AIDS Expert Predicts 300,000 New Cases Worldwide in 1991

There will be 300,000 new cases of AIDS diagnosed in the world in 1991 if present trends continue, and between 5 million and 15 million people are already infected with the virus that causes the deadly disease, a leading U.S. AIDS official told the International Conference on AIDS here Wednesday.

Dr. James W. Curran, director of AIDS programs for the federal Centers for Disease Control, made his predictions against a backdrop of added discussion of signs that the epidemic is continuing to widen in the heterosexual population.

“We live in world that has denied the heterosexual connection,” Curran said at a press conference. “Everybody should have information on AIDS and how it is transmitted before they get out of junior high school. If I had my way, I would have a course on AIDS in every grade school in the world.”

On the final day of the three-day conference at the Palais des Congres, there were also these developments:

- The AIDS virus has been detected in additional types of brain cells by a research group at University of California Medical Center, San Francisco, and the Scripps Clinic in La Jolla, a finding that may help to explain some of the severe brain abnormalities found in some AIDS patients.

- Physicians at the Walter Reed Army Institute of Research said 454 of the 305,747 military recruits tested between October, 1985, and March, 1986, had antibodies to the AIDS virus, including 1.9 out of every 100 recruits tested in Manhattan and 1.1 out of every 100 tested in San Francisco. The number of positive tests was highest in areas of the country where the greatest number of AIDS cases have developed.

- Accurately diagnosed cases of AIDS are being underreported to public health officials by 10% in major American urban areas, according to a Centers for Disease Control review of death certificates in Boston, Chicago, New York and Washington.

- In a brief presentation added to the program at the last minute, a Soviet physician, in the frankest discussion to date of AIDS in the Soviet Union, announced that 12 blood donors out of 10,000 tested, including native-born Soviets and immigrants from Africa and Asia, had been diagnosed with AIDS virus infection and one diagnosed in 1984 is critically ill. The physician said strategies against the disease were being planned.

- Physicians from the Hospital St. Louis in Paris said they had boosted the immune system of two AIDS patients with white blood cell transfusions and medicines for 12 months in one case and 18 months in the other, although the virus is still present in their blood. The treatments are related to ones disclosed here Tuesday that have apparently been successful for 10 months in an American AIDS patient, who also received a bone marrow transplant from his identical twin brother.

Issue Gets Attention

The issues of the spread of AIDS beyond the chief risk groups of homosexual men and intravenous drug users and to new members of these risk groups in many countries received increasing attention at the conference of more than 2,500 physicians and other health workers.

For example, high rates of viral infections were reported in drug addicts in urban areas of Spain, Italy and Ireland in recent years, while in countries such as Belgium, Denmark, France and Switzerland an increasing number of infections in homosexuals are being seen, according to Dr. Jean-Baptiste Brunet of the Hopital Claude Bernard in Paris.

“The most striking thing is the rapid spread of the virus in drug addicts,” Brunet said in a plenary address. “Two years after the beginning of the United States epidemic, we (Europeans) are experiencing similar epidemics.”

AIDS is an invariably fatal disease, which is caused by a virus called HTLV-III, or the “human immunodeficiency virus” (HIV). It breaks down the body’s immune system, leaving victims vulnerable to a variety of infections and tumors.

As many as 30% of those infected with the virus may develop AIDS within five years and others will experience immune system abnormalities or serious illnesses related to AIDS.

Means of Infection

The virus is spread by intimate sexual contact, through the blood by contaminated transfusions or needles, and from infected mothers to their newborns. The disease is believed to be almost never spread by casual transmission, such as among school children, family members and co-workers.

Many presentations at the conference linked the spread of AIDS to heterosexual contact, a route of transmission of the disease common in Africa and increasingly being recognized in Western countries, including the United States.

Such heterosexual spread of AIDS accounted for 2.1% of AIDS cases diagnosed in the United States in the first four months of this year, compared to 1.1% of cases diagnosed during all of 1984, according to the Centers for Disease Control.

As of June 16, 326 AIDS cases attributed to heterosexual transmission had been diagnosed in the United States out of a total of 21,726 cases; 11,815 of these patients have died.

By 1991, 3,100 cases stemming from heterosexual transmission, out of a total of 74,000 AIDS cases, are projected in the United States, according to Curran.

High-Risk Group

Most of the Americans who will develop AIDS in the next five years are high-risk group members who have already been infected with the virus. Their cases will not be preventable unless there is an unanticipated breakthrough against the disease, many AIDS physicians said here.

Until a vaccine or other therapies to combat AIDS are developed, the only certain way to avoid the disease is to remain free of infection with the virus. Officials said that mass education efforts, emphasizing such measures as the use of condoms and avoidance of a promiscuous life style to prevent sexual spread of the virus, can play a key role.

“We should not be too negative about health education with something as frightening as this,” Curran said. “There are (many) people who have quit smoking cigarettes and this frightens me much more than (cigarettes do).”

Meanwhile, new and disturbing information about AIDS virus infections of the central nervous system were described by Dr. Jay Levy of UC Medical Center in San Francisco. These infections, which cause patients to become severely confused and unable to care for themselves, are being recognized in an increasing number of AIDS victims.

Leading Theory

While a number of researchers, including Levy, had previously isolated the AIDS virus in the brain, the leading theory was that the virus infected only brain cells that are related to the body’s immune system, not cells devoted purely to nervous system functions.

Levy and his co-workers presented evidence that the virus could invade one of these nervous system cells called an “oligo-dendrocyte” and that the virus could also be grown in the laboratory in brain tumor cells.

These findings, if confirmed, may make it much more difficult to develop therapies against the AIDS virus, according to Levy. This is because viral particles in these brain cells might escape detection by the immune system, even if it could be protected against the virus by a vaccine or drugs. Moreover, the virus may “directly destroy infected brain cells,” he said.

AIDS is expected to be a major campaign issue in California this year. Page 35.