areas of medicine where they have differing meanings.
Surgeons say that an appendectomy cures appendicitis because after its removal there is no chance the appendix can become inflamed again. But cancer cures are measured in terms of five-year disease-free survival, even though patients may die from the same cancer years later.
For bacterial infections, a cure may be declared for those like gonorrhea or pneumococcal pneumonia that permanently disappear after antibiotic treatment. If a patient develops gonorrhea or pneumonia again, it is from a new exposure.
Viral infections are another story. Cures of most viral diseases like influenza occur naturally, a result of the immune system's defenses. Chicken pox is usually considered cured after the last scab disappears from the skin. But the chickenpox virus remains dormant in nerve cells and often causes shingles in infected individuals decades later. What triggers the delayed effect is not known.
Eradication and elimination are words generally used in the public health field to describe the disappearance of a disease from a geographic area. Only one disease, smallpox, has been eradicated from the world. But many other diseases have been eliminated from certain regions, like polio from the Americas.
Now virologists at the meeting are applying the words eradication and elimination to individual patients in whom H.I.V. cannot be detected after combination drug therapy. Yet no one can say the virus has permanently disappeared because H.I.V. still could be hidden somewhere in the body.
The fact that the concept of a cure for AIDS is on the brink of being tested has caught key Federal officials and agencies by surprise.
There is "no cure on the horizon" for AIDS, Dr. Helene D. Gayle, who heads the AIDS program at the Centers for Disease Control and Prevention in Atlanta, wrote in the program for a session devoted to preventing H.I.V.