Broadened Definition of AIDS Proposed by U.S.

To get a more accurate picture of the AIDS epidemic, the federal Centers for Disease Control on Thursday proposed changes in the definition of the disease that would result in an increase in the number of cases reported.

CDC officials said that they have proposed to state and territorial health officers, who are charged with reporting AIDS cases to the Atlanta-based federal agency, that they add the most severe forms of AIDS-Related Complex--estimated to affect thousands of people--as well as irreversible neurological disorders to the list of AIDS cases.

At the same time, the agency said it also has suggested the addition of a new category called “presumptive” cases. This would include patients who are recognized as AIDS sufferers by physicians with expertise in the deadly disease, although they have not been subjected to the invasive, sometimes painful and expensive confirmatory tests.

The additional cases, however, must be confirmed by laboratory evidence--by either the test that detects AIDS antibodies in the blood, indicating exposure to the virus, or by a viral culture.

“The purpose of these proposed changes is to be able to track the serious, irreversible diseases associated with (AIDS) infection not limited to those conditions which have heretofore been called AIDS,” said Dr. Timothy J. Dondero, chief of the surveillance and evaluation branch of CDC’s AIDS program.

Dondero said he could not estimate how many additional cases would be added to the national AIDS statistics as a result of the changes. “It’s a question I think none of us can answer,” he said.

AIDS, or acquired immune deficiency syndrome, is caused by a virus that destroys the body’s immune system, leaving it powerless against certain cancers and otherwise rare infections. It can also invade the central nervous system, causing severe neurological disorders.

Until now, AIDS has been defined, for national reporting purposes, by the opportunistic diseases that commonly strike those with seriously damaged immune systems. These include, among others, pneumocystis carinii pneumonia, a respiratory infection caused by a parasite, and Kaposi’s sarcoma, a capillary form of cancer.

But experts have increasingly identified additional serious manifestations of AIDS infection, such as dementia, and the more serious forms of AIDS-Related Complex, such as wasting-away syndrome, which are frequently as debilitating and fatal as the opportunistic infections.