AIDS Expected to Be a Treatable Disease in ‘90s

In the 1980s, AIDS in the United States was largely an untreatable disease of middle-class white homosexuals. In the 1990s, it is likely to be a treatable disease of poor black and Latino heterosexuals.

And worldwide, by the end of the ‘90s, 6 million people may be ill with AIDS, the specialists project.

In the second decade of this epidemic upon the Earth, the face of AIDS will change:

* It will be increasingly linked with poverty, passed through the nation’s slums via needles and sex.

* The number of people with AIDS will grow dramatically as those who were infected throughout the 1980s fall sick.

* Medical science will develop more tools to control HIV, the AIDS virus, perhaps slowing the lethal course of the infection.

As acquired immune deficiency syndrome spreads, the burden upon society will grow with it.

The U.S. government estimates that the cost of taking care of AIDS patients in 1992 will range from $5 billion to $13 billion. Big city hospitals, especially those in poor neighborhoods, will be hit hardest. Experts believe New York City will need 1,000 to 1,500 more beds by 1991 just to deal with AIDS patients.

The seeds of the epidemic’s next decade have already been sown. An estimated 1 million to 1.5 million Americans are now infected. Most, perhaps all, will eventually become ill.

“Even if not another single person gets infected, which of course won’t happen, there will be a steady increase in the number of people who get sick and die from AIDS over the next 10 years,” said Dr. William Haseltine of Dana Farber Cancer Institute in Boston.

By the end of 1992, the U.S. Public Health Service projects, 365,000 Americans will have gotten AIDS, and 263,000 of them will have died. In 1992 alone, there will be 80,000 new cases of AIDS and 65,000 deaths.

The virus typically lingers quietly for a decade after the initial infection until it eventually destroys the immune system, causing AIDS. The victims of the early 1990s will be the legacy of the epidemic’s silent but explosive start in the early 1980s.

Most early victims were homosexual men. Because of safer sex habits, the rate of new infections has slowed to a trickle among this group. But the virus continues to spread through shared needles among drug addicts, largely poor black and Latino males in the big cities, and from them to their sex partners, mostly women.

The future of AIDS in the United States will depend, in part, on whether those who contract AIDS through sex with drug abusers will pass it on sexually to others. If this happens--there is no evidence of it yet--AIDS could become a sexually transmitted disease of the urban poor.

“That’s the big question mark that hangs over the next decade,” said Dr. Andrew R. Moss of UC San Francisco.

The heterosexual transmission of AIDS is already a major problem in other parts of the word, especially Africa, where 10% to 15% of the people in some cities are thought to be infected.

“We expect that the decade of the 1990s will be worse--and perhaps much worse--than the 1980s,” said Dr. Jonathan M. Mann, director of the World Health Organization’s AIDS program.

The WHO has put together the educated guesses of many experts and projects that nine times more people around the world will get AIDS during the 1990s than during the 1980s. By the year 2000, there could be 6 million AIDS cases, and 18 million people could be infected.

Just how many people will have AIDS in the United States a decade from now is impossible to predict with any certainty.

“What happens 10 years from now will reflect transmission that hasn’t yet occurred,” said Dr. Timothy Dondero of the U.S. Centers for Disease Control. “There are a lot of unknowns, but to me the biggest--because it’s likely to have the most radical change--is the impact of preventive therapy in infected people to prevent the onset of AIDS.”

Recently, researchers showed that the drug AZT can forestall the development of AIDS in infected people who are not yet sick. If all goes as scientists hope, other drugs under development will attack the virus at various stages in its life cycle. The goal is to hold the virus in check.

“HIV infection would become a chronic disease, a lifelong disease, something for which you would need to take medication for a long time, like hypertension or diabetes,” said Dr. Clifford Lane of the National Institute of Allergy and Infectious Diseases. “Some people will still do poorly, but hopefully the majority will be able to do much better.”

Instead of succumbing to AIDS, people might live with the virus in relatively good health for 20 or 30 years.

Many experts are less optimistic about finding a vaccine that will protect people from the initial AIDS infection. The difficulty is in priming the body to put up impenetrable barriers that will prevent every single invading virus from taking root in vulnerable blood cells.

“We know it’s going to be exceedingly difficult, based on all the immune information that has been generated,” said Dr. David Ho of Cedars-Sinai Medical Center in Los Angeles. “It looks harder, rather than easier, as we learn more and more.”