The MacNeil/Lehrer Report; AIDS: The Mysterious Disease

[Tease]

JIM LEHRER [voice-over]: It's new, it kills, and it's spreading: A.I.D.S., a disease that has medical science baffled.

[Titles]

LEHRER: Good evening. There are few scarier things than the discovery of a new killer disease, one medical science admits is mostly a mystery for which there is no certain cause or cure. Such a dreaded discovery was made last year, and it's since become an epidemic, already having killed more people than two other of the most recent mystery diseases, Legionnaire's Disease and toxic shock syndrome. Doctors have called the new one bizarre, frustrating, frightening. And it's only been in recent weeks that they've given it an official name -- acquired immuno-deficiency syndrome, A.I.D.S., or AIDS, as it's now called. It's considered bizarre because, unlike other diseases, it suppresses a person's natural immunity against various infections and certain types of cancer. The National Cancer Institute has pledged $1.2 million to research on AIDS amidst the silver-lining hope of some scientists that the research process might unlock mysteries to cancer itself. Tonight, the new disease called AIDS, and the unanswerable questions about it. Robert MacNeil is off; Charlayne Hunter-Gault is in New York. Charlayne?

CHARLAYNE HUNTER-GAULT: Jim, it was in the spring of last year when the medical community first realized that this mystery disease had reached epidemic proportions. At first it appeared that its only victims were young homosexual men in a few large cities, notably New York and San Francisco. In these cases, otherwise healthy young men were turning up with rare forms of cancer and infections that would ultimately kill many of them. Doctors then discovered that they were getting these unusual illnesses because their natural immunities had collapsed and they were unable to fight them off. But the seemingly exclusive link between that group and AIDS proved to be short-lived when other pieces of the puzzle began to fall into place. Similar illnesses were discovered in 69 male and female drug addicts, all believed to be heterosexual. Then 32 male and female Haitian immigrants contracted the disease, all but one were heterosexual, and only one used drugs. And, most recently, AIDS was uncovered in three hemophiliacs -- a small number, to be sure, but statistically high for that group, according to doctors. This last development strengthens suspicions that the disease may be spreading through the blood because of the shared need of hemophiliacs for large amounts of blood. So far, more than 500 known cases of AIDS have been documented in 26 states and nine countries. Sixty to 80 new cases are currently being reported each month. The fatality rate so far is an alarming 40%. For a closer look at this puzzle, we turn to a man who has been treating AIDS victims for the last two years in New York City. He is Dr. Bijan Safai, chief of dermatology at the Memorial Sloan-Kettering Cancer Center. Dr. Safai, what specifically are the symptoms of the AIDS disease?

Dr. BIJAN SAFAI: The AIDS has so far appeared in four different types: one is Kaposi's sarcoma, which is a rare cancer which appears on the skin in the mucous membrane of the mouth, in the G.I. tract, or in lymph glands. The second type is infectious with opportunistic agent, which takes advantage of the decreased immunity of the host. The third form of this AIDS is in an individual that they have come down with generalized enlargement of their lymph gland, and loss of weight and weakness. And the fourth type are the individual that they have come down with a sort of wasting syndrome, having loss of energy, loss of weight, and unable to work and function properly.

HUNTER-GAULT: So a person with any -- can a person have any one or all of those symptoms?

Dr. SAFAI: Yes.

HUNTER-GAULT: They could have all of them?

Dr. SAFAI: Yes, they could have one or two or more than that.

HUNTER-GAULT: What do you know about the causes of this disease?

Dr. SAFAI: Charlayne, initially it was thought that the drugs which were mostly used by homosexual individuals was the cause of the syndrome. Later on it was believed that lifestyle factors were involved.

HUNTER-GAULT: Lifestyle of the --

Dr. SAFAL: Lifestyle of, again, the homosexual. But then the disease started to spread to heterosexuals, Haitian and hemophiliac. It seems now that the cause of the AIDS is probably an infectious agent, and that is spreading through the individuals that have come down with the disease.

HUNTER-GAULT: So how would it be contracted? Would it be only through blood transfusions, or --

Dr. SAFAI: No, it seems that the agent can be transmitted, number one, by sexual contact, and number two, by blood product. It is possible that the agent can be transmitted by other ways that we don't know yet.

HUNTER-GAULT: What happens when someone gets it?

Dr. SAFAI: There is a continuous deterioration of the system, the human system. An individual -- they may appear initially with very small tumor on their skin and a very low immunity, and they continue to develop more tumors and further decrease in their immune system. Eventually they may come down with infectious agent that's fatal.

HUNTER-GAULT: What exactly does it mean for a person's entire immunity system to collapse? Nothing works? Nothing?

