AIDS Death Rate in U.S. Declines for First Time

WASHINGTON —  For the first time since the AIDS epidemic began in the United States 16 years ago, deaths from the disease have declined nationwide, federal health officials reported Thursday.

And in a sign that the trend is likely to continue, the encouraging numbers do not significantly reflect the growing use by AIDS patients of powerful new drug combinations that include protease inhibitors, which appear likely to extend survival further.

Deaths among people with AIDS dropped 13% during the first six months of 1996, compared with the same period the previous year, according to the federal Centers for Disease Control and Prevention. A separate tabulation of AIDS deaths for the entire year in Orange County found a decrease of 14.7%, county health officials said.

Health officials attributed the reduction to increased resources devoted to treatment and prevention, particularly in improved therapies designed to stave off often life-threatening AIDS-related infections.

“The protease inhibitors and combination therapies are apparently what’s responsible for this,” said Dr. Ron Taylor, program manager for the Orange County Health Department’s HIV Program. “We’re getting fewer AIDS cases reported, which could mean that more people who are HIV-infected are not progressing to an AIDS diagnosis. And the drop in the mortality indicates that those with AIDS are remaining alive.”

However, he said the long-term effectiveness of the new treatments remains untested as doctors report increasing numbers of patients “crashing”--developing sudden intolerances to the drugs.

“No one has been on these long enough to see if they’re really going to work for the long term,” Taylor said. “We’re extremely hopeful, but it will probably be a few more years before we really know.”

Local and federal officials stressed that the new trends should not cause complacency among the public.

“We’re finally seeing deaths go down, but it’s not good enough,” Health and Human Services Secretary Donna Shalala said. “Too many people are still dying, and too many people are still getting infected. The new drugs don’t work for everyone. We must still focus on prevention.”

Lorri Mier, HIV program manager for Orange County’s AIDS Response Program, said the decrease should not lead to reduced efforts to combat the disease.

“Our attitude is that whenever you get complacent and people start thinking there’s a cure on the horizon, that’s when you can really get into trouble,” Mier said. “We’re still going full force with all of our prevention programs.”

Ralph Bassett, program manager for the Laguna Shanti AIDS-support organization, said AIDS workers have noticed the decline in mortality. But he stressed that that means the needs of AIDS patients are simply changing.

“There is just as much client activity going on,” Bassett said. “What they’re not needing is to make out their wills, basically.”

While the overall numbers are upbeat, the patterns varied among gender and racial groups and risk groups, with some not faring as well as others. “The numbers are shifting to our most vulnerable people,” Shalala said.

For example, while the number of AIDS deaths declined 15% among men, deaths among women were up 3%. Also, deaths declined 18% among gay men and 6% among intravenous drug users, but increased 3% among those who had become infected through heterosexual contact.

The news was not entirely unexpected. Last month, during a major AIDS meeting here, New York City health officials reported a substantial and unprecedented drop of nearly 30% in AIDS deaths there and federal officials saw it as a harbinger of a national trend.

Also Thursday, the HHS said it would release an additional $202 million in funds under the Ryan White Comprehensive AIDS Resources Emergency Act, which provides resources for treatment of people with HIV and AIDS.

Many local health officials have credited the drop in AIDS deaths to funding increases in this program that have made therapy and health care services more accessible.

The CDC reported that AIDS deaths increased steadily through 1994, but increased only slightly in 1995, which was viewed as a leveling off when adjusted for increases in the population.

During January through June in 1996, there were an estimated 22,000 deaths, compared with 24,900 reported during the same time frame in 1995. In Orange County, there were 232 deaths in all of 1996, compared with 272 deaths the year before.

Deaths declined in all four regions in the United States, with the West experiencing the greatest drop, 16%. The Northeast experienced a 15% drop, while the number was 11% in the Midwest and 8% in the South.

The number of AIDS deaths declined among all racial/ethnic groups. The drop was greater among whites (21%), than among blacks (2%) or Latinos (10%).

In more good news, the CDC said that while the number of people diagnosed with AIDS continues to grow, the rate of growth has slowed in recent years. Between 1994 and 1995, the number of people diagnosed increased 2% from 61,200 to 62,200. Between 1993 and 1994, the growth rate was 5%.

In Orange County, there was a decline in new cases, with 437 reported in 1996 compared with 563 in 1995, county health officials said.

If these trends continue, “hopefully, with a combined strategy to prevent new infections and to provide early diagnosis and treatment for people who are infected, AIDS incidence will soon begin to decline,” CDC said.

Times staff writer Scott Martelle contributed to this story.