Chipping Away at the Epidemic
I don’t see a vaccine anytime soon,” says microbiologist Susan Adams Fiscus ’68, director of the retrovirology lab at the University of North Carolina at Chapel Hill. But Fiscus, who’s also an associate professor of microbiology and immunology, does consider the latest combination of recently licensed drugs — and those awaiting approval — as the greatest immediate hope for combating AIDS.”As we learn how to treat the opportunistic infections associated with AIDS,” she says, “we’re turning AIDS into a chronic disease, like diabetes, where some patients will live fifteen to twenty years still healthy.” Fiscus points out that if scientists can determine why certain AIDS patients live much longer than others, the medical community can help larger numbers of individuals “live a relatively long life. During that time, a vaccine might come.”
Ultimately, Fiscus is unequivocal about how best to deal with AIDS. “We know how to prevent AIDS,” she says. “Condoms are extremely effective.”
Fiscus’s recent work has brought her some media attention. Back in 1994, Fiscus and her team from Chapel Hill and Duke participated in a larger study examining the effects of the drug AZT administered to HIV-positive pregnant women and their newborns. The study found a two-thirds reduction in the transmission of HIV to the infants. Media outlets like The New York Times and USA Today highlighted the good news.
The significance of the findings, however, was downplayed by some members of the medical and research communities, who questioned the effectiveness of such drug therapy outside an experimental setting. They pointed to anecdotal evidence, which suggested that pregnant women would resist taking AZT, as well as the length of time it takes doctors to put new findings into practice.
Fiscus defends the legitimacy of the study’s findings. “Lots of people tried to dampen the enthusiasm a little bit because they said it was an extremely clinical, controlled trial,” she said. “But it works at least as well in the real world.” In 1995, field studies made by her facility, the state-designated diagnostic lab for perinatal HIV transmission in North Carolina, demonstrated clearly the effectiveness of treating mothers and infants with AZT: The number of infected babies decreased as dramatically as in the original study.
Yet Fiscus understands the skepticism sometimes exhibited by her scientific peers. “It’s legitimate and important to question results,” she said. “Too many times we’ve been led down the garden path, wildly euphoric, only to be disappointed six months later.”
People in and out of the scientific community often seem surprised at studying HIV in connection with pregnant women. Fiscus cites a recent scientific meeting in San Francisco, where the Centers for Disease Control presented results of a ten-hospital study of pregnant women with HIV. Some in the audience were shocked that so many of the infected women were not in high-risk groups. Fiscus was not among the surprised. “They were pregnant,” she says matter-of-factly. “In order to get pregnant, they had to practice unsafe sex.”
Widely quoted statistics that link AIDS to specific class, race, gender, and drug-use status contributed to the perception that the women in the CDC study “didn’t appear to be at risk because they didn’t fit the preconceived notions,” Fiscus says. The idea that only certain targeted groups are most likely to be at risk is costly, both in terms of capital expenditure and in human lives.
“From a public-health standpoint, it’s expensive. It’s cheaper to test everyone than just to treat those who are infected,” she says.
In November 1995, the National Institutes of Health awarded her lab $1.3 million to measure viral “load” in HIV and to monitor the sensitivity of the virus to particular drugs. The new research is part of a national clinical trials network. “It’s not just to see whether the patients will live or die,” she says of the trials. “It’s to determine the benefits of the drugs.”
When it comes to funding for AIDS research, Fiscus believes in survival of the fittest, which makes for a leaner, meaner, and ultimately more effective effort to treat and defeat AIDS. “Funding is extremely competitive,” she says, and that’s as it should be. The failure of certain projects to secure funding “can only improve the science. If there is too much money around, it’s a waste of everyone’s time and money.
“Times are tight. Only the best projects should be funded. It may not be as fast as some scientists would like … but scientists are reasonable people. We pay taxes, too.”
This focused researcher also appreciates life’s quirks of fate. She says it was pure “serendipity” that led to her position at Chapel Hill, where she oversees a staff of seven technologists, two post-doctoral fellows, a secretary, and several work-study students. Her packed schedule involves teaching, personnel issues, grant writing, committee meetings, conference attendance, and paper presentations.
Graduating from Bates with a biology major and chemistry minor, Fiscus pursued a master’s degree in botany at Duke. Degree in hand but unable to find a job in her field, she continued graduate work at Colorado State University in a doctoral program in viral immunology. Two subsequent post-doctoral fellowships (working with cat and chicken viruses) were separated by a year of unemployment. Her occupational future looked uncertain. “I wrote to everyone I knew and those I didn’t,” she says. Deciding to seek employment based on the location of her husband’s job offers, she eventually landed the Chapel Hill position, heading a lab focused on, of all things, humanretroviruses. A great deal in life amounts to chance, she muses. “Serendipity: it’s the bottom line.” Moving in rhythm with the career trajectory of her husband, “I was able to take over my own life, make my own mistakes.” Cats and chickens notwithstanding, working with human viruses “is a lot more important and interesting to me.”