STATEMENTS OF:

NONDEPARTMENTAL WITNESSES

DR. WILLIAM A. HASELTINE, HARVARD UNIVERSITY

DR. MALCOLM A.S. MOORE, MEMORIAL SLOAN-KETTERING CANCER

CENTER

DR. DON C. DES JARLAIS, NEW YORK STATE DIVISION OF SUBSTANCE ABUSE

PREPARED STATEMENTS

Senator WEICKER. Our first witness is Dr. William Haseltine, chief, laboratory of biomedical pharmacology, Dana-Farber Cancer Institute, Harvard.

Dr. HASELTINE. Mr. Chairman, I am going to limit my remarks to a summary of what I have submitted. I would appreciate it if you could enter the text of the testimony as well as addendums. One is a question and answer, commonly asked questions and answers on the subject of AIDS. In a similar format, a second is a description of myths and answers to those myths and, third, is something called a battleplan for the fight against the AIDS.

Senator WEICKER. Your statement and the various addendums along with the statements accompanying you will be included in the record in their entirety at this point.

[The statements follow:]

[CLERK'S NOTE.-A revised statement submitted by Dr. William Haseltine has been received and is being retained in the subcommittee files.]

(169)

STATEMENT OF DR. WILLIAM A. HASELTINE

We are now engaged in another deadly episode in the historic battle of man versus

microbe.

To this

These battles have shaped the course of human evolution and of history. We have seen the face of our adversary in this case a tiny virus that causes AIDS. We have yet to take its full measure. We now know it by the havoc it wreaks upon the immune system defenses and the brain. The epidemic is worldwide. battle we bring the strength that we have as human beings, the ability to communicate, to organize, and to think. We also bring to this fight our accumulated hard won knowledge embodied in our biomedical community. here today to tell you is something about the scope of the problem, what we have learned about this new disease AIDS, and most importantly, how much more we still must do. I will urge you to help us marshall our resources to stem this deadly

epidemic.

What I am

From our current vantage point, it seems as if this disease appeared in our midst as some unwanted guest, suddenly and without warning. In this country alone, well over one million people are now carriers of this virus, and to the best of our knowledge, most of these people will remain carriers for life. About one hundred thousand of those people infected with the virus in the United States are women. The prospect in some areas of the world is bleaker still. Infection in many European countries is almost on a par with that of the United States. In Central Africa, within the so called AIDS belt over ten million people are now infected, accounting for almost one tenth of the entire population. These people also are likely to life long carriers of the disease as well.

These numbers assume even more ominous proportions when we consider the ultimate health impact of infection. We have studied this disease for almost six years. In that time we have learned to recognized the many faces of this afflication. In the early days, it was first detected by keenly observant physicians as an unusually high incidence of rare forms of cancer and unusual infections in young men. We now know that infection is manifest in many guises. Most notably, and most serious is the gross impairment of the immune system and of the brain. its ultimate form, the disease destroys so much of the immune system that the body cannot defend itself against infection. The brain may also be reduced by

In

massive tissue destruction to one third its normal size. Other life threatening forms of this disease include at least three types of cancer, all lethal unless treated, infiltration of the lungs with white blood cells, and failure of the clotting components of the blood.

Many of these symptoms of infection, other than the major defect in immunity, have been recognized only within the past year as being an integral part of the disease process. As much as this disease was thought to be primarily a disease of the immune system, it must now be considered to be a disease of the brain as well. Almost one half of all the people infected with the virus six years ago, have some major serious medical symptom of infection and the toll may rise still

further.

The most recent studies of the fate of infected people paint a picture that is consistent with a slow progressive degeneration of the immune system and of the brain. A recent eighteen month follow up investigation of infected soldiers completed by the U.S. Army reveals a pattern of continuously worsening disease status in the majority of those infected. Those with no symptoms or mild symptoms progressed to more serious symptomatic states. Those with serious symptoms progressed to death or to terminal illness. One third of the soldiers studied in this group were women. Their disease progressed in a fashion

indistinguishable from that of men.

