Introduction

THE DIVORCE 135
By the end of July, the hope that combination therapy would cure
AIDS patients was, if not defeated, in full retreat. The European Concorde
trial’s preliminary results had shown that early use of AZT did not
prolong life any longer than waiting until the disease had manifested
itself. The study results, when first reported in the British biomedical
journal Lancet in April, had sent Burroughs Wellcome’s stock plunging.
31 In desperation, many dying patients began using AZT in combination
with one of the other two nucleosides that had been approved, ddC
and ddI. The FDA, in granting their approvals, had suggested they be
used in combination with AZT since neither by itself had been shown to
be more effective than the first AIDS drug. The combinations worked
better, the agency seemed to be saying.
But in Berlin, the University of Miami’s Margaret Fischl reported the
long-awaited results of ACTG 155, the trial that combined AZT and
ddC. The definitive study showed that taking the two together was no
better than taking each one separately. The original studies for AZT had
shown that while the drug was effective in slowing the progression of disease,
the virus mutated, and within a year almost half of the patients
were once again being ravaged by opportunistic infections as their
immune systems deteriorated. ACTG 155, which had followed patients
for up to three years, showed that 42 percent of patients taking AZT
became seriously ill or died, as did 43 percent on ddC and 39 percent on
the combination, a statistically insignificant difference. The only positive
result was that those patients who entered the trial with higher CD4
counts did somewhat better, suggesting early treatment might improve an
HIV carrier’s long-term prospects. Fischl emphasized that relatively
minor point in her presentation to the meeting, which infuriated the
AIDS activists present. David Barr, a New York City lawyer and ACT UP
member, stepped to one of the floor microphones. “The answer to the
study you designed is that the study shows no difference between combo
and monotherapy,” he shouted. “You have staked your career on these
drugs. I have staked my life.” 32
Combination therapy suffered another setback in late July when Harvard
Medical School announced that Chow’s original test-tube study on
the three-drug cocktail was flawed. Scientists at the Wellcome Research
Laboratories in England and the Pasteur Institute in France had challenged
the study. Hirsch and Chow, forced to retest their samples, sheepishly
admitted that mutant HIV did in fact eventually overwhelm the
combination. Lawrence Altman, the physician-journalist who covered