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Fighting AIDS

Dr. Stoneburner, head of the AIDS Epidemiology and Surveillance Unit, is a slim, dark, handsome South Carolinian who got his M.D. from Tulane University in New Orleans and worked in a community health center in a poor part of that city, and in West Africa. He got his epidemiology training at the CDC. His first discovery at the Health Department was an increase in tuberculosis among blacks and Hispanics, and in neighborhoods where intravenous-drug use was widespread.

"That's unprecedented in TB history. TB has declined for a century as living conditions, general health, and chemotherapy have improved," Dr. Stoneburner says. Researchers think that the rise may be linked to AIDS: TB may be another opportunistic infection that indicates an HIV infection that has not yet been diagnosed.

"TB is an infection with important implications for public health. TB spreads easily. You don't get it, like flu, from being sneezed on in the subway, but you might get it from spending an hour in a room with somebody who's infectious," Dr. Stoneburner says.

Is it possible that infection with the AIDS virus is not invariably fatal? Is it possible that somebody can be a lifelong asymptomatic carrier and never develop the disease? Yes, says Dr. Donald Armstrong, 55, chief of infectious disease at Memorial Sloan-Kettering Cancer Center. "There are people infected with the virus who have been followed for years and haven't developed the disease, and I'm not sure that they will.

"If there are a million or a million and a half people infected with the virus and only 25,000 cases of AIDS, then there are a million and a half, minus 25,000, walking around healthy," Dr. Armstrong says. Some may come down with the disease, but many may not.

"Even among those with lymphadenopathy, only 7 percent per year have so far come down with the disease. In the others, after a period of years, the lymphadenopathy may go away and they'll become immune and not have the disease. They might develop immunity. Then the virus might disappear from their blood and they wouldn't be infectious. We just don't know," Dr. Armstrong says.

"Chronic viral infections are not unheard of—even infections of lymphocytes, as occurs with the AIDS virus. In the majority of people there's no disease as a result," Dr. Armstrong says. "After infectious mononucleosis, people may carry the Epstein-Barr virus for years without any disease, although we don't know how long a person will be infectious. A herpes carrier can transmit the virus with no apparent disease," he says.

"Some people infected with the virus have been followed for years and have not developed AIDS."—Donald Armstrong

Dr. Armstrong, a reserved man, organized the Intercity Infectious Disease Rounds, during which the city's leading infectious-diseases specialists share information about puzzling cases. In 1980 and 1981, doctors began presenting cases of what is now known to be AIDS. "When a number of cases of an unknown disease occur, it's an epidemic," he says.

Since then, as an expert in opportunistic infections, Dr. Armstrong has seen several hundred AIDS patients. He and his colleagues at Memorial Sloan-Kettering, along with researchers at the Greater New York Blood Program, are studying the natural history of infection with the AIDS virus. Previous plasma donors who were found to be asymptomatic carriers of the virus, and lymphadenopathy patients with AIDS infection, are being followed and compared with a control group of uninfected homosexual men in Ithaca and New York City. From this study, the researchers hope to learn what happens to people infected with the AIDS virus.

Dr. Armstrong is head of the AIDS Treatment Evaluation Unit at Memorial, and he heads a drug-discovery unit, supported by the National Institutes of Health, that looks for and tests new drugs against AIDS. So far, the unit has tested dideoxycytidene, a drug related to AZT; it will soon put patients on AZT, and will test the effects of high and low doses of AZT. Trials of AZT and alpha interferon are being planned.

"We're in the infancy of learning about this complicated group of viruses," he says; precautions are in order. A practical man, Dr. Armstrong is in favor of making sterile needles available to drug addicts, to see if that would reduce the risk of infection.

"If individuals know they're at risk, whether they're positive by test or not, they should alter their behavior to protect other people and themselves. Whether they're heterosexual or homosexual, if they have sexual contact with anybody else without using a condom, they're taking a risk. Condoms may not be perfect at preventing infection, but they're better than nothing.

"The gold standard is celibacy. If everybody were celibate, there'd be no further spread of this disease by sexual transmission," Dr. Armstrong says. "But it's not practical to assume that everybody's going to be celibate. Not from a moral point of view but from a practical one, the more partners you have, the greater your chance of contracting the disease."


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