AIDS in U.S.: 365,000 Cases by 1993 Feared

Federal health officials estimate that about 365,000 Americans will have contracted AIDS by the end of 1992, meaning there will be nearly 100,000 new cases in that year alone.

In the seven years since the fatal disease was first identified, 63,726 Americans have been afflicted with AIDS, of whom 35,798 have died.

The statistics emerged from two days of closed sessions last week in Charlottesville, Va., as the Public Health Service met to plan strategy for the coming years of the deadly epidemic.

The projections for 1992, although startling, do not reflect any real change in the trends or acceleration of the spreading of AIDS infection, according to sources who attended the meeting.

Rather, they said, the figures are based on the longstanding--although rough--estimate that perhaps 1.5 million Americans are currently infected with the AIDS virus. They also take into account the government’s newly expanded criteria for defining the disease, which include more AIDS-related conditions.

Further, sources said, evidence now indicates that once an individual is infected, the risk of developing the full disease does not decrease over time. Thus more people can be expected to become ill than earlier believed.

“What it really means, though, is that we’re going to have a big problem facing us in the scope of health care,” said one official present at the meeting, who requested anonymity.

Federal health officials at the meeting also estimated that there would be about 88,000 new cases in 1993, but one of them stressed: “This does not necessarily reflect a downturn in the number of cases. The 1993 number is a very, very soft figure.”

Last week’s session was a follow-up to a similar private meeting two years ago at the Coolfont resort in Berkeley Springs, W. Va., about 100 miles northwest of Washington. At that time, federal health officials said the cumulative number of AIDS cases would reach 270,000 by the end of 1991, with more than 74,000 new cases expected to be diagnosed in that year.

Projections Agree

The results of that meeting, known as the Coolfont Report, also said that more than 145,000 cases of AIDS would require medical attention in 1991.

“The picture hasn’t changed,” Dr. James Curran of the Centers for Disease Control AIDS program told the meeting last week, according to one source.

One of several draft reports compiled during the meeting--this one dealing with the epidemiology and surveillance of the epidemic--said that the 26,200 cases reported in the last 12 months “represent a 71% increase over the previous year” and that, in 1986, “AIDS ranked eighth among all diseases in years of potential life lost before age 65.”

The report said that, thus far, the 1986 Coolfont projections have been accurate. The actual numbers of cases diagnosed in the last two years--15,900 in 1986 and 20,600 in 1987--represented 94% of the numbers (15,800 and 23,000) that had been predicted, it said.

Distant Future Unclear

“Projections of AIDS cases for two to three years in the future are expected to be reasonably accurate,” said the report, but it added: “Long-term forecasts of AIDS incidence approaching five years and beyond are less accurate. Long-term projections depend upon the ability to forecast the future spread of . . . infection in the population which, in turn, depends on many unknown factors; shorter term projections rely primarily on the progression to disease among those already infected.”

All of the reports, copies of which were obtained by The Times, explored numerous aspects of the epidemic, such as patient care and medical care delivery problems, AIDS education and prevention efforts, intravenous drug use, vaccines and therapeutics, blood and blood products.

“In the coming years, there is the strong possibility that the life span of the infected patient will be significantly increased with the advent of effective (therapies), not only in persons with AIDS, but also in the mildly symptomatic and asymptomatic individual,” said the draft report on future health care. “There will need to be a resultant shift in the design of the care model from the terminally ill to the chronically ill in an effort to better meet patient needs.”

Further, the report said that “easing of licensure requirements and reimbursement alternatives” are needed “to allow the development of new types of non-acute facilities for people infected with (the virus) . . . .”

Accommodations Needed

“One of the problems we’re going to be facing is that a lot of these people won’t need to go into the hospital, or will need care once they leave the hospital,” one source said. “We’ll have to come up with more programs outside of the hospital to be able to treat them.”

Among other themes sounded at the meeting, sources said, was frustration over continuing criticism of the government’s handling of the epidemic. Earlier last week, reports from both President Reagan’s AIDS commission and the National Academy of Sciences and its Institute of Medicine attacked the federal response to the AIDS epidemic.

“There was a tremendous amount of frustration that the Public Health Service wasn’t getting credit for what it has done,” one source said.

Discrimination a Concern

Sources who were at the meeting also reported a developing consensus in favor of federal action to prevent discrimination against people with AIDS and others infected with the virus. The presidential commission issued a similar call last week.

“These protections need to be in place for us to get our job done,” said one federal health official who attended the planning sessions. “We were saying that even before we’d heard what the commission had done.”

AIDS, or acquired immune deficiency syndrome, destroys the immune system so that the body is powerless against certain cancers and otherwise rare infections. It also can invade the central nervous system and cause severe neurological disorders.

In this country, AIDS has primarily afflicted homosexual and bisexual men, intravenous drug users and their sexual partners.