AIDS Deaths Down 44% in U.S.; New Cases Drop

The number of AIDS deaths in the United States dropped 44% in the first half of 1997 compared to the same period in 1996, with Los Angeles and New York City showing even greater declines.

According to the figures from the Centers for Disease Control and Prevention released Monday, the number of new AIDS cases dropped 12% during the same period, although the number of people living with AIDS rose 12% to 259,000.

The decline in deaths and severe illness is due to new forms of therapy, particularly the advent of protease inhibitors about three years ago. When a protease inhibitor is combined with two other drugs that block a viral enzyme called reverse transcriptase, concentrations of the virus in the blood are dropped to undetectable levels in most patients who can tolerate the drugs.

“We are at a very special moment in the epidemic of HIV/AIDS,” epidemiologist Dr. Kevin DeCock of the CDC told the Fifth Conference on Retroviruses and Opportunistic Infections, meeting in Chicago.

But access to the expensive treatment--or lack of it--is creating a distinct class system. “This is now a disease that very disproportionately affects the most disadvantaged populations,” DeCock added.

This marks the second straight year of decline in AIDS deaths, but the latest drop is much steeper. The CDC reported 21,460 AIDS deaths in the first six months of 1996, a 14% decline from the previous year and the first decrease since the beginning of the AIDS epidemic in the early 1980s. In the first six months of 1997, there were 12,040 deaths.

Similarly, the number of new cases of acquired immune deficiency syndrome dropped 9% from 1995 to 1996, and 12% to 29,520 in the first six months of 1997.

DeCock cautioned that the drop in AIDS cases and deaths does not mean that the AIDS problem is winding down. Between 35,000 and 40,000 people are newly infected with the human immunodeficiency virus each year, DeCock said. No one is sure how many Americans are HIV-positive, but the CDC estimates the number is between 400,000 and 650,000.

But new infections are declining sharply among infants as the result of prenatal treatment of the mothers with AZT. “It is not unrealistic to speak of the elimination of pediatric HIV in the industrialized world,” DeCock said.

The picture was even more dramatic in New York City, which has 3% of the U.S. population but 16% of its AIDS cases. AIDS deaths in the city fell 29% in 1996 and 48% in 1997, according to Dr. Mary Ann Chiasson of the New York City Department of Health. “For the two years combined, that’s a 64% drop,” she said--from 7,000 in 1995 to 2,600 last year.

Chiasson said there was not a big decline in the death rate for women a year ago. “The good news is, this year, they are beginning to catch up,” she said.

In Los Angeles, the number of AIDS deaths dropped 55% from 1996 to 1997 and the number of new cases reported dropped 32%, according to Dr. Paul Simon of the County Department of Health Services. The drop in new cases was much greater among whites, he noted, indicating that other ethnic groups are not receiving early diagnosis and treatment.

About 40,000 people in Los Angeles County--out of a population of 9 million--are now HIV-positive, according to Simon, “but they are not distributed uniformly.” Pockets of infected individuals occur in Hollywood, West Hollywood, Silver Lake, Long Beach and, surprisingly, among the very poor in the downtown area.

Orange County also mirrored the national trend, with county health officials reporting that 41 people died as a result of the disease in the first half of 1997, contrasted with 113 in the same period in 1996, a decrease of 64%. All but two of those deaths were reported in the second quarter of 1997, however, and agency officials could not be reached Monday night to explain the wide variance in the statistics.

New cases totaled 90 in the first half of last year, down from 191 in the first half of 1996.

Dr. Amy McNaghten of the CDC reported on a study of 40,000 AIDS patients in nine cities, including Los Angeles. She found that the risk of death for patients taking the triple therapy that includes protease inhibitors was 63% lower than the risk for patients taking only one drug, and 86% lower than for those taking no drugs.

Unfortunately, many people do not receive the most effective therapy because of its cost--about $15,000 a year per person. Dr. Paul Denning of the CDC, who studied AIDS patients in Los Angeles, San Francisco and New Jersey from January to October 1997, reported that only 18% were receiving triple therapy. Another 22% were being treated with two drugs and 10% with one, but fully 47% were receiving no therapy at all.

More than half of those with AIDS had also not been tested to determine the level of virus in their blood, a key determinant in choosing therapy, he added.

The downside of the lowered AIDS rate is that it makes it more difficult for researchers to monitor progress against the disease. AIDS cases must be reported to health agencies, but HIV infection is not. With the decline in AIDS cases, “I think we are rapidly losing the ability to track the epidemic,” Chiasson said.

DeCock said that the United States should begin requiring reports of new HIV infections, with names attached, just as it now does for AIDS. That proposal has been controversial, but it is a matter of “real urgency,” he said.

“The trends are extreme and our ability to monitor the disease is incredibly weak [compared] to what it was a few years ago.”

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AIDS Statistics

Number of U.S. AIDS cases for the first six months of 1997, compared to the same period a year earlier:

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% ’96 ’97 change Deaths 21,460 12,040 -44% New cases 33,590 29,520 -12% Total cases 229,000 259,000 +13%

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Source: Centers for Disease Control