Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
The San Francisco Chronicle - Friday, January 28, 2000
Carl T. Hall, Chronicle Science Writer
Even assuming the worst, however, 10 years of expanded use of the life-saving protease inhibitors and other AIDS drugs are expected to at least balance out the feared increase in new infections that could result.
"It's a complicated picture, but the bottom line is we really could make things a lot better with these antiviral medicines,'' said Sally Blower, an epidemiologist at the University of California at San Francisco.
Blower and her colleagues produced an elaborate mathematical model to find out just how the life- saving drugs might affect the course of the AIDS epidemic in the San Francisco gay community. Details of the study are being published today in the journal Science.
About 30 percent of gay men in San Francisco are thought to be HIV positive. The fear has been that the AIDS drugs would lead to complacency among infected men, which in turn could lead to more high-risk sexual activity.
At the same time, medical experts worry that more widespread use of the antivirals could result in more drug-resistant strains of HIV and, consequently, more infections that do not respond to treatment.
Predicting the course of the local AIDS epidemic depends heavily on what assumptions are made about those two variables, according to the new analysis.
For most of the next 10 years, a big increase in unsafe sex practices, along with the emergence of drug- resistant strains of HIV, could easily produce more deaths and new infections at first than the drugs are capable of preventing. "Five years into the future you've made things worse,'' Blower said. But "after 10 years you balance things out,'' even under the most pessimistic scenario -- including a doubling of unsafe sex practices and 60 percent of new drug-resistant cases per year.
The point of the study, she said, is that thousands of lives could be saved, and the epidemic of new infections significantly thwarted, if San Francisco's gay community keeps its collective guard up.
Under the most optimistic scenario, which assumes that San Francisco gay men continue to practice safe sex and drug-resistance problems do not change for the worse, the benefits of expanded treatment are enormous.
In that case, Blower found the anti-HIV drugs are capable of achieving a one-third drop in AIDS deaths and 40 percent fewer new infections over a 10-year period.
"Even small changes in risk behavior will reduce the benefits in the short run,'' she said.
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