New Data Suggest Limits to AIDS Drugs : Statistics: Although deaths continue to decline, the dramatic reductions of previous years have not been repeated. The figures upset hopes that the epidemic is under control.

WASHINGTON —  Although deaths from AIDS continued to drop in 1998, the decline fell far short of the dramatic reduction of the previous year, public health officials said Monday, dampening hopes that powerful new drugs finally have brought the epidemic under control.

That patients have been living longer and with a nearly normal quality of life had inspired a public sense of euphoria over the battle against AIDS. But the latest statistics, from the national Centers for Disease Control and Prevention, suggest an eventual leveling off of the death rate at many thousands per year unless there is further progress against the disease.

“People want a quick fix to this epidemic,” said Dr. Helene Gayle, who directs AIDS programs for the CDC. “Progress has been good, but there are no quick fixes.”

The new statistics strengthen the long-held view among public health officials that the answer to curbing the epidemic lies in more prevention efforts and access to care and treatment, as well as in continued investment in research to develop more potent drugs.

“Any drop in AIDS deaths is good news--but these data suggest that further reductions will require new approaches,” said Dr. Jeffrey P. Koplan, director of the CDC.

AIDS deaths, which dropped for the first time in 1996, plunged by an astonishing 42% in 1997 as patients made growing use of drug combinations, or “cocktails,” that included potent new drugs known as protease inhibitors. Last year the decline was 20%--still significant but not as sharp as in the previous year.

New AIDS cases are showing the same pattern, CDC officials said. They declined by 18% in 1997 but only 11% last year.

“It’s not a reversal by any means--yet,” Gayle said.

Altogether, there were 44,289 new AIDS cases in 1998, and 17,047 Americans died of the disease. There are about 900,000 people in the United States infected with the AIDS virus, the CDC estimates.

CDC officials said that the leveling off of progress against AIDS probably reflected a combination of numerous factors.

For example, most individuals who know they are infected by the AIDS virus are already being treated and may have received the maximum benefit. Like all AIDS drugs thus far, the newest ones probably have a short duration of impact before the virus becomes resistant to them.

Also, many patients have a difficult time adhering to the complicated and cumbersome drug regimens.

“I see it in my patients all the time--the drugs just don’t work forever,” said Dr. Lawrence Deyton, director of AIDS services for the Department of Veterans Affairs, the largest single provider of AIDS services in the country. “Of those I started on these drugs two or three years ago, probably only 5% to 10% of them are still on a successful regimen. The vast majority can’t tolerate the medications, or [staying with the regimen] is just too much for them.

“The drugs have shifted the death curve to the right,” he added. “They are prolonging the time that somebody has the disease and can be treated. But these people are ultimately dying. It’s just taking longer.”

Steven Fisher, a spokesman for AIDS Action, a Washington-based lobbying and education group, said of the new data: “Our worst fears have become a tragic reality. For the first time, our concerns about current AIDS treatments are confirmed by a leading epidemic indicator.”

The new data, which were presented at a conference in the CDC’s headquarters city of Atlanta, included close-up looks at selected cities.

In New York City, AIDS deaths dropped 63% in the two years between 1995 and 1997 but only 25% between 1997 and 1998, said Mary Ann Chiasson, of the New York City health department.

In Seattle the slowdown was even more striking. AIDS deaths there declined by only 27% between 1997 and 1998 after plunging by 66% in the single year from 1996 to 1997.

While Los Angeles County did not release data at the Atlanta conference, Dr. Peter R. Kernt, director of HIV epidemiology for the county, said that the number of AIDS deaths there declined 52% between 1996 and 1997, and 34% between 1997 and 1998.

“Declines in mortality appear to be slowing in Los Angeles County for all racial-ethnic groups,” he said, “and it is expected that these decreases in mortality will eventually become level or stabilize.”

Minorities, who have been hit disproportionately hard by the AIDS epidemic, have benefited less than whites from the recent progress against it, the CDC figures showed.

For example, AIDS deaths fell 35% in 1997 and 17% in 1998 for African Americans, compared with 51% and 22% for whites. AIDS death rates for blacks remained nearly 10 times higher than for whites and three times higher than for Latinos.

Blacks, who make up about 13% of the population, accounted for 49% of AIDS deaths in 1998. Thirty-two percent of deaths were among whites, while 18% were among Latinos.

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Leveling Off

Deaths from AIDS continued to decline last year for the third straight year, but the rate of change was not as steep.

Thousands

1995: 49,351

1998: 17,047

Source: Centers for Diease Control and Prevention