Newsday - November 24, 1999
Laurie Garrett, Staff Writer

While deaths in the United States are down, UN AIDS reported yesterday that 2.6 million people will have died of AIDS globally by the end of 1999, the largest number ever for a single year.

Overall, the world's AIDS epidemic has claimed more than 16 million lives and infected 50 million people since 1980, UN AIDS said in its annual report. And though some countries have managed to slow the spread of HIV, the international community overall is at a loss to stem the tidal wave of deadly viral transmission.

For the first time in its annual reports, UN AIDS did not try to soften its grim news with rosy promises of future fixes, such as vaccines, cures or preventive microbicides. No such products are available or in promising positions in the development pipeline.

The agency said that 33.6 million people are infected now with HIV, 5.6 million of whom were newly infected this year.

HIV continues to hit hardest in the poorest place on earth, sub-Saharan Africa, the report said. About 70 percent of the world's cases are concentrated in that region where, on average, 8 percent of adults are infected. In some African communities, more than a third of adults are infected.

While average life expectancy in southern Africa rose from 44 to 59 between 1950 and 1999, the UN AIDS report forecast a dramatic change in the next decade: By 2010, the agency said, life expectancy will fall to 45, because of AIDS.

But the most rapidly growing epidemic right now is in countries of the former Soviet Union, chiefly Russia, Ukraine and Belarus, the report said. In contrast to Africa's sexually-transmitted epidemic, the Russian region's epidemic is driven by intravenous drug use, said Dr. Bernhard Schwartlander, chief epidemiologist for UN AIDS.

Schwartlander said the HIV is expanding hand in hand with a narcotics epidemic among youth. The Siberian city of Irkutsk, for example, had no cases of HIV in January, he said, but has now recorded at least 1,300 cases, all among young IV-drug users.

"The sad reality is that preventing AIDS is not a priority in these countries," said Peter Piot, executive director of UN AIDS.

An epidemic in Asia is newer, but important, officials said, because half the world's population resides in that region. With the exceptions of Thailand, South Korea, Japan and the Philippines, all of Asia is experiencing epidemic growth, with about 6.5 million infected with HIV.

Another 2.6 million people are living with HIV today in North and South America; about 900,000 of them in the United States. HIV is claiming fewer lives in the Americas, largely because of treatment with highly active antiretroviral therapy, or HAART. HIV continues to spread, but HAART treatment is slowing the progression of infection to AIDS and death.

However, drug-resistant strains of HIV have emerged and spread sexually to newly infected individuals in the region. And researchers are reporting new problems associated with HAART.

Last week, for example, [NOV. 19]Dr. Barbara McGovern of Tufts University in Boston reported that HAART users are dying of liver failure at a rate 35 percent greater than their counterparts who aren't taking the toxic drugs. And Bristol-Myers Squibb, manufacturer of the HAART drug ddI, issued strong warnings regarding the medicine's toxic effects on the pancreas, following the recent deaths of four HIV patients who suffered pancreatic toxicity.

Still, the poor nations of the world are clamoring for access to HAART drugs, which are costly. UN AIDS has negotiated price reductions with drug manufacturers, but only one drug-AZT-has come down to a cost that is within the grasp of poor Africans and Asians.

Next week, UN AIDS representatives will attend a World Trade Organization meeting in Seattle where, Piot said, the agency will argue that HAART drugs ought to be marketed at higher prices in the United States and other wealthy countries, and more cheaply in Africa, Asia and the former Soviet Union.

What will happen with HIV in the new century? Piot noted that a recent review of global AIDS forecasts made during the 1980s showed that estimates ran too high for North America and western Europe. But for Africa, Asia and eastern Europe, "reality has far surpassed even the worst-case scenarios made in the 1980s."

Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1999. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .