The Day the Magic Stopped : Medical Prognosis Is Unclear

The health and longevity of Magic Johnson, like that of others infected with the AIDS virus, will depend on factors that were unclear Thursday--such as when Johnson became infected, the current condition of his immune system and whether he has developed any symptoms.

The average period between infection with the human immunodeficiency virus and diagnosis with full-blown AIDS is now 10 years, according to the latest studies. After that diagnosis, new treatments have extended the average patient’s survival to several years.

“If he is early enough in the infection, he could have survival in that time frame,” said Dr. Michael Gottlieb, who in 1981 identified the disease that has since come to be called AIDS. “On the downside, if he turns out to have had this infection for several years, the prognosis may not be that good.”

The Lakers’ team physician, Dr. Michael Mellman, described Johnson’s current condition as good. He said Johnson is healthy and is expected to remain so for a long time. He said Johnson is not on medication but that the issue is being discussed.

Mellman did not, however, address what AIDS experts say are telling indicators of a person’s true prognosis--Johnson’s approximate date of infection, the level of key immune system cells called T-helper cells and any symptoms he might already have experienced.

“His cell counts and his real symptoms are going to give you as much (information about his prognosis) as anything,” said Dr. Howard Liebman, an associate professor of medicine and pathology at USC School of Medicine who both treats patients and does AIDS research.

Though Mellman suggested Johnson was retiring at least in part because the rigors of professional basketball could weaken his immune system, several AIDS specialists said Thursday that even intense exercise is not in itself harmful to immunity.

They said, however, that infected people may experience intermittent, flu-like symptoms and fatigue, which might make it difficult to play. Mellman said Johnson had been feeling tired and unwell. He has also missed three regular-season and two exhibition games this season, and was said to have flu.

“Exertion alone does not affect the immune system,” Gottlieb said. “It’s more the possible side effects of medication and intermittent symptoms that might affect his sense of well-being and his performance.”

As a person’s T-helper cell count drops, the person becomes vulnerable to increasingly dangerous infections.

Initially, the symptoms are vague--for example, weight loss, fevers, night sweats, unexplained diarrhea. Later come more serious infectious diseases, such as pneumocystis pneumonia, and various malignancies, any of which justify diagnosis of full-blown AIDS.

Under current thinking, a T-helper cell count of 200 cells per cubic millimeter of blood is a powerful indicator that a patient will develop more serious infections. Studies suggest one-third of patients with levels that low will have AIDS within two years.

New treatments for pneumocystis pneumonia have extended survival after an initial bout with that disease to 20 to 28 months, specialists say. But it is difficult in general to say how long the average patient lives after diagnosis. The range is from months to years.

Studies also indicate that patients without symptoms but with T-helper cell levels below 500 can benefit by early, preventive treatment with anti-viral drugs. One study found that such treatment could significantly slow the disease’s progression to AIDS.

T-helper cell levels are not the only benchmark. Even early symptoms such as night sweats, fever and weight loss can be significant in patients with relatively high T-helper cell counts. Patients with those symptoms are eight times more likely than other patients without symptoms but with comparable T-cell levels to develop full-blown AIDS over the next two years. “It’s really extraordinary and heroic of him to be so honest,” Gottlieb said of Johnson. “Perhaps that will encourage other not to deal with their HIV or AIDS secretly.”

As of Sept. 30, 13,415 people in Los Angeles County had been diagnosed with AIDS and 70% of those had died. In California, 37,420 people had been diagnosed and 68% of them had died. Nationally, 195,718 had been diagnosed; 126,159 of them had died.