Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Newsday - August 31, 1999
Laurie Garrett - Staff Correspondent
Meanwhile, the number of people getting infected with HIV in the United States continues to total about 40,000 a year-a figure that has not budged for a decade.
"We want a new strategy for HIV prevention ... [THAT IS]a detailed and concrete game plan for the future," said Dr. Jeffry Koplan, director of the Centers for Disease Control and Prevention, in a speech to the National HIV Prevention Conference here.
No one can say exactly which factors have been responsible for bringing the annual new HIV infection rate down from some 150,000 people in 1985, to 40,000 a year, each year since 1990. The enormous death toll exacted by AIDS reduced the size of the pool of HIV-infected people. And some interventions clearly played a role, notably screening the blood supply, giving AZT to pregnant women and their babies, and provision of sterile needles to IV drug users, Koplan said.
But the lack of clarity about which prevention and public education efforts have worked the best is particularly troubling now because "everything has changed. We are in a new era. Our approach to prevention has to change," due to the impact of anti-HIV treatments, said Dr. Helene Gayle, who heads up all of the CDC's AIDS/HIV programs.
In 1996, hundreds of thousands of Americans infected with HIV started taking Highly Active Anti-Retroviral Therapy, or HAART, treating their HIV with potent cocktails of new drugs. And the impact of HAART was profound, Gayle said.
Between December, 1995, and November, 1997, the numbers of HIV-positive Americans dying of the disease decreased nationally by 68 percent. And the numbers progressing from infection to AIDS dropped by a third.
"As we anticipated," Gayle continued, "we are now seeing a slowing of that trend." "What we all hope will not happen ... is that we'll see an actual increase in AIDS cases and deaths," Gayle continued.
Between December, 1997, and December, 1998, nationally the number of people progressing to AIDS fell by just 11 percent (versus 30 percent the previous year), and deaths fell just 20 percent (compared to 60 percent the previous year.) The CDC's Dr. Scott Holmberg in a survey of some 4,000 HIV patients treated in clinics in eight U.S. cities found evidence of increasing drug resistance and toxic side effects among HAART users.
Gay men continue to have the highest risk of acquiring HIV, the CDC's Dr. Hillard Weinstock said. Their rate of new infection is four times that of IV drug users, and in 1999 eight of every 100 gay American men will become newly infected with the virus.
One glimmer of hope was offered by Dr. Jeff Rothman of the New York State Department of Health. Testing done at 26 sites statewide reveals that HIV rates among narcotics users are declining. In 1990 more than 21 percent of New York State's narcotics users were HIV-positive. In 1998, only 6.8 percent of some 30,000 drug users tested came up positive.
Several factors may explain that decline, including statewide HIV education campaigns and needle-exchange programs, Rothman said. But another reason is that heroin is far cheaper and purer. So, Rothman said, more heroin users are now inhaling rather than injecting.
National and local data on the epidemic offer very limited glimpses at who is getting infected, and, therefore, toward which groups prevention campaigns ought to be targeted.
Dr. James Curran, dean of the Rollins School Public Health at Atlanta's Emory University, spoke of the difficulties of tracking the disease. All surveillance of the epidemic has been based on nationally mandated reporting to the CDC of AIDS cases. But HAART therapy has blocked progression to AIDS for some 300,000 Americans, making all of the CDC's data weak and conjectural.
HIV reporting-versus AIDS reporting-offers hope of developing a national surveillance system that could once again serve as a national conscience, Curran insisted, guiding prevention policies. But most states still refuse to conduct HIV reporting, due to controversies over confidentiality.
ILLUSTRATION/PHOTO: AP Photo - Dr. Helene Gayle, who heads the Centers for Disease Control's AIDS/HIV programs, presents new information on treatment.
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