Red Faces In White Coats

The news of Feb. 17 left AIDS researchers and activists baffled. Massachusetts General Hospital announced that a 31-year-old medical student, Yung-Kang Chow, might have found the "Achilles' heel" of HIV, the virus that causes AIDS. A unique, three-drug combination had so mangled a key enzyme in HIV that it stopped replicating in a test tube. If the result could be repeated in AIDS patients, that would be big news, since the virus spreads by sending out replicas of itself. But while Chow's results were interesting, they weren't new. Researchers had learned of the experiment at last summer's AIDS conference in Amsterdam.

Still, the announcement triggered a flood of publicity. Thousands of calls poured into AIDS hot lines, drug companies, and doctors' offices across the country. HIV-infected patients lined up to be included in a national 200-patient test, scheduled to begin this summer, of Chow's triple-whammy drug combo.

Now, AIDS experts--as well as the study's authors--are worried that the hoopla has triggered another round of raised expectations that will go unfulfilled. "It's made patient after patient falsely hopeful," says Boston physician Calvin J. Cohen, who treats numerous AIDS patients. And Dr. Martin S. Hirsch, a prominent MGH AIDS researcher who supervised Chow's research, says the reaction to the study has been "devastating." He says he regrets the study "has been blown out of all proportion."

SKEPTICS. Chow and Hirsch tried to avoid hype. In announcing the study, they stressed that the results were only achieved in a test tube and could easily fail in humans.

But stories of new treatments for AIDS have a way of taking on a life of their own. And some scientists suggest MGH fanned the flames. In announcing their findings, Hirsch and Chow soft-pedaled an important detail: The three-drug approach worked with only certain strains of HIV--variations of the most common form, known as HIV-1--but it didn't work against other strains. An insidious feature of AIDS is its ability to mutate and develop many different forms.

MGH's use of the term "Achilles' heel" also doesn't sit well with some. Says Dr. William S. Haseltine, a top AIDS researcher at Harvard University: "I doubt they found the Achilles' heel--there are probably lots of Achilles' heels."

Some competing AIDS researchers also worry that the MGH experiment will inspire a host of unproductive imitations. Merck & Co., which makes pyridinone, a drug similar to one of the three used in Chow's combination, is now under pressure to do tests similar to his, even though scientists there are deeply skeptical of his approach.

Hirsch maintains that Chow's three-drug strategy "is the best approach we have yet." Maybe he's right. But in all the excitement, it's important to remember the limitations of Chow's study. Most of all, it's worth remembering that the real trials--with human subjects--have yet to begin.

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