Is the AIDS Epidemic Over?

       I agree that Sullivan and Sanford have sound reasons to buoy themselves with hope right now: These drugs clearly are an important advance. The question I have is, as journalists, how high should we turn the hope knobs? Sullivan and Sanford have chosen to turn them up so high that they remind me of the guy in the movie Spinal Tap who brags, “My amp goes to 11.”
       I am neither a physician nor a scientist and do not want to pretend to wear either hat. If you, as a leading AIDS clinician, expect that some HIV-infected people may be able to leapfrog from new treatment to new treatment and live into old age, I think that is both logical and heartening. What I am hearing from you and other AIDS researchers, though, is a far cry from the bold statements that Sullivan and Sanford make. And you don’t address these bold statements in your e-mail.
       Sullivan, remember, writes that “this ordeal as a whole may be over” and is describing an eyewitness account of the end of the epidemic. You state above that “AIDS isn’t over.” Does this mean you disagree with Sullivan? Do you think the epidemic can end without a vaccine, as Sullivan, by not mentioning the word “vaccine,” implies? Sanford claims that “I am probably more likely to be hit by a truck than to die of AIDS.” He is your patient. Would you use those words if he asked you to describe his prognosis? More to the point, what do you think about the messages these writers are conveying to infected people who read their articles? Are these messages ones you think that they, as prominent journalists–they are not simply HIV-infected people writing a “My Turn” in Newsweek–should convey?
       The other main point I’d be curious to hear you address is the cost of false hope. My sense, again as a journalist, is that giving people false hope can lead to serious problems, only some of which I outline in my article. You treat HIV-infected people day in and day out. How do you discuss the future with them right now? I suspect you lard your conversations with caveats, just as you’ve done here: “We expect that for some, the current remission may last long enough. …” Although David Sanford acknowledges that he’s “not out of the woods,” he also writes, “I’ve survived this scourge.” Has he? Again, would you tell him that? And do you agree with Sullivan’s assessment that a diagnosis of HIV infection today “no longer signifies death,” but “merely signifies illness”?
       As for the talk of a cure at the Vancouver conference, I think the researchers carefully presented the thesis about the possibility of eradicating HIV from people who recently had become infected, and I didn’t see any egregious press accounts that screamed “AIDS CURED!” or the like. Indeed, one researcher stood up at the best-attended session that discussed this idea and, as I briefly mentioned in my S


article, described how one of his patients in this situation stopped taking drugs, and his virus quickly returned. Talk about sobering. Then again, did the presentations about the possibility of curing people who are treated early unduly influence the thinking of Sullivan and Sanford? I think that’s a fair question, and one that I can’t answer.
       Finally, a minor quibble: I don’t think rational drug design had a whole lot to do with the leading protease inhibitors moving forward. I spoke with several chemists at both Merck and Abbott, and they emphasized how they found their compounds largely through the traditional trial-and-error process. This reaffirms my sense that developing effective anti-HIV drugs–and proving that they work–is going to continue to be a daunting, humbling process. Especially when the target is as shifty as HIV.

–Jon Cohen