San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119
David Perlman, Chronicle Science Editor, Vancouver, British Columbia

More than 15,000 people are expected for five days of sessions, during which some of the world's leading experts will present their latest findings in basic research, clinical care and successful AIDS prevention efforts.

Fifteen years after the global epidemic was first recognized, research into the AIDS virus, or HIV, has never moved more swiftly.

Powerful new anti-viral drug combinations are being deployed. Three virus-fighting compounds in a new class called protease inhibitors recently have been approved for use, and more are being developed. New techniques for monitoring the levels of the virus in patients are enabling doctors to manipulate treatments more effectively.

PREVENTION PROGRAMS WORK

And in some developing nations, prevention programs -- including the wide distribution of free condoms -- are beginning to show success in stemming the tide of new infections.

"There's a period of excitement -- and even optimism -- that we haven't had before," said Dr. Paul Volberding of the University of California at San Francisco, the former president of the International AIDS Society and director of UCSF's AIDS Clinic at San Francisco General Hospital.

"It's possible today to dare think we might have the tools to eradicate the virus entirely from patients -- that's still only a possibility, but it's now our goal," said Volberding, who will present new treatment guidelines for HIV infections and AIDS at a preliminary conference sponsored by the American Medical Association tomorrow, and again after the major meeting formally opens Sunday.

Developed by an international group of experts as a result of recent advances in basic research and drug development, the recommendations are expected to set new standards for AIDS care -- at least in countries where advanced medical treatment is available.

"There is a rich body of evidence that shows we are beginning to wage an increasingly successful rebellion against the pandemic," said a statement issued in Vancouver by leaders of the conference organizing committee.

That evidence represents a striking contrast to the somber moods that many delegates reflected during the most recent international AIDS conferences -- in Berlin in 1993 and Yokohama in 1994.

IMPACT ON POOR

But even with that optimism, experts monitoring the spread of AIDS throughout the world are increasingly appalled at the impact of the disease on entire populations in developing nations, where poverty makes even conventional AIDS drugs unavailable and the rising death rate among women and children threatens the future.

New surveys prepared for the conference estimate that as many as 30 million men, women and children have been infected by the AIDS virus since the epidemic emerged in 1981, and that up to 9 million have died.

At least 21 million people are living with AIDS or HIV infections today, according to those studies, which were prepared by disease surveillance experts from the Harvard-based Global AIDS Policy Coalition and the United Nations Program on HIV/AIDS.

And more than 90 percent of all HIV infections, AIDS cases and deaths so far have been among people in the poorest developing nations, primarily in Africa and Asia, according to Dr. Daniel Tarantola of the global coalition and Dr. Peter Piot of the United Nations. Meanwhile, the rate of new infections is actually beginning to slacken in many industrial nations of Europe and North America, they noted.

SPOTLIGHT ON SOUTHEAST ASIA

Most striking in this picture is the fact that within less than a decade, Southeast Asia has emerged as the epidemic's biggest focus. Last year alone, for example, there were nearly 3 million new infections in Southeast Asia, while in sub-Saharan Africa -- where the infection rate raged most wildly in past years -- about 1.5 million new infections were detected.

The new studies also underscore the myths about AIDS that still prevail among many Americans and Europeans, who see the epidemic as affecting primarily gay and bisexual men and users of injection drugs.

Worldwide, the disease overwhelmingly affects heterosexuals, the surveys show. In Africa, AIDS killed nearly twice as many women and children as men last year alone, and it is now the primary cause of death among the world's women between ages 25 and 40.

And according to Piot of the U.N. AIDS program, more than 70 percent of all HIV infections in the world so far have been caused by heterosexual intercourse, while 5 to 10 percent of the infections have occurred among homosexuals. Injection drug use, contaminated blood transfusions and the reuse of once-sterile needles in some desperately poor Third World clinics account for the rest.

In the United States, the most recent estimates from the Atlanta- based Centers for Disease Control indicate that 40,000 new infections were officially reported last year; cumulative AIDS cases in the United States since the beginning of the epidemic total more than 506,000. Nearly 80,000 of them are of women and children, and the proportion of women with AIDS in America is rising steadily. Women and injection drug users are now the fastest growing group of HIV- infected people in America, according to the CDC.

Looking at the epidemic's global future, experts at the Harvard- based coalition predict that "if the epidemic trends persist through the end of the century, it is most likely that between 60 million and 70 million adults will have been infected with HIV by the end of the year 2000. Of these adults, about 50 percent will be in Southeast Asia and about 40 percent in sub-Saharan Africa."

A QUALIFIED OPTIMISM

Nonetheless, to Piot, the international conference's slogan, "One World, One Hope," expresses at least a qualified optimism.

"A kind of collective depression set in after Berlin and Yokohama, but now the mood is more upbeat and lively because of advances in treatment and the emergence of evidence that AIDS prevention efforts -- in Thailand and Uganda, for example -- are beginning to pay off," said Piot in an interview this week.

"But the AIDS gap around the world remains, and where the epidemic is at its worst people cannot hope to benefit from the new drugs," he said. "At best, they can only dream of palliative treatment for some of the infections that AIDS causes."
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