First the bad news. Worldwide twenty-two million people are infected with the AIDS virus. In addition 8,500 new infections occur each day while only two years ago that number was 7,500. Approximately two-thirds of the AIDS infections in the world are in sub-Sahara Africa. India, with its three million AIDS infected citizens now ranks as the country with the largest number of infected individuals. Behind India in the number of infected AIDS cases are South Africa with 1.8 million cases, Uganda 1.4 million, Nigeria 1.2 million and Kenya with 1.1 million.
Since 1981 when AIDS was first recognized, over five million individuals have died as the result of this disease and yearly death rates worldwide are now in the one million ran; ge. At home, AIDS has already claimed the lives of more than 325,000 Americans.
The good news is that new infection rates are stabilizing in the United States where estimates of infected citizens is in the 650 - 900 thousand range and actually decreasing in some countries like Thailand and Uganda. It appears that in Uganda and Thailand public education about safe sex is the main reason for the decline of new AIDS cases. Reports in these countries also indicate a decrease in the number of sexual partners, decrease in marital infidelity as well as increase in abstinence rates. It appears, therefore, that even in poor countries like Uganda, education about this deadly virus can reduce the tragedy of infection.
In the United States AIDS prevention programs are also working. The Center for Disease Control in Atlanta has reported an infection rate drop in San Francisco since the 1980's from 8,000 to 1,000 cases a year. These figures and statistics point to the fact that prevention does work to reduce AIDS cases worldwide in both rich and poor countries. Part of this prevention success has also been the significant increase in condom use. Nonprofit companies like Population Services International of Washington, D.C. reports that this year it will sell 175 million condoms in Africa compared to only about four million sold in the late 1980's before the company began distributing condoms.
There is more good and bad news. There was considerable optimism at the Vancouver meeting concerning the breakthrough in the treatment of AIDS patients that was realized this past year. A variety of new drugs including a class of drugs known as protease inhibitors in combination with other standard HIV drugs have shown considerable promise in short term use of keeping the AIDS virus in check and reducing AIDS to a chronic illness rather than one that is always fatal in a relatively short period of time. In some cases HIV positive patients have even tested HIV negative with treatment.
The bad news is that is not clear whether or not these newer drugs will hold up when given for an extended period of time. The AIDS virus seems to be able to adapt quite well to treatment in the past and the fear it will once again do so is ever present. Many of the study trials involve a small number of patients who have been treated for less than a year and it is well known that it takes an average of ten years of positive HIV status to evolve into full-blown AIDS.
Concern at the meeting was also raised about the possibility of multiple drug resistant HIV strains being caused by the new therapy and that many at-risk individuals will resume high risk activities because effective treatment in now available. In addition, some physicians have noted several patients who have failed this new and helpful combination therapy.
This new combination drug therapy is also very expensive costing approximately $12-$16,000 a year for each patient.
It has been estimated that if only half of the infected US citizens take these new drugs, the cost would be $6 billion a year. Since many AIDS patients are on Medicaid, this would put intense strain on this already financially troubled government program.
And what will happen worldwide in countries that have displayed either an inability or an unwillingness to pay for such expensive therapy? In many third world countries, access to basic drugs that treat known complications of AIDS such as tuberculosis, pneumonia, diarrhea, fungal infections and pain, is already severely restricted. Therefore, how can we expect those countries, which have some of the highest rates of AIDS in the world to begin using these newer effective, but expensive drugs?
Maybe during the 12th International Conference on AIDS there will be even more good and less bad news.
(Frank H. Boehm, MD is a professor of OB/GYN and Director of OB at Vanderbilt Medical Center in Nashville, TN. He can be reached at his web site http://dr-boehm.com. Dr. Boehm resides in Boca).