February 28, 1997 in Nation/World

Deaths From Aids Fall Significantly In U.S. Various Drug Therapies Credited For 13 Percent Decline In First Half Of 1996

David Brown Washington Post

Deaths from AIDS fell significantly in the United States last year for the first time since the AIDS epidemic began in the early 1980s, federal health officials reported Thursday.

The decline in AIDS deaths occurred in all regions of the country and in all racial and ethnic groups. However, the trend was not seen among women or among people infected with the AIDS virus through heterosexual contact - two demographic groups in which the epidemic still is growing.

Epidemiologists at the Centers for Disease Control and Prevention in Atlanta, which made the announcement, believe deaths from AIDS are falling for two reasons. The number of HIV-infected people who are progressing to full-blown AIDS the advanced, often-lethal stage of the disease - is leveling off. At the same time, better medical therapies are prolonging the survival of patients who already are at that stage.

The total number of deaths from AIDS in the first six months of 1996 was 22,000 compared with 24,900 deaths during a similar period in 1995 - a 13 percent decrease, according to data compiled by the CDC. Although there had been slight declines for short periods earlier in the epidemic, last year’s was by far the largest.

The trend appears to have begun in 1995. Only some of the fall can be attributed to the growing use of protease inhibitors, a potent new class of anti-viral drugs that became widely available last spring. Protease inhibitors commonly are used now in combination with two other anti-viral drugs in what’s become known as “triple therapy.”

“AIDS deaths began to plateau in 1995, and that really suggests that something began to happen before protease inhibitors were licensed by the FDA (Food and Drug Administration),” said John W. Ward, CDC’s chief AIDS epidemiologist.

Two forces, in particular, appear to have preceded the arrival of the first protease inhibitor in December 1995.

One was the use of two-drug anti-viral combinations, which prolonged survival among AIDS patients even though the drugs are less effective than triple therapy.

The second is more widespread use of an anti-infective pill that helps prevent Pneumocystis carinii pneumonia, the most common “opportunistic” infection in AIDS patients, whose immune systems are damaged severely.

The nationwide decline in deaths from AIDS reflects a trend detected in several cities in the last few months.

Daily deaths from AIDS in New York fell by about 50 percent between November 1995 and November 1996. Total AIDS deaths in King County, which includes Seattle, fell 43 percent last year compared with the average annual number of deaths in the preceding three years. In San Francisco, total AIDS deaths fell 15 percent between the last half of 1995 and the first half of 1996.

In Virginia, AIDS deaths fell from 443 during the first half of 1995 to 345 during the same period in 1996, a 22 percent decrease, according to the Virginia Department of Health.

But the drop in mortality nationwide was not distributed evenly among groups of AIDS patients.

Although the decline was 13 percent overall, it was 32 percent among American Indians and Alaskan natives; 21 percent among non-Hispanic whites; 10 percent among Hispanics; 6 percent among Asians; and 2 percent among non-Hispanic blacks. AIDS deaths fell 15 percent among men, but rose 3 percent among women.

AIDS deaths among men infected by sexual contact with other men fell by 18 percent. Deaths among people exposed through intravenous drug use fell 6 percent. But people exposed through heterosexual activity experienced a 3 percent rise in deaths.

The magnitude of the trend also varied by region. AIDS deaths fell 16 percent in the West, 15 percent in the Northeast, 11 percent in the Midwest and 8 percent in the South.

The rate of HIV-infected people progressing to full-blown AIDS was generally stable from the start of 1994 through mid-1996, the CDC found. However, the rate of progression was seven times higher among blacks and three times higher among Hispanics than it was among whites.

Epidemiologists estimate that 600,000 to 900,000 Americans are infected with with human immunodeficiency virus, the virus that causes AIDS.

“Like much in recent AIDS news, this news is mixed,” said Christine Lubinski, deputy executive director of the AIDS Action Council, which represents hundreds of AIDS service organizations in the country. “It’s good to see that AIDS deaths declined. … However, the deaths are increasing for women, and the infection rates are increasing for people of color. What we need to do is ensure that everyone at risk of HIV, or living with HIV, has access to good prevention and health care.”

Worldwide, AIDS deaths continue to rise. Last year, more than 1.5 million people died from the disease, which amounted to about 25 percent of all AIDS deaths since the start of the epidemic.

President Clinton said he is “greatly encouraged” by Thursday’s announcement, calling it “evidence that this terrible epidemic is beginning to yield to our sustained national public-health investment in AIDS research, prevention and care.”

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