AIDS Cases Could Triple by 2000, Meeting Is Told : Science: Speaker in Berlin urges that $2.5 billion more be spent each year to fight pandemic.

BERLIN —  A decade after the discovery that the human immunodeficiency virus causes AIDS, worldwide experts acknowledge that there are as many questions as answers about the disease and that efforts to prevent the global spread of the pandemic are, by and large, not working.

As the Ninth International Conference on AIDS got under way Monday, Dr. Michael Merson, head of the World Health Organization’s Global AIDS Programme, predicted that the number of new AIDS cases could triple by the year 2000.

He called upon world leaders to commit an additional $2.5 billion for prevention each year until the turn of the century, money he said would cut the number of new cases in developing countries in half.

“Can the world afford the necessary $2.5 billion?” Merson asked. “Well, $2.5 billion is scarcely one-twentieth of the $49 billion spent on Operation Desert Storm. It would hardly buy a can of Coke for everyone in the world. We’re not talking a lot of money here.”

Merson was not the only speaker to frame the fight against the disease in terms of decades rather than years. In his opening remarks to an assembly of 13,000 scientists, doctors, social service providers and patients from 166 nations, German President Richard von Weizsaecker lamented: “There is still no vaccine. There is still no cure for AIDS.”

And Anthony Fauci, the U.S. government’s top AIDS expert, suggested that no single drug or vaccine will ever be developed to prevent or cure the disease. Rather, Fauci said, controlling a virus as complex as HIV will likely take a combination of therapies.

“We still do not fully understand how the virus destroys the body’s immune system,” Fauci said. “There was the naive assumption years ago that the virus comes in and it individually destroys cells and that’s how you get AIDS. We know now that it is much more complex than that.”

In his remarks at the large plenary session that kicked off the scientific portion of the conference, Fauci also said new research shows that while the immune system fights back after a person has just been infected with HIV, this response may actually do the body more harm than good.

According to Fauci, naturally occurring immune proteins called cytokines, which alert the immune system that HIV is attacking the body, may help the virus multiply in the lymph nodes, where another group of immune cells, so-called CD4 cells, become infected.

CD4 cells, which help the body fight off a wide variety of infections, are a major target of the AIDS virus; when a person’s CD4 count falls too low, he or she becomes vulnerable to illnesses that often kill AIDS patients.

Thus, Fauci suggested, the virus presents researchers with a paradox: how to suppress one part of the immune system, the cytokines, while enhancing another, the CD4 cells.

Merson of the World Health Organization said that the highest priorities in scientific research should be a vaccine for use in developing nations and a “vaginal microbicide”--a virus-killing agent that women could use to protect themselves against infection.

A major theme of this year’s conference has been the rapid spread of HIV among women; Merson has said that 45% of all new infections in adults occur in women, up from one-third three years ago. The World Health Organization estimates that more than 13 million people have been infected with AIDS since the start of the pandemic and predicts that the number could reach 40 million by the turn of the century.

Yet the person who drew the biggest reaction on the opening day of the conference was not Merson nor Fauci nor the German president nor any other suit-clad official.

He was Aldyn McKean, a 44-year-old sharp-tongued AIDS activist from New York, who was invited unexpectedly to the podium during the opening session by conference Chairman Karl-Otto Habermehl, a German virologist. Although McKean’s name was not on the program, ACT UP-New York had been negotiating with Habermehl for a year for the right to speak. Habermehl relented Monday morning.

Wearing jeans, a T-shirt and two small gold earrings in his right ear, McKean announced to the assembled crowd: “I am a proud queer, an AIDS activist and a person with AIDS.”

To the scientists in the audience, McKean pleaded: “Please help us. We have been screaming for six years. Nobody cares about another AIDS activist demonstration anymore. The answer is for scientists and researchers to stand up once in a while and say: ‘Yes, they (activists) are right. They need to be paid attention to.’ ”