Dr. SAFAI: Yes. You see, we are continuously exposed to both internal and external factors, and the immune system is set up to defend our system from all these foreign or internal material. And basically the immune system is responsible for fighting infections and cancer. So when someone's immune system is deteriorating and is destroyed, it means that individual cannot fight infections or cancer, and obviously can come down with either or both.

HUNTER-GAULT: Well, very briefly, how do you treat something like that?

Dr. SAFAI: Obviously, the treatment should be directed toward improving the immune system or toward the cause of that. Now, in this situation, because we still don't know the cause of the AIDS, we have been trying to help the individual immune system and boost their immunity to hopefully they come up and fight with the cancer and infections.

HUNTER-GAULT: And I assume that the reason the fatality rate is so high is because the system is so completely wiped out that a person can't resist?

Dr. SAFAI: Exactly. These individuals, they cannot fight any infection.

HUNTER-GAULT: And it kills them.

Dr. SAFAI: And they cannot fight cancer, and so they come down with both, and it's fatal.

HUNTER-GAULT: Quickly?

Dr. SAFAI: Yes. I mean, the mortality rate is 40%, as you mentioned, and the survival is very short. It is about 16 to 18 months.

HUNTER-GAULT: All right, thank you. Doctor. Jim?

LEHRER: The federal government has a team of medical detectives who spring into action whenever a new mystery disease emerges. They work for the Center for Disease Control in Atlanta. The CDC currently has 100 people working on a special task force on AIDS. It is headed by Dr. James Curran, who is with us tonight from the studios of Georgia Public Television in Atlanta. Dr. Curran, does the incidence of AIDS constitute an epidemic in your official CDC terms?

Dr. JAMES CURRAN: Well, yes it does, Jim. The definition of an epidemic refers to the greater-than-expected occurrence of illnesses. These illnesses, these severe infections and rare cancers occurring in previously healthy people are so unprecedented that even a handful of cases would represent an epidemic.

LEHRER: I see. Well, Charlayne used the figure that 60 to 80 new cases are reported each month. Is that a growing curve, say, was it 30 to 40, and then it went 50 to 60, and now it's 60 to 80? Has that been the pattern?

Dr. CURRAN: We became aware of this problem, as Charlayne mentioned, in the spring of '81, and during the remainder of 1981 approximately one case per day -- 30 cases per month -- were reported to us. During the past six months this has risen to approximately 75 to 80 cases per month.

LEHRER: Any reason for you to believe it isn't going to continue to grow at this rate?

Dr. CURRAN: I would anticipate a continued relatively slow but steady increase in incidence.

LEHRER: Doctor, in a general way, what are your 100 people doing?

Dr. CURRAN: Well, our activities are divided into more or less three areas.One is surveillance. We're trying to keep very close tabs on the numbers of cases occurring in terms of their distribution around the country; looking for clues through the identification of new risk groups or new individuals.

LEHRER: All right, let's stop there, if I may. What have you found, if anything, in that particular area thus far?

Dr. CURRAN: Well, I think over the past year the most striking distribution findings were the relative limitation of the cases among homosexual men to a very small number of large cities in the United States. Secondly, a very similar geographic limitation of cases in IV drug users in the same cities. Thirdly, I think, the occurrence of the syndrome in Haitians who have recently entered the United States. And, finally, the reporting of three cases in hemophilia-A patients. All of these were detected through a surveillance mechanism.

LEHRER: Well, I mean, what does all that add up to in terms of risk?You talked about risk groups. Have you identified any other risk groups? Are these the only risk groups, or is there any conclusion that you can draw, in a general way?

Dr. CURRAN: Well, I think in terms of risk to other people who have not been identified, there are perhaps a handful of cases, another 25 or 30, who do not fit into any of these categories. This is a common finding with any new syndrome, based on inaccurate histories or other things like this. I think it's safe to say that the syndrome is not readily spread in the population. It's not an explosive disease that need cause panic. It's not something that's likely to be, for example, airborne, that would cause explosive incidents, like influenza.

LEHRER: I see. Have you gotten any clues yet in terms of how it is spread, possibly through blood transfusions or through blood devices of any kind?

Dr. CURRAN: Well, I think the infectious hypothesis, the idea that an infectious agent may be underlying the disease in all the groups, comes from the occurrence in relatively segmented sectors of society and segmented places, and also groups that seem to have virtually nothing else in common. There are models. There are types of diseases -- types of hepatitis viruses, for example -- which cause disease in such disparate populations as we see affected here.

LEHRER: Yeah. Finally, let me ask you this, Doctor. Based on the work that your folks have done thus far, and what you still anticipate doing, how long do you think it's going to be, if ever, that you're going to come up with a definitive answer on this?