AIDS is a disease that does not

discriminate on the basis of sex. The slow, perhaps inexorable progession of the disease is consistent with what we know about diseases caused by viruses similar to the AIDS virus in animals such as sheep and goats infection is followed by a degenerative process that occurs slowly over a period of years. We must be prepared to anticipate that the vast majority of those now infected will ulimately, over a period of five to ten years, develop life threatening illness. I do not need to tell you what the impact of this disease will be on a health care system. We see this wave of devastating disease approaching. The magnitude and nature of the problem is crystal clear. As the disease continues to spread, the magnitude of the problem must increase. I urge you to begin planning now for the inevitable.

How did this unwanted spector appear so rapidly? We now know that a spread of the disease in the United States and Europe was preceded by a massive spread of disease in Central Africa. As best as we can tell, the disease began about twenty years ago. By now, one tenth of the adult population of Central Africa is infected half of them being women. We also know that a virus, very similar to the virus that causes AIDS in humans, is found in wild colonies of green monkeys inhabiting Central Africa. In the green monkey, the virus does not seem to cause serious illness, or if it does, the symptoms come on so slowly that the monkey dies of natural causes before the virus works its damage. However, as is often the case with viruses that jump the species barrier, this virus is much more damaging to the new host species, in this case humans, than to the species of origin. The virus seeks out different types of immune cells in humans as Humans also live much longer than do monkeys and for this

compared to monkeys.

What in

reason a monkey population might be a tolerable rate of progressive brain

disease is intolerable to us. As best as we can peer into the past, it appears that sometime within the past twenty to thirty years, a monkey virus crossed the species barrier into humankind. Thereafter, it has spread with alarming speed throughout the African and now the world population.

The

What accounts for both the rapid and widespread distribution of infection? answer to this question lies in the nature of the disease agent itself, and its mode of transmission. In what must be regarded as a mixture of intuitive brilliance and great good fortune, the microbe responsible for this disease was isolated within three years of the first clinical description of the disease itself. That it was found at all is a tribute to the commitment that has been made to biomedical sciences over that past twenty years. The particular field of expertise from which the discovery of the virus arose, was that of cancer research, more specifically the virus cancer program of the National Cancer Institute, a program that itself was at the time of discovery of this virus well past its heyday. This program had received a burst of support in the early days of the National Cancer Program beginning in early 1970's. More recently, this program was in the process of slowly being dismantled as the promise of early production of vaccines to human cancers had not been realized. Interest in this program was rekindled prior to the discovery of the AIDS virus, as recent work

originating in that program had revealed that a rare form of human leukemia was indeed caused by a virus. Work on this newly discovered leukemia virus as well as the methods developed for detection of and vaccination for the virus were underway at the time the AIDS epidemic was first noted.

Analogy played a central role in the discovery of the AIDS agent. Certain similarities including the type of cell infected, the modes of transmission of the AIDS agent, and the type of immune abnormalities present in affected individuals were reminiscent of properties of the human leukemia viruses. guess was made that the AIDS agent might be similar to the leukemia virus. Methods and reagents that had been used to isolate the human leukemia virus were applied to the AIDS problem, both at the National Cancer Institute in the United States and at the Pasteur Institute in Paris. In both cases, these methods resulted in isolation of the same virus. That virus is now known as either LAV (the Pasteur Institute designation) or HTLV-III (the National Cancer Institute name), and is often called either HTLV-III/LAV or LAV/HTLV-III.

Intensive

studies of AIDS patients have unambiguously linked this virus to disease. Another link in the causal chain between disease and this virus is the observation that exposure of some monkeys to the AIDS like virus isolated from a colony of domestic rhesus monkeys reproduces within a very few weeks both the immune symptoms and the brain degeneration typical of human infection.

Regarding the discovery of the microbes that work in this disease, without the experience and materials developed over the past fifteen years in the successful quest for a human leukemia virus, progress towards finding the AIDS microbe would have been much slower. Indeed, we still might not have known the cause of this disease today. Had the AIDS epidemic appeared in the United States twenty or even ten years ago, we would not have had many of the tools that we now possess to recognize the virus and to combat it. The discovery of the AIDS virus is an example par excellence of the wisdom of our investment in

fundamental biomedical research. No one could have anticipated this new disease or the importance that studies of the human leukemia virus would have in understanding this new epidemic. It was simply a bet that paid off.