San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Friday, September 12, 1997 - Page A1
Sabin Russell, Chronicle Staff Writer

Federal researchers yesterday reported that the AIDS death rate among adults ages 25 to 44 had fallen 26 percent in 1996, an astonishing drop among the core population where AIDS has struck the hardest.

Health and Human Services Secretary Donna Shalala hailed the findings as "a truly remarkable achievement," the highlight of an administration report that also showed significant lowerings in the rates of infant mortality, homicide and teen pregnancy.

Since the epidemic began in 1981, deaths from AIDS climbed relentlessly, and in 1994 the disease became the nation's leading killer of younger adults in America, outpacing deaths from all accidents, such as car wrecks, plane crashes, falls and drowning. The decrease in AIDS deaths means that accidents are again the No. 1 cause of death among younger adults.

The latest figures put the AIDS death rate in the adult group at 27.2 per 100,000, compared with 36.9 in 1995. "This is one of the largest drops we've ever seen in the death rate from a single cause in a single year," said Kimberly Peters, a federal statistician with the Centers for Disease Control and Prevention.

AIDS experts say there is no single cause that can explain the decrease, but the use of new anti- viral drugs approved in late 1995 and early 1996 clearly are playing a role.

"This is a payoff from a combination of research, clinical trials, drug development and behavior modification," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the federal government's leading agency for AIDS research.

Fauci also attributed the declining death rate to the dramatic shift toward safer sex that occurred in the mid-1980s, which sharply reduced the infection rate among gay men. Because it can take more than 10 years for an HIV infection to develop into AIDS, the decreased death rate was, in effect, predicted more than a decade ago by successful prevention efforts.

Fauci said strides made in the treatment of the opportunistic infections that ultimately kill AIDS patients also have saved lives, as has the growing understanding among doctors about how best to manage the disease. "The longer you do something, the better you get at it," he said.

Yesterday's report by the National Center for Health Statistics is just the latest in a string of encouraging stories of progress in the battle against AIDS, but the good news is tempered by the still horrific death rate for the disease, and concerns that the favorable trend may not continue.

Fauci cautioned that the heartening statistics could take a nasty turn upwards in the future, if the beneficial effects of the latest AIDS drugs wear out. The latest drug regimes, centered on combinations of new protease inhibitors and older anti-viral drugs, could simply be postponing deaths that will occur in great numbers later on.

He also noted that the favorable results in the United States are not occurring in Africa and Asia. "Not only are deaths not tapering off, but they are accelerating with no end in sight," he said. "From a global standpoint, this epidemic is still out of control."

Timothy Rodrigues, a spokesman for the San Francisco AIDS Foundation, said there are many reasons to be cautious about the latest statistics. "The challenge is that we are starting to see some people fail with the protease inhibitors," he said.

The increased longevity of AIDS patients also is straining the fragile infrastructure of services such as housing and medical care. With more people not dying of AIDS, there are more people living in need of help. Patients who once were resigned to what seemed like certain death are now struggling with issues such as whether and how to return to the workforce.

Tom Coates, director of the University of California at San Francisco AIDS Research Institute, notes that the benefits of new medical care are not being shared equally by all segments of society.

The federal study found decreasing death rates among many segments of the AIDS community, but the rate of decrease was not identical. In the same age group, the rate for men fell 27 percent, and the rate for women 17 percent. Among white males in the group, the death rate fell 32 percent, while the death rate among black males of the same age fell only 19 percent.

"These figures point to the discrepancy between what's available for much of the population and what's available to poor people," he said.

In addition to the decline in AIDS deaths, federal statisticians found that:

-- Homicide rates per 100,000 population fell 11 percent, to 8.4 in 1996 from 9.4 the prior year.

-- Infant mortality fell to 7.2 deaths per 1,000 live births. One third of the decline is attributed to a 15 percent decline in deaths due to sudden infant death syndrome. Deaths decreased after researchers urged parents to have their babies sleep on their backs or sides, rather than their tummies.

-- Teen birth rates among 15- 19-year-olds fell 4 percent. The figure has declined by 12 percent since 1991.
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