Dr. CURRAN: Well, all of us are optimists. We like to think that the laboratory will find the cause tomorrow. Unfortunately, there have been no laboratory breakthroughs at CDC or elsewhere, as far as I know. But there are many of our laboratory scientists and many people throughout the country working very hard.

LEHRER: But you couldn't say tonight that you're close?

Dr. CURRAN: I couldn't say that we have any important breakthroughs, and I'm hoping that we're close.

LEHRER: All right, thank you. Charlayne?

HUNTER-GAULT: Now to the part of the puzzle that deals with the prospect of AIDS providing clues to the workings as well as the cause of cancer. For that we have Dr. Bruce Chabner, director of the cancer treatment division at the National Cancer Institute in Bethesda, Maryland. Dr. Chabner, first, is the AIDS disease itself a form of cancer?

Dr. BRUCE CHABNER: No, the basic syndrome is not a form of cancer. As Dr. Safai mentioned, it occurs in multiple different forms. One is lymph-node enlargement, a wasting disease. These are not cancer.

HUNTER-GAULT: Well, does everybody who gets the AIDS get cancer?

Dr. CHABNER: No, only a fraction of the patients get cancer. The thing that's so interesting and unusual is that they get a particular type of cancer, Kaposi's sarcoma, which is very unusual in the general population. It's ordinarily seen only in old people, and it's a very benign form of cancer in the older patients that get it.

HUNTER-GAULT: It's like a skin cancer?

Dr. CHABNER: Basically a skin disease. This disease, interestingly, occurs in Africa, too, and it's in a more malignant form in Africa which resembles the disease we're seeing in this population of patients.

HUNTER-GAULT: Well, why do you think that this can then shed light on the causes and workings of cancer?

Dr. CHABNER: Well, for many years scientists have been interested in the relationship between the immune system and cancer. There in fact are other examples of immunodeficient patients, for example, patients who have received renal transplants, or kidney transplants, and then have received medicine to suppress the immune response to their kidney. These patients also may develop, on rare occasions, Kaposi's sarcoma, or lymphomas. And so we have reasons to suspect that the immune system prevents in some patients -- or, in normal people, I should say, cancer. And when the immune system goes awry, as in these patients, that cancer may result.

HUNTER-GAULT: Well, do you have any suspicion that what is causing AIDS also causes cancer or vice versa?

Dr. CHABNER: That's possible. Yes, there is certainly suggestive evidence that a virus may underlie both syndromes. For example, viruses can suppress -- viral infections can suppress the immune system, and there are specific viruses that affect the lymphoid tissues which are responsible for immunity, and the same viruses can cause cancer. In the last year, for example, a virus has been isolated which appears to be the cause of cancer of the lymph nodes. And this was a very important breakthrough in cancer research, and we are hopeful that we can find similar cause -- identify a cause for this disease, and then perhaps develop treatmen based on that finding.

HUNTER-GAULT: What exactly is the Institute hoping to accomplish with the $2 million it has committed to research in this area?

Dr. CHABNER: Well, we have ongoing research, which amounts to perhaps a half a million dollars worth of commitments in direct monies, but we have made, in a new commitment which is now in the process of going through the application business, and that would be for about $1.25 million, and this money will be designated to support research in finding the cause and developing effective treatments for the disease.

HUNTER-GAULT: Do you think that a breakthrough on AIDS would bring you any closer to a breakthrough on treating and preventing cancer?

Dr. CHABNER: I think it would be certainly very important in this, a step in this direction. We have in this disease a population of patients where we can study the progression from immune deficiency to, eventually, development of cancer, and this is a process which we can't study in most patients who have cancer. We can't go back and study their immune system prior to the time they developed the cancer.

HUNTER-GAULT: So that's the kind of thing you would be doing with the money?

Dr. CHABNER: Yes. We have designated in these grant applications that we want people to study not only the cancer as it exists in the patient now, but patients who have some of the pro-dromal types of the disease, the immune deficiency syndrome without cancer.

HUNTER-GAULT: I see. All right, thank you. Jim?

LEHRER: Dr. Safai, you first. What do you think of the silver-lining possibilities here, that through research on AIDS some mystery having to do with cancer itself might be unlocked?

Dr. SAFAI: What we are really facing here is an experimental of the nature. We always try in the medical science and research to develop animal model for different diseases. And here we are faced with an experiment of the nature which puts in front of us individual patients that they develop infections, they develop cancer, and they have lack of immunity. So when we unravel this whole situation, we hopefully will understand the relation between the immunity, infection and cancer, which will definitely help in the understanding, treatment and prevention of cancer.

