FEWER SUCCUMB TO AIDS IN U.S.; COUNTY DEATHS ALSO DECREASE.

Byline: Lawrence K. Altman New York Times

AIDS deaths continue to decline in Los Angeles County and across the United States, and the trend is expected to go on, public health officials said Monday.

Nationally, the number of deaths dropped 19 percent, to 30,700 from 37,900, in the first nine months of 1996, compared with the same period of 1995. Among women, the number of deaths dropped for the first time.

The overall decline was attributed to greater access to medical care and to development of newer drug therapies for the AIDS virus and for the myriad opportunistic infections that can occur as fatal complications of AIDS, itself a potentially fatal disease.

The national decline in deaths is reflected in Los Angeles County figures, which show a 56 percent drop in the first six months of 1997.

According to the Los Angeles County Department of Health Services, there were 1,345 reported AIDS deaths in the first six months of 1996, compared to 586 in the first half of 1997.

Dr. Paul Simon, a medical epidemiologist for the county, called these latest figures ``very good news,'' attributing the heavy drop to advances in medicine.

``It suggests the treatment is having a beneficial effect on these patients,'' he said. ``They are responding well to the medication.''

Despite the good news, Simon said he did not see the trend continuing at its current pace. He said he expects the figures to level off at some point because the AIDS virus eventually develops resistance to newer drugs.

Worldwide, AIDS cases and AIDS deaths are on the increase, and experts have said that the combination drug therapies that have helped reduce deaths in the United States are unlikely to have a similar impact in the regions of Africa and Asia where the disease is growing. The cost and difficulty of administering the therapies are barriers to their effective use in poor countries.

The decline in the United States began before the first protease inhibitor drug was marketed in December 1995, said Dr. Helene Gayle, who heads the AIDS programs of the Centers for Disease Control and Prevention in Atlanta.

Gayle and advocates for people with AIDS said they were heartened by the good news, particularly because some public health officials had suggested that improvements reported earlier by New York City and the CDC were due to incomplete reporting or statistical quirks.

``We have entered a new era in the HIV epidemic, both in terms of treatment and prevention,'' Gayle said at a news conference.

The number of people living with AIDS has increased 10 percent since mid-1995, Gayle said. But she and speakers from the AIDS Action Council, a Washington-based national advocacy organization that says it represents 1,400 AIDS service organizations, expressed deep concern about the disproportionate rates of decline in AIDS deaths among men, women and minority groups.

Deaths of women decreased by 7 percent, compared with the 22 percent decline in deaths among men. Yet, in the first six months, deaths among women had risen 3 percent. No explanation for the reversal was given. Of all AIDS cases now, 80 percent are in men and 20 percent are in women.

While the number of deaths dropped 28 percent for whites, the drop was 10 percent for African-Americans and 16 percent for Latinos.

In reporting data for the first six months of 1996, health officials earlier announced a 13 percent drop in the number of deaths. Over the longer period, the decrease grew to 19 percent.

Gayle said that her federal agency would analyze AIDS case reports to try to determine what proportion of the improved death rates was due to older and newer combinations of drugs to combat HIV and opportunistic infections.

The four marketed protease inhibitor drugs are vastly improving the condition of many people with the human immunodeficiency virus, which causes AIDS. But the drugs have not worked for many other people, either because they cannot adhere to the rigid schedules required for such therapy or because the therapy has failed them.

``Thus far, we do not think that the full effect of protease inhibitors has kicked in'' in this country because of low use among many groups, particularly the poor, Gayle said. ``We hope that with more and more people getting protease inhibitors, we may see an even greater effect'' on the death rate.

However, Gayle and the AIDS Action Council warned that the gaps would widen if the newer drug therapies were not made available to more people with HIV. A government-appointed panel of AIDS experts recommended last month that combination anti-HIV therapy be offered to infected individuals.

A survey conducted by AIDS Project Los Angeles found that knowledge about such drug therapy was low among African-Americans and non-English-speaking people with HIV, and that access to protease inhibitors was limited among many uninsured and poorly educated groups.

One reason behind the optimism expressed Monday is that the incidence of new AIDS cases has slowed dramatically in recent years. The increase in AIDS cases was 2 percent in 1995, the latest year for which data are available, a large drop from the increase of 85 percent per year in the mid-1980s. Gayle said that if the trend continued, as expected, the incidence of AIDS cases could drop for the first time when the data for 1996 are fully analyzed and reported later this year.

``New AIDS cases are now increasing most rapidly among women, particularly minorities,'' Gayle said, and ``heterosexual transmission is the fastest-growing mode of transmission.''

However, it takes several years for HIV infection to develop into AIDS. And at least 40,000 new HIV infections are occurring each year, Gayle said.

Daniel Zingale, the executive director of the AIDS Action Council, said the new figures ``underscore the need for a concerted national effort to remedy the inequities that exist in access to federal HIV prevention programs and health care services, inequities which significantly contribute to the spread of HIV.''

The Centers for Disease Control and Prevention estimates there are from 600,000 to 900,000 infected people in the United States. The average cost of the new drug therapy can be $15,000 a year, not including the costs of medical care and the laboratory tests that are needed to monitor the therapy.

Christine Lubinski of the AIDS Action Council called on government officials to double the budget for anti-HIV drug therapy. She said that before the marketing of most protease inhibitors in 1996, 65,000 people received support from the AIDS Drug Assistance Program, which had a budget of $207 million. The 52 ADAP programs are paid for by the federal government with support from some states. Last year, ADAP and other federal programs had a budget of $385 million to meet the drug therapy needs of an estimated 80,000 HIV-infected people, Lubinski said.

Dr. Victoria Sharp of St. Luke's-Roosevelt Hospital in Manhattan said the new therapies are allowing many more AIDS patients to stay out of the hospital and saving insurers $190 million a year. But Sharp said the savings were not being put back into outpatient care, leaving ``medical providers caught in a revenue crunch'' that does not provide enough money for such care.

In closing the conference on a cautious note to counter any overenthusiasm about the favorable trend about AIDS death rates, Zingale of the AIDS Action Council said: ``AIDS is not over, but if we act like it is, it may never be.''