By William J. Cromie

Gazette Staff

Diana, Princess of Wales, announced yesterday that she will visit a Harvard AIDS program in Thailand to which she is contributing funds from an auction of her dresses and gowns. Diana will attend a fundraising reception on June 23 and the auction on June 25 at Christie's in New York City. She plans to go to Thailand Nov. 22-26.

"We're happy and grateful for the generous gift," said Myron (Max) Essex, chairman of the Harvard AIDS Institute (HAI).

"The Princess has had a long interest in AIDS," according to Deeda Blair of Washington, D.C., who serves on the HAI Advisory Council. "She spends a lot of time in hospitals visiting friends and others with AIDS. When Diana decided to auction her dresses, she gave them to the AIDS Crisis Trust in England, which was founded by a friend of mine, Marguerite Littman. After a decision to have the auction in the U.S., it was decided to share the proceeds with U.S. charities, including the Harvard AIDS Institute."

The HAI Advisory Council, in turn, selected Diana to receive its 1997 Leadership Award.

"When we contacted her, she said she preferred that the presentation be made in a developing country, rather than at a dinner in New York City," Essex said. "Actually, there will be a presentation both in New York and in Thailand, site of our largest international effort."

Sales of catalogs, which range from $60 (paperback) to $2,000 (deluxe edition) each, plus the auction of 79 cocktail dresses and ball gowns, size 8-10, is expected to bring between $2 million and $4 million after expenses. Ten percent of the proceeds, plus all money from the reception, will go to three charities in the U.S. Half of these amounts will be split between the HAI and the AIDS Care Center of New York Hospital-Cornell Medical Center, and half will go to the Memorial Sloan-Kettering Cancer Center.

"These funds we receive will be used for different AIDS programs that we run in developing countries," Essex says.

"The support and visit are wonderful news; we're really short of funds," says Marc Lalleimant, who leads the research team in Thailand. His group is just starting a program aimed at preventing infections in children born to mothers with HIV, the virus that causes AIDS. The effort is being run by the HAI; OSTROM, a French research organization; two universities in Thailand; and the Thai government. Major funding comes from the National Institutes of Health.

Essex and Lalleimant agree that one of the areas of need in Thailand is formula milk for newborns. The babies cannot be breast fed, as is traditional, because the virus can be transmitted with the milk. But the cost of providing formulas for 1,500 women for up to six months is prohibitive.

Thailand's Ministry of Public Health provides some funds for purchasing artificial milk but not nearly enough to cover the need. "When Princess Diana visits Bangkok, she will make a presentation to Thai companies and citizens, asking them to assist with such funding directly," Essex notes. She will also visit Chiang Mai in northern Thailand, headquarters of the HAI research effort.

Treating An Epidemic

Heterosexual HIV infections have reached epidemic proportions in northern Thailand. The HAI program will give infected women and their babies zidovudine, or AZT, a drug that has been shown to sharply reduce transmission of the virus in experiments done in France and the U.S.

"Giving AZT, plus immunoglobin to boost the immune system, reduces the number of HIV infections in children by more than two-thirds," Lalliemant explained in a telephone interview. "Usually one-third to one-half of the babies are born with the infection; AZT can cut that to 4-8 percent."

In the American and French studies, infected women took the drug for three months and their infants for six weeks. Trying to do the same in Thailand would be extremely difficult. Galaxo Wellcome, maker of the drug, supplies it without cost, but the women are scattered throughout many urban and rural areas.

"We can't tell exactly when the fetus gets infected," Lalleimant admits, "but good data strongly indicate that it's late in the pregnancy. We feel sure that we can safely cut the mother's course of treatment to one month, and the baby's to three to four days. That would provide a tremendous savings. Also, the babies would still be in hospital care while they receive the drug, while their mothers adapt to feeding them formula."

The women will be divided into four groups. One will receive a three-month course of treatment, one the short course. Mothers in a third group will get the long course while their babies get a short course. In the fourth group, mothers receive the shortened treatment while their babies get the longer treatment.

"Every woman will receive the drugs that we believe can prevent transmission of the AIDS virus to their children," Lalleimant says emphatically. "Irresponsible press reports have claimed that we plan to give some of the women placebos [inactive substances], so we can compare results with and without the drugs. Those reports are absolutely false."

Placebos are involved, however. Women and babies on the short treatment take them for a period so that all the mothers receive "drugs" for the same amount of time. Researchers who evaluate the results will not know who took which course of treatment, so that outcomes can be evaluated without bias.

"The placebo provides added reassurance that the long regimen is as effective in the Thai women as it was in French and American women," Lalleimant notes. "And placebos allow us to better estimate the degree of effectiveness of the shortened regimen."

Ironically, some evidence indicates that the short regimen may be the most effective.

"When AZT is first administered, the body's virus load drops quickly," Lalleimant explains. "But then it rises again in a few weeks. Therefore, lowering the virus load one month before giving birth could turn out to be more protective than starting treatment three months before birth. That may be wishful thinking, but it's not crazy. It's not even unreasonable."