mNEWS & COMMENT

'Mystery' Virus Meets the Skeptics At a hastily called meeting in Atlanta, 300 researchers heard about AIDS-like illnesses without HIV. The evidence for new viruses is, to put it mildly, sketchy.

ATLANTA-Try this as the plot for a thriller: a 3 new, unidentified, "mystery virus," which causes 3 AIDS but isn't the AIDS virus, is afoot, playing havoc with the blood supply and killing thousands while researchers scurryto develop diagnostic tools and yet anotherblood test. Great story, right? Well, that isn't precisely the story Newsweek broke right before the interna- Pondering the evidence. H~ (/eft, and sudhir Gupta were two tional AIDSconferencein of the key presenters at the CDC's Atlanta meeting. Amsterdam 3 weeks ago. In fact, all that was really known was that a footprints of virus," he conceded, "but in fact dozen or so people seemed to have some AIDSall of us who've been in the laboratory for any like symptoms but showed no traces of HIV in length of time have been down that road their blood. Yet after Newsweek's article was before where you're thinking you've found pickedupbyotherpublicationsandputthrough something and in fact it's either nothing or the media megaphone, that's the message most it's unrelated to what you're looking at." people around the world heard. As for the safety of the blood supply-the A huge international conference packed question that excites the most public alarmwith hungry reporters in search of a story James Curran, head of the CDC's HIVIAIDS isn't the place to puzzle out a sketchy new program, said there is no cause for concern, scientific phenomenon. So, before the worldas of yet. "I've seen no convincing evidence wide panic index climbed out of sight, the so far that the syndrome or syndromes are U.S. Centers for Disease Control (CDC) transmitted by an agent, let alone an agent called a smaller meeting on 14 August where that is blood borne or is spread through the all scientists who know of HIV-negative blood supply," he said. Still, the meeting's people with severe immunodeficiency could take-home message, as offered up by Curran, come and put the evidence to a tough, diswas: "Keep an open mind." Curran, Fauci, passionate review. In a jam-packed auditoand the other scientific notables gathered in rium here, that's just what 300 researchers Atlanta stressed that every effort-including did. The verdict? After 7 hours of presentasetting up CDC and NIH hotlineeis being tions, most in the audience left Atlanta dismade to collect all cases to find out what, if tinctly undenvhelmed. The evidence for any anything, HIV-negative immunesuppression new virus is somewhere between sketchy and really means. nonexistent. What's more, it isn't even clear that the scattered cases represent anything Who, What, Where, When? other than the results of more sophisticated By sendingthe alert far and wide through the detection of immune disorders that have almedical community, the CDC was able to ways been present in the populace, but have turn up a fair sampling of people who have a remained undetected until the age of AIDS, low count of CD4 cells (the white blood cells with its sophisticated diagnostic tools. that HIV infects and kills) but don't seem to "At the risk of being destroyed because of be infected by the AIDS virus. These cases giving you my opinion, I personally don't were presented in the morning session of the think this is really terribly new," Anthony Atlanta meeting. More than 80 candidate Fauci, head of the National Institute of AlU.S. cases were discussed. But of that total, lergy and Infectious Diseases, told the reonly 30 met the CDC's recently formulated searchers and the 60 journalists present. Mirdefinition for what is now being called by the roring the day's mood, Fauci expressed contongue-twisting name of "idiopathic CD4+ siderable skepticism that a new immune-supT-lymphocytopenia" (ICL). pressing virus would be found. "There are The new criteria for ICL include: two sepa1032

SCIENCE

VOL. 257

21 AUGUST 1992

rate CD4 tests below 300 cells per cubic millimeter of blood (the normal count ranges from 800 to 1200) or CD4s less than 20% of the total lymphocytes; no known causes of immunodeficiency or therapy that could deplete T cells (the family CD4 cells belong to); and, of course, no evidence of infection by the AIDS viruses, HIV-1 or HIV-2. Of the 30 cases that meet these criteria, 13 have had illnesses that are considered hallmarks of A I D S s u c h as Pneumocystiscarinii pneumonia, extrapulmonary cryptococcosis, and cytomegalovirus infection. The 30 cases constitute a remarkably varied grab-bag. They have been collected over more than 7 years, they live in 15 states, range from 18 to 70 years old, and the majority (54%) have no known risk factors for HIV. This heterogeneity led the epidemiologists present at Atlanta to conclude that, whatever is going on here, there probably isn't a single cause for all the cases. And the notion that a single transmissible agent doesn't account for all these cases was bolstered by the fact that although most of the patients' sexual and household contacts have yet to be studied, the few that have been examined appear to have normal CD4 counts. After the morning's review of the clinical data, the throng of scientists took a lunch break and got down to the day's main eventparsing the virology data. On the witness stand were the four researchers who have the best evidence so far for non-HIV-viruses that might cause an AIDS-like syndrome: Sudhir Gupta of the University of California,Irvine, David Ho of the Aaron Diamond AIDS Research Center inNew York, Jeffrey Laurence of the Cornell Medical Center, also in New York, and Robert Garry of Tulane University School of Medicine. Data from Laurence, Gupta, and Ho touched off the fuss at Amsterdam, and because they have yet to publish most of their results, the presentations were eagerly awaited. Ho, Laurence, and Gupta described their efforts to isolate a new retrovirus from immune-suppressed patients. Despite the similarities in the four lines of work, there is one fundamentaldifference: Ho and Laurence are lookingforonetypeofretrovirus,whileGupta and Garry are working with an entirely different category of retrovirus, one that, until now, was thought by many researchers to be incapable of causing human disease. The Gupta-Garry type is known as an "intracis-

