ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Saturday, January 25, 1997 TAG: 9701280120
SECTION: NATIONAL/INTERNATIONAL PAGE: A-8 EDITION: METRO
RESEARCHERS ARE UNABLE to determine what caused a decline that may extend to cities nationwide, but say the revolution in treatment can't take full credit.
The number of New York City residents dying of AIDS plummeted nearly 30 percent from 1995 to 1996, by far the most significant drop since the epidemic began.
More than 7,000 people died of AIDS in New York City in 1995; 5,000 died last year, according to death records monitored by Dr. Mary Ann Chiasson and her staff at the New York City Department of Health.
Experts at the fourth Conference on Retroviruses and Opportunistic Infections in Washington said preliminary reports indicate decreases in other cities.
Dr. Harold Jaffe of the national Centers for Disease Control and Prevention, a key player in the battle against AIDS since the beginning of the epidemic, called the downturn good news but said it was difficult to determine why it occurred.
Although some New York AIDS patients have been using protease inhibitors since early 1995, the decline preceded the Food and Drug Administration's licensing of the new drugs. This makes it unlikely that the current revolution in AIDS treatment can take full credit for the decline in deaths.
By 1991, the number of New Yorkers newly diagnosed with AIDS reached a plateau, and that figure has been constant. So, the decline in AIDS deaths is not caused by a decline in the numbers of people coming down with AIDS, Chiasson said.
``The major change that's occurred has been a dramatic increase in Ryan White money to New York City,'' Chiasson said.
Ryan White was an Indiana youngster who contracted AIDS from a blood transfusion and died.
In 1994, Congress allocated $40 million to New York City through the Ryan White Act for care and treatment of HIV-positive people. In 1995, that federal underwriting skyrocketed to $100 million, most of which covers the costs of drugs and clinical care for patients who are unable to pay for their treatment. In New York City, more than half of all people with AIDS pay for their therapy via Ryan White funds and Medicaid.
When Ryan White funds increased in fiscal year 1995, New York and many other cities and states began aggressive campaigns to encourage blacks and Latinos infected with the human immunodeficiency virus to get on drugs that prevent key killer opportunistic infections, such as pneumocystic pneumonia.
A recent CDC study by Dr. John Ward showed that median survival time with AIDS in the absence of pneumocystic pneumonia prophylaxis is 35 months; with the drugs, it's 47 months.
The good news about AIDS deaths is not mirrored at the other end of the nationwide spectrum: initial HIV infection. According to the CDC's Dr. Paul Denning, new infections continue to increase among 13-to 25-year-old Americans, particularly heterosexuals. New cases of HIV infection rose 20 percent in that age group from 1990 to 1995, reaching about 25,000 infected last year. The biggest jumps in new infections, as well as newly diagnosed AIDS, in 1995 were among females who got HIV through heterosexual intercourse.
Nearly 35 percent of new HIV infections in 1995 were among heterosexual women and girls, and for black females the numbers acquiring HIV through heterosexual intercourse rose 160 percent from 1990 to 1995.
Participants at Friday's conference also heard news of another promising protease inhibitor that may soon be available for people infected with HIV - one that appears to cause fewer side effects than those in widespread use.
Nelfinavir, manufactured by the San Diego-based company Agouron, attacks the ability of HIV to package copies of itself to release into the bloodstream, infecting more cells in the body.
Adding to enthusiasm about the drug (which will be marketed under the name Viracept) is recognition that when HIV develops resistance to nelfinavir it does not affect the other protease inhibitors. That means that patients who fail with nelfinavir could easily switch to another protease inhibitor.
LENGTH: Medium: 79 lines KEYWORDS: FATALITYby CNB