Source: AFP, Ars Technica, Canadian Press
PARIS -- The campaign against AIDS marks an important anniversary this week, bringing to mind victories of science and the human spirit but also defeats, stigma and ignorance in a combat that has claimed more lives than World War I.

On May 20 1983, in a paper published in the US journal Science, a team from France's Pasteur Institute, led by Luc Montagnier, described a suspect virus found in a patient who had died of AIDS.

In the absence of a known infectious agent, AIDS was truly terrifying, as an essay on the anniversary in Ars Technica points out -- nobody truly knew how to avoid or prevent it. That's why the Science paper was so significant: it was the first step towards us coming to grips with HIV.

The paper from Montagnier's lab was pretty limited, as the patient had a number of other viral infections going at the same time. The authors correctly picked out a T-cell specific retrovirus as the culprit, but incorrectly suggested it was a relative of another virus. Some of this confusion resulted in a political, financial, and scientific spat with Robert Gallo that was eventually settled, at least publicly.

It took another three years to resolve the spat over the pair's rival claims to be first to discover the AIDS virus, enabling the duo to share equally in the glory.

Regardless of the politics and the problems with the initial publication, the paper set researchers down the path of taking some of the mystery and fear out of AIDS. It was also an essential step for understanding the biology and evolution of the virus, which have helped scientists develop targeted therapies and prevention.

At last, a key had been found to understanding the mysterious immune-ravaging disease -- the "gay plague" as British tabloids smugly called it -- which had surfaced among American homosexuals two years earlier.

The mood was upbeat.

Never had a new, killer pathogen been identified so quickly.

Stoked by the success of antibiotics and the polio vaccine, optimism was brimming that this threat would now be stopped in its tracks.

"Today's discovery represents the triumph of science over a dreaded disease," the then US health secretary Margaret Heckler declared, when Gallo staked his claim on the virus discovery in April 1984.

"We hope to have a vaccine ready for testing in about two years."

Few promises have been so tragically premature.

When Heckler uttered those words, the tally of known cases of AIDS was less than 3,000.

Today, the number stands at 25 million dead, heterosexual and homosexual alike, and another 33 million infected.

The scale of human misery, though, is incalculable. A ragged army of more than 11 million children have lost one or both parents to the disease.

So what happened?

"In the field of AIDS, a huge number of mistakes have been made over the past 25 years," sighs a leading French researcher, Olivier Schwartz.

At a press conference today to mark the anniversary, the mood was less than upbeat, and the bickering that characterized the discovery of the virus was in evidence again, with Gallo suggesting that vaccine researchers are wasting money and time.

Montagnier, Gallo and other researchers said that new ideas, young talent, and injections of money are needed to invigorate the war against AIDS.

Men and women in the front line of the combat said there had been some remarkable successes in fighting AIDS.

They hailed the swift identification of the pathogen that causes acquired immunodeficiency syndrome (AIDS) and the advent of the "triple cocktail" of drugs in the mid-1990s that transformed a death sentence into a manageable disease.

But they also spoke of cruel setbacks.

These include the search for a vaccine -- the only way of stopping the global pandemic -- and an HIV-blocking vaginal gel to shield women.

Such failures show basic questions remain to be answered about HIV's shape-shifting properties and its stealthy invasion of immune cells, they said.

"We still don't completely understand the various forms of the virus. It's more complicated for us than we thought," Montagnier said.

"We need to go back to the question of basic research, to have new ideas, new teams, to take a new look at cellular biology," said Jean-Francois Delfraissy, director of France's National Agency for AIDS Research (ANRS).

Alice Dautry, head of the Pasteur Institute, said the next phase of AIDS research called for "a multidisciplinary approach, for looking at the problem through different eyes. When there is a problem, it has to be attacked from every direction."

Gallo called for a rethink of vaccine strategy in the light of what he characterized as two bad flops in this field.

