270,000 AIDS Cases Predicted by 1991 : Way Sought to Deal With Expected Burden on Health-Care System

Projecting that by 1991 the number of AIDS cases will top 270,000, with 175,000 deaths, the Public Health Service is expected to recommend that a blue-ribbon commission be created to decide how the nation should cope with the anticipated burden on the health-care system, The Times has learned.

The number of AIDS cases over the next five years “will strain the existing health-care resources of the nation,” according to a report by the health service following a private three-day strategy session that ended Friday.

“An organized national response to the health service and health financing needs posed by AIDS is urgently needed,” said a draft of the report obtained by The Times. The report is expected to be released next week.

85 Experts Met

The meeting brought together 85 experts, including public health officials, scientists, health care providers and epidemiologists, in Berkeley Springs, W. Va., about 100 miles northwest of Washington.

The report said that more than 145,000 cases of AIDS would require medical care in 1991. An estimated 16,000 new cases are expected to occur this year, and more than 74,000 new cases are projected for 1991 alone.

These projections “may underestimate by at least 20% the serious morbidity and mortality” attributable to AIDS because of “underreporting” of AIDS cases, the report added.

“Given the projection of cases and costs over the next five years, the size and nature of the problems associated with the delivery of services to persons with . . . symptoms will strain the existing health care resources of the nation and the delivery system,” the document said. “All the states and territories have experienced this di1936023923special impact on a selected number of metropolitan areas.”

Disease Spread Expected

However, while fewer than 60% of the cases were diagnosed outside New York City and San Francisco through 1985, “by 1991 more than 80% of cases are predicted to be reported from other states and localities,” according to the report.

Currently, there is a lack of “organized system or consortia of service delivery programs appropriate to meet the needs of AIDS patients in most high prevalence and potentially high prevalence areas of the country,” the report said.

“Planning to develop, maintain and support the human resources necessary to cope with the AIDS problem is critical,” it added. “Many communities have budgetary and other restraints which impact on the availability of long-term care beds for AIDS patients. Provision of hospice care to those patients can be the key to efficient and humane care.”

More Research Urged

The report recommended increased research and demonstration projects on the “appropriate types of care needed at different stages of illness” and on the “costs of services and more cost effective provision of needed services.”

The blue-ribbon panel should be composed of representatives from public, private and voluntary organizations, the report said, and should determine “how each sector of our society can contribute to financing and resource needs.”

While homosexual and bisexual men and intravenous drug users will continue to be at highest risk for AIDS, the report said, nearly 7,000 cases among heterosexual men and women are expected to develop within the next five years. These will include “patients with reported heterosexual contact with an infected person or someone in a risk group” in addition to cases in which heterosexual transmission is the major risk factor, the report said.

11,645 Have Died

The report also said that, by 1991, there will be more than 3,000 cases of AIDS in infants and children. As of Monday, there was a total of 21,302 reported cases and, of those, 11,645 persons have died.

From 1 million to 1.5 million Americans are believed to be infected with HTLV-III, the virus that causes AIDS, the report said, and “most persons who develop AIDS between 1986 and 1991 will be among those who have already been infected.”

AIDS, or acquired immune deficiency syndrome, destroys the body’s immune system, leaving it powerless to resist infection. It is transmitted through sexual contact--with the exchange of body fluids such as semen and blood--and through the sharing of unsterilized hypodermic needles. It has also been spread through transfusions of contaminated blood or blood products, although a blood-screening procedure begun last year has made that risk slight.

The report estimated that in 1991 alone the direct health-care costs of persons with AIDS will be at least $8 billion, representing 1.2% of the expected total U.S. personal health-care expenditures of about $650 billion that year. Some at the meeting believed that the figure was too conservative, according to one participant. “We think a more realistic figure is from $12 billion to $16 billion,” this official said.