HIV'S SPREAD IS UNCHECKED AIDS-SLOWING TREATMENTS

Eclipse Rising Infection Rate, Study Says

Although the number of new AIDS cases in the United States has declined
substantially in recent years, HIV continues to spread through the
population essentially unabated, according to data released yesterday by
the Centers for Disease Control and Prevention.

The first direct assessment of HIV infection trends shows that the recent
decline in U.S. AIDS cases is not due to a notable drop in new infections.
Rather, improved medical treatments are allowing infected people to stay
healthy longer before coming down with AIDS, overshadowing the reality of
an increasingly infected populace.

"The findings of this report give us a very strong message, that mortality
may be going down -- therapy is working -- but HIV continues its relentless
march into and through our population," said Thomas C. Quinn, an AIDS
specialist at the National Institute of Allergy and Infectious Diseases.
"These data tell us we have a lot of work to do."

The findings also confirm previously identified trends showing that women
and minorities are increasingly at risk. Especially worrisome, officials
said, is that the annual number of new infections in young men and women 13
to 24 years old -- a group that has been heavily targeted for prevention
efforts -- is virtually unchanged in recent years.

"It certainly documents that we have ongoing new infections in young
people," said Patricia L. Fleming, chief of HIV/AIDS reporting and analysis
at the CDC in Atlanta.

The report also shows continuing high numbers of new infections among
intravenous drug users, a population that has recently been the focus of a
political debate over the value of needle exchange programs that offer drug
users clean syringes to prevent the spread of HIV, the virus that causes
AIDS. [International financier George Soros yesterday offered $1 million in
matching funds to support needle exchange programs around the country, the
Associated Press reported.]

CDC officials would not comment directly on President Clinton's decision
this week to extend a ban on federal funding of needle exchanges. But both
Fleming and Quinn said that AIDS prevention programs in this population
need to be improved.

"It's clear that something stronger is needed to slow this epidemic," Quinn
said.

The new figures, in today's issue of the CDC's Morbidity and Mortality
Weekly Report, are based on HIV test results compiled by 25 states from
January 1994 to June 1997. They indicate that the number of new infections
during that period remained "stable," with just a "slight" decline of 2
percent from 1995 to 1996, the most recent full year included in the new
analysis. By contrast, deaths from AIDS declined 21 percent in 1996 and
dropped an additional 44 percent in the first six months of last year.

From 1995 to 1996, the number of HIV infections increased by 3 percent
among women. And it jumped 10 percent among Hispanics, although officials
said that figure was imprecise. Infections declined by 2 percent in the
white and 3 percent in the African American populations.

All told, the study tallied 72,905 infections during the survey period. The
number nationwide is much higher, since participating states account for
only about 25 percent of U.S. infections.

The single biggest risk category was men having sex with other men, but
heterosexual transmission continued its steady increase. Most of those
cases involved women contracting the virus through sex with male drug
users, Fleming said.

The survey is the first to track infection trends by looking directly at
HIV test results in people coming to clinics and other health care outlets.
That's a major change from the previous system, in which officials simply
estimated the number of new infections by counting the number of people
newly diagnosed with AIDS.

The old "back calculation" method worked fine during the first 15 years of
the epidemic, when HIV infection progressed predictably to disease over a
period that averaged about 10 years. With drug therapies now slowing
disease progression, however, the number of new AIDS cases no longer
reflects the number of new infections, and public health officials were
becoming uncertain about how they were doing in prevention efforts.

The new reporting system, now spreading to other states, has helped
officials regain those bearings, Fleming said. And although everyone wishes
the numbers were more encouraging, she said, at least officials now have a
clearer picture of the task at hand.

Tracking the Epidemic

Results of a study of AIDS and HIV diagnoses from 1994 through June 1997:

Who is diagnosed with HIV:

Women 62%

Men 28

Blacks 57

Whites 34

Hispanics 7

How they got it:

Male homosexual sex* 32%

Injecting drugs 18

Heterosexual sex 18

Drugs & homosexual sex 4

Other/unreported 28

* Thought to be underreported.

SOURCE: Centers for Disease Control and Prevention

) Copyright 1998 The Washington Post Company