Miami Herald - February 18, 2005
Fred Tasker, ftasker@herald.com

New AIDS cases jumped one-third in Miami-Dade County and nearly one-half in Broward in 2004, the first increase after a decade of decline.

State officials said Thursday the spike was most likely because of an aggressive new statewide testing program, which checked 900,000 Florida residents for HIV and AIDS last year.

"Over the past three years we have really expanded testing and counseling," said Thomas Liberti, AIDS director for the Florida Department of Health. "When you do tests, you find cases. That's our job."

Another factor: aging long-term HIV patients developing resistance to antiretroviral drugs and progressing into full-blown AIDS.

"The largest percentage increase in AIDS for 2004 was in people 50 and older," Liberti said. "These are people who were infected [with HIV] 10 or 15 or 17 years ago, who are running out of drug options."

The new testing programs found 1,349 new AIDS cases in Miami-Dade in 2004, a 33 percent increase over 2003. In Broward, they found 1,010 new AIDS cases, up 49 percent. Statewide, AIDS cases grew to 5,816 in 2004, up 24 percent.

SOUTH FLORIDA

Statewide, South Florida also had the highest rates per capita in 2004: 58.4 per 100,000 people for Broward; 56.7 for Miami-Dade; 51.8 for Monroe; and 37.6 for Palm Beach. The statewide rate is 33.5. All except Palm Beach rose from 2003 rates.

Miami, Broward and Palm Beach counties for years have been in the top 10 metropolitan areas in the country for HIV and AIDS, leading to the increased testing and prevention efforts by the Florida Department of Health.

ILLEGAL DRUG USE

The increased testing also found that new HIV cases statewide fell in 2004, but Miami-Dade County did not see a similar decline -- in part because of a suspected increase in risky sexual behavior fueled by illegal drug use, health officials said.

New HIV cases were down 3 percent statewide, 9 percent in Broward County and 15 percent in Palm Beach County -- but held steady in Miami-Dade.

"We're very concerned with . . . crystal meth," Liberti said. "If you introduce drugs into a population that has disease, you have problems. We've been through this before with crack cocaine and IV drug users who shared needles. It leads to all kinds of unprotected sex."

Liberti said he wants to see early 2005 numbers before he concludes that the AIDS surge is due more to increased testing than a resurgence of AIDS in Florida after decades of decline.

But he added: "If it was an out-of-control number of AIDS cases, then HIV cases would have the same increase. The fact that there's a 3 percent [statewide] decline is an encouraging sign that we're holding fast on the front end."

OLDER PATIENTS

Two factors come into play in the increased AIDS rates among older patients, said Jolene Mullins, early intervention consultant with the Broward County Health Department.

First, aging tends to weaken the immune system, whether you have HIV or not. Second, the longer a patient is on antiretroviral drugs, the more likely he or she is to develop resistance to those drugs. Doctors fight this by switching long-term patients to new drug cocktails, but in severe cases they can come close to running out of options.

"Sometimes the immune system will go down despite medical care, and we may not be able to get the virus under the control we want," said Corklin Steinhart, an HIV specialist at Mercy Hospital in Miami.

Liberti said a majority of the new AIDS cases were diagnosed by detecting the increased viral load in the blood, rather than the usual way AIDS is found -- when patients develop pneumonia or other AIDS-related illnesses.

Liberti said Florida AIDS fighters also are concerned by reports by New York doctors of a patient with a new strain of HIV that has proved highly resistant to the usual antiretroviral drugs. It is resistant to three of the four classes of such drugs, and to a total of 19 individual drugs.

No such cases have been identified in Florida, he said.

"But we're tracking the situation very closely, waiting for more information. We will put our heads together and decide how to react."

"We're concerned," said Mullins, in Broward. "There are very strong links between the populations of New York and South Florida. And the risk factors are in clubs, with use of crystal meth among men who have sex with men."

Herald staff writer Jacob Goldstein contributed to this report.

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