Percentage of AIDS Cases in Heterosexuals Rises Sharply

The percentage of new AIDS cases in the United States spread by heterosexual contact, while still small, has doubled since 1984, a leading AIDS epidemiologist from the federal Centers for Disease Control announced here Tuesday.

Dr. Harold W. Jaffe said such cases accounted for 2.1% of AIDS cases diagnosed in the first four months of 1986, compared to 1.1% of cases diagnosed during all of 1984.

The new federal statistics reinforce fears of some public health officials that it is only a matter of time before the AIDS epidemic reaches outside the established risk groups in the United States, which primarily are homosexual men and intravenous drug users.

‘Statistically Significant’

“The trend is numerically small but statistically significant,” Jaffe said in an interview at the International Conference on AIDS. He described the increase as steady since 1984 rather than a dramatic jump in the first four months of this year.

The Centers for Disease Control have reported that as of June 16, a cumulative total of 326 AIDS cases had been diagnosed as heterosexually transmitted out of the nearly 22,000 AIDS cases recorded in the United States. About 12,000 of these patients have died.

In another development at the conference, Dr. Anthony S. Fauci, a leading AIDS researcher from the National Institutes of Health in Bethesda, Md., announced the first apparently successful reconstruction of an AIDS patient’s immune system. Although the therapy, which included a bone marrow transplant from the patient’s twin brother, is unlikely to directly benefit many AIDS victims, it was described as an encouraging step for researchers.

Jaffe said the increase in reports of heterosexually transmitted AIDS is of serious concern to health officials. “This needs to be observed for a longer period of time. We need to follow it closely,” he said.

Dr. Dean F. Echenberg of the San Francisco Department of Public Health, who forecast the trend in the Journal of the American Medical Assn. last year, said “We have been warning heterosexuals about this for 18 months.” Three such cases were diagnosed in San Francisco women in May, one caused by a single sexual contact with an infected man, Echenberg said.

“Heterosexuals can get AIDS just like gay men. It will just be a question of time until we see how widely this has spread,” Echenberg added.

Little Change in Distribution

Jaffe’s summary of U.S. AIDS statistics showed “remarkably little change” in the distribution of cases in the major risk groups, aside from more being diagnosed outside New York City, San Francisco, Los Angeles and other urban areas where the disease has been concentrated in the past.

However, there was a shift in reports on one of the major illnesses striking AIDS patients. The tumor Kaposi’s sarcoma, which is seen almost exclusively in homosexual men, has declined as the initial manifestation of AIDS from 34% of cases diagnosed in 1981 to 17% in cases that developed in 1985, Jaffe said. He added that he is uncertain how to explain this development.

Fauci’s announcement involved treatment of a 36-year-old man who had been seriously ill with Kaposi’s sarcoma. The patient was described as “completely well” 10 months after treatment, which included a bone marrow transplant and white blood cell transfusions from an identical twin brother and antiviral medication.

Fauci cautioned, however, that his work is highly experimental and that the long-term benefits, if any, will not be known for at least a year. Two other patients who were treated similarly are very ill, and a third died several years ago.

His approach to AIDS therapy will have little immediate impact because of the requirement that a potential patient have an identical twin, but the demonstration that an AIDS victim’s immune deficiency can be repaired could bolster other treatments against the virus.

Bone marrow transplants have been tried a few times before with AIDS patients and non-identical donors and failed, Fauci said. The bone marrow cells and white blood cells of twins, however, are the same, which maximizes the chances of success.

But Fauci’s demonstration that restoration of the immune system in AIDS patients is possible is likely to increase interest in a variety of therapies, such as combining an antiviral drug with a drug that stimulates the immune system. These immune stimulators include interferons and interleukin-2, which is also being tested in cancer patients.

‘Important Building Block’

“We have established the feasibility of immune reconstitution in an individual who had developed the full-blown form of AIDS,” Fauci said. “This is not in any way or form a breakthrough, but . . . it is an important building block of knowledge.”

The patient is still receiving white blood cell transfusions from his brother every three weeks, which will be stopped in August if he continues to do well, Fauci said.

After Fauci’s patient developed Kaposi’s sarcoma in his lymph nodes, he received the antiviral drug suramin and white blood cell transfusions, followed by the bone marrow transplant.

In the latter therapy, bone marrow cells were withdrawn from the hip of his twin with a syringe and then infused into his bloodstream through a vein.

Subsequent tests show that the patient regained the ability to make antibodies against bacterial proteins. Fauci called this the most important test of restored immune function.

The AIDS virus disappeared from the patient’s bloodstream and the number of T cells in his bloodstream, which are attacked by the AIDS virus, normalized. His enlarged lymph nodes shrank, and he gained weight, although the lymph node tissue has not been examined under the microscope to prove that the cancer disappeared. Nor could Fauci exclude the possibility that the virus remains hidden somewhere in the patient’s body.

Fauci’s announcement contrasted with other reports on treatments for the fatal disease, which destroys the body’s immune system, leaving the victim vulnerable to a variety of infections and tumors.

Some of the data, on drugs such as the widely publicized antiviral agent AZT or azidothymidine, was too preliminary to be interpreted. The drug is being tested against a placebo in a study involving 260 AIDS patients from across the country. The results are not expected to be known until the end of the year at the earliest.

Suramin, a drug that raised similarly high expectations in 1985, was shown to be a failure and to make some patients worse in separate French and American studies made public here.

Fauci said his patient received suramin, but it probably had nothing to do with his improvement.