in the! Spoitlight

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I. of tough scientific questions to ponder at the thinks is real and needs explanat~on. :d recent rneeting on the mysterious syndrome But if Newsweek and the CDC find themselves at the center of sion withcbut HIV. But there was also plenty to a controversy for the way the story broke, the researchers hunting 1 1 " ponaer ~n tne way tne lay press, scientific institutions-nc rtanly t' 'or the "mystery viruses" are in an even more uncomfortable the CDC-and the researctlers thems F)osition. "This is extremely unt dled the rnedia basic scientists to open frenzy of the "mystery virus" story. their lab notebooks to Nobel la1ureates..anc 1 National Academy of ,* . In all probability, there wouldn't have been such an ~ nemat 5kience members in front of 80 press," James Curran, director of the CDC's AIDS pro;;ram told t he audienc:e at the recent meetilng tional jc ~urnalisticfeeding frenzy if Ne wsweek h:idn't chosen to run the :itory in the 27 July issue, whiclI came oui:just before the in Atlanta. "I admire them and feel sorry for them.' intemat~ ional AIDS conference in Amscterdam-t iming that even The virologists fe; 4tlanta-' Laurence, David . Ho of NPPIIFPIJPG . . - ..- ..-2k writer Geoffrey Cowley conceaes was "not entirplv the Aaron Diamond n l u s ~ e s e a r c Center, h and sudhlr bupta of he Univer,sity of Califomia, Irvine-aren't feeling sorry for themcoincide ntal." Cocvley and J E :ffrey LaurcEnce of tht:Comell b cal Cent:er, whose data forrrled much of the bas is for the !story, selves, but they are 1Nary of doing science in the spotlight. Ho both den y the rumcrr-which spread far amd wide at the Amste,rdam vvorries the~tby parcc:ling out tidbits, the public will be misled. 1 . 11 1 1 conference-mat the Cornell researcner l e a1 ~ e dthe story to People don t remember all the qualifiers," he says. "Thpv'll ..-I Jiust Cowley. "I came to the story the hard way," says Clowley. "It 'S not remember the conclusions and bottom lint2s." LaurerIce is unco m6ortable "doing this in a bubble" and want:i.to make. siure he sper~ d s something that was just plopped into my lap a cveek befor e the conference as part of a cynical ploy to get public.ity." e:nough time gathering and analyzing the data. "1 don't want to be a tzmbarrasse:d," he say:5. Cowley was, ir1 fact, not: the W only rep(xter who 1cnew abou Like La1urence, GI.lpta sees gcbod a HIV-fretz AIDS-li ke cases. I 2 2is well as bad comir1g out of t:he I ,. ._ ... rence nktman or The New Ynrk medla barrage. Although he th~nks Times s2~vshe knr:w of cases for 2 it is "very important" that governseveral rnonths bu t did not 1.rreak ment agencies ha! 7e mustel.ed forces to evaluate tll e syndrome the stoqI because 1le didn't t hink 1 t 1 . ~t was nls papers place to anquickly, the fact that tne story came nounce something the CDC was out during the interriational connot confident enough of to pubference wa late. "It crelish. Altman was surprised to find, ated a panic," says ~ u p t a"It . went after the Newsweek piece appeared, like fire." One researcher who feels that the CDC haci presented six the fire was out of proportion to cases ofthe conditican is now being the spark that lighted it is the Nac211en --..- .. . ia~opatnlcCD4+ T-lvm- L tional Academy member who sub:010nitted Gupta's paper describing his P ~ O C Y~enia," ~ ~ I or I Mecet the presis. CDC's ,James Curlran (left)wit h Newswt rado met:ting this spring. %IDS-likecases to the Proceedings Gec3ffrey Cowley, who broke the "mystery viru!5" story. But ii!the CDC1 was willir1g to $the National Academy of Sciences. 1 .1~ 1 1' . a small I1 maKe me six cases puoltc In meetlng In Loloraao, tney r