Of the prototype vaccines that are in the pipeline, many would be a waste of money and precious resources and could discourage volunteers from taking part, if they were put into costly, large-scale trials, Gallo said.

"Some fundamental biological questions are needed (to be addressed) before some vaccines go forward, or we tend to waste money, produce a depressing atmosphere in the field and take money away from the basic science that is needed right now," he said.

Thus -- without a vaccine or vaginal gel on the horizon --  the main shield against HIV in the 21st century remains the rubber condom, invented in the 19th century -- or sexual abstention, which is timeless.

Compounding the scientific challenges of the virus, there was catastrophic delay among politicians, policymakers, religious leaders and the public too, about rooting out the taboo, stigma, myth and complacency in which AIDS proliferates.

This work still remains dangerously incomplete.

At today's press conference in Paris, Gallo attacked what he called a worrying tendency to sideline AIDS as a manageable disease in the age of antiretroviral drugs.

Only a fraction of people living in Africa who need the lifeline therapy actually receive it, he said.

"The [2004 Indian Ocean] tsunami made great headlines, as it should have -- 200,000 people died in one month," he told a press conference at the Pasteur Institute as the three-day meeting got underway.

"But every month, there's an AIDS tsunami -- 200,000 people die of AIDS. Do you think it gets the attention it deserves?"

In China, India and the countries of the former Soviet Union, the peril remains of the virus leaping from niches of infection among drug users, homosexuals and prostitutes to a mainstream epidemic.

To mark the anniversary of the publication of the original paper on what came to be called HIV, Science today published three new papers. One of them looks for lessons in the STEP vaccine trial spearheaded by Seattle-based HIV Vaccine Trials Network that was cut short due to a vaccine's failure to provide protection.

According to the Ars Technica summary, the paper suggests we should expect more of the same -- small population sizes from small trials and large trials that are cut short. As such, it urges that consideration be given to how researchers can extract as much as possible from that limited data, overcoming its poor statistical significance by searching for correlations with genetic and immune factors.

But the Canadian scientist leading an international effort to maximize global activity in the field is far more hopeful that a vaccine will still be developed. The despair that set in after the failure of the latest effort to develop an AIDS vaccine has given way to a renewed determination on the part of the scientific community, he said.

As the world marks the 25th anniversary of the publication Montagnier's paper, there is a consensus that more, not less, human research is needed in pursuit of the quest, Dr. Alan Bernstein said in an interview with Canadian Press last Thursday.

Bernstein, who is executive director of the Global HIV Vaccine Enterprise, said he remains hopeful success can be built upon the lessons learned from the failure of the STEP trial and other efforts to date.

He expresses far more hope for a virus than the gloomy picture Gallo painted at today's press conference.

Those who argue the failure of the STEP trial and another, earlier trial are evidence investment in HIV vaccine research is misplaced and the goal cannot be reached "are misguided," wrote Bernstein, who last fall completed a seven-year term as the first president of the Canadian Institutes of Health Research.

"The development of new drugs and new vaccines always takes time and is never a straight line and it's always marked by failures," he explained.

"I think that's sort of just been the history of medicine. What the public hears about, of course, is when there's a success. 'Oh, we have a new vaccine. Fabulous.' But what you tend not to hear about are all the dead ends and false starts and things that go wrong, by and large."

"We're a lot smarter than this virus," Bernstein told Canadian Press last week.

"So I am an optimist. I think you have to be as a scientist."

"I could not guarantee that one day we'll have a vaccine. But not to try is to say to all the 33 million people who are infected with the virus and the 2.3 million who are becoming infected with the virus every year: 'We're giving up."'

Full article: AFP: From 'gay plague' to global tragedy: An AIDS anniversary
25 years of HIV | Ars Technica
Call for fresh thinking as AIDS pandemic marks quarter century | AFP
25 years after HIV virus discovered, AIDS vaccine effort must go on: Bernstein | Canadian Press