Unanswered questions
Clearly there are still more questions than answers aboutthis syndrome. What is it? It is a communicable (or "community acquired") cellular immune deficiency. Is it "new"? Yes. Why has it appeared ? This is still an open question,best answered by asking two more questions-What is the cause? and Why is it able to cause it? Three answers have been suggested.
Firstly, the "hot bed" theory argues that the traffic in humanmaterial in certain quarters by abnormal routes has reached such a level that, combined with the effects of drug abuse of various kinds, the sheer weight of chemical and microbial insult to the body in general, and to T lymphocytes in particular, goes beyond the tolerable limit. Eventually irreparable damage is sustained, which becomes manifest clinically in one or other of the variety of components of the syndrome.
Secondly, the drug theory points to drug abuse as the common denominator between the non-homosexuals and the main mass of patients. Much attention has focused on amyl and butyl nitrite as relative newcomers to the scene, but they are scarcely enough alone to cause all the damage.
Thirdly, the virus theory argues that the apparent communicability of the immune defect points to a microbial origin. Various viruses affect the lymphocytes-for example, measles, cytomegalovirus, and Epstein-Barr virus. That there may be another is not surprising.
The first and second of these theories are worth considering;the factors are undoubtedly relevant. Whether or not an unknown virus, perhaps formerly held at bay by adequate cellular immunity, is a reality is still conjecture. One possibility is the introduction of an animal virus into the homosexual system. The list of those at risk, now that haemophiliacshave been added, and also prisoners, has a familiar ring to those acquainted with the control of hepatitis B.
This brings us to the last question of all. What is to be done ? Towards the end of 1982 the tally of cases was 788, but this may be more than the tip of a large and rather chilling iceberg yet to come. Specific treatment for the various aspects of the syndrome has been weighed in the balance and mostly found wanting. Antimicrobial chemotherapy for the infectionshas proved ineffective in some cases and somewhat disappointingin many others. Anticancer treatment for Kaposi's sarcoma has been hampered by the leucopenia. The results of attempts at thymic supplementation have not been long lasting, and bone marrow transplantation has been suggested and tried in at least one case.
The absence of any effective treatment for these patientsunderlines the importance of a preventive approach. If there is a microbial agent, and if it is present in patients' body fluids and particularly their blood, this means that there is a greater need than ever for care in handling human materials and in monitoring artificial human to human transfer of any kind. Human blood may carry, among other things, hepatitis B virus, at least two non-A, non-B hepatitis viruses, and cytomegalovirus; and the possibility of transmission of human T cell leukaemia virus in blood has recently been aired. Prevention raises issues larger than those simply of cross infection. Ironically, despite all the uncertainties, this disease (like genital herpes, which has also attracted much attention in the American lay press) is essentially preventable. The abandonment of promiscuity, homosexuality, and drug abuse could eventually stop both diseases in their tracksthoughthat is hardly likely to prove an acceptable solution.