LEHRER: Dr. Curran, do you share that hope with Dr. Chabner and Dr. Safai?

Dr. CURRAN: Well, I think there is hope that much of the intense therapeutic research that's going on now may shed some light on immune therapy in general. I think it unfortunately is a cruel experiment of nature, indeed. But perhaps much will be learned from it.

LEHRER: Yeah. Dr. Safai, earlier you told Charlayne about how to treat -- about the treatment process. There are no drugs, no anything like that, that if you diagnose somebody at your clinic to have AIDS, there's really very little that you can do about it other than to treat one of those four end results, is that correct?

Dr. SAFAI: Obviously, one of the approaches is to treat one of the end results, namely, to treat Kaposi's sarcoma with radiation and chemotherapy, or to treat the opportunistic infection with antimicrobiotic agent. But we have taken another direction, and that is to use what is called now "biologic response modifier." These are agents or factors that they have developed from the lymphocyte of healthy individuals. And a good example of that is interferon. Interferon is thought to have an anticancer effect, antiviral effect, and also, if given at the right time, may stimulate the immune system. So with these characteristic, they have been treating several of these patients with interferon, and to date we have some promising results. We are far away from coming with a definitive answer and treatment, but this direction seems to be very promising.

LEHRER: Dr. Chabner, do you have anything to add to that in terms of any particularly dramatic successful treatment situations where you might not have expected success, and yet there was success?

Dr. CHABNER: No, we really haven't. I think the basic problem of treating immune deficiency is not well understood. It's certainly not understood in this patient, this population of patients.There are some genetic diseases that resemble this in which bone marrow transplantation is curative. But this has not been attempted on any great scale in the treatment of these patients. It's something that will be done, probably.

LEHRER: Is there any kind of early warning that the average person could pick up, or do you have to wait until you have one of these four things that Dr. Safai outlined at the very beginning?

Dr. CHABNER: Well, there is evidence now that suppression of the immune system may be more common in the gay population than we're seeing just in these affected patients, and this is worrisome, and it may be the reason for the fact that the disease is increasing in numbers, that the affected population may be somewhat larger than we're actually seeing with the disease. Unfortunately, there's no way of treating this at the present timethat's certain to restore immunity.

LEHRER: But my point is, is there any way to even diagnose it until it's almost to a point where you can't do anything?

Dr. CHABNER: Well, there's no certain way. What I meant in the previous statement was that by testing the immune system it may be possible to tell whether a patient has an early stage of the disease. This is really very hypothetical, though, and there's really no single test that's diagnostic.

LEHRER: Dr. Curran, there have been reports, which I read today, that there has been some panic among hemophiliacs around the country as a result of the three cases thus far. Is there reason for panic? Is there something special hemophiliacs should do in terms of their blood transfusions? Obviously their lives depend on getting them.

Dr. CURRAN: No, Jim, I think it is unwise and premature for persons with hemophilia to panic. I think the disease syndrome has to be put in some perspective. There have only been three patients with hemophilia-A who fit the case definition. And while -- since the cause of the problem is not known, we can't say for sure that the problem is exactly the same thing.It would seem to be a coincidence, and that's what led us to choose not to ignore this.

LEHRER: In other words, you haven't established the link in those three hemophiliac cases between AIDS and blood transfusion; is that what you're saying?

Dr. CURRAN: No, that's precisely right. What causes the breakdown in immunity in these hemophilia patients is unknown, and the blood products received by hemophiliacs are tremendously important for their health and well-being. And there have been tremendous breakthroughs over the past several decades in the treatment of hemophilia. So I think that we're lucky that hemophilia patients are so well treated in the United States and under the good care of doctors, and they should seek their advice.

LEHRER: Dr. Safai, finally, a point that Dr. Curran made earlier, which was that this did not appear to be an explosive disease, something that there was need for the general public to be panicked or to be that concerned about. Do you agree with that?

Dr. SAFAI: Yes, I do agree with that, and if you compare the number of patients that have been reported over the past two years with the number of individuals at risk, it is very small. We are talking about 500 patients in a population of several million, probably homosexuals, and many drug addicts that are supposed to be at risk at the present time. So it's not really a major problem.

LEHRER: In a word, Dr. Chabner, do you agree with that?

Dr. CHABNER: I do, except that, of course, it's a serious new problem, and any time something like this crops up which we don't understand, we have to take it very seriously, and many lives are affected.

LEHRER: Thank you, Dr. Chabner, Dr. Curran, Dr. Safai. And good night, Charlayne.

HUNTER-GAULT: Good night, Jim.

LEHRER: And we'll see you tomorrow night. I'm Jim Lehrer. Thank you and good night.