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AIDS toll underestimated in IV drug users.

AIDS toll underestimated in IV drug users

New York City's intravenous drug abusers are dying of AIDS-related illness at rates far exceeding the official AIDS death toll for that population group. "Official AIDS statistics greatly underestimate the amount of [AIDS]-related deaths among drug abusers; they are probably missing at least half," says Don C. Des Jarlais of the New York State Division of Substance Abuse Services.

Des Jarlais, Rand L. Stoneburner of the New York City Health Department and their colleagues note in the Nov. 11 SCIENCE that from 1982 to 1986, New York City recorded 1, 197 official AIDS deaths among intravenous drug users. Their research, however, suggests that another 2,520 addicts died of AIDS-related illness during that same period.

Because of flaws in the AIDS surveillance system, health officials have "greatly underestimated" the impact of AIDS on minority communities where drug abuse is prevalent, Stoneburner says.

Public health specialists have long suspected a far higher number of AIDS-related deaths among addicts than those recorded by the government. Stoneburner and his colleagues investigated New York City's narcotics-related death rates and found sharp mortality increases starting in 1982. While death certificates attributed some of the deaths to AIDS, they listed many more as due to illnesses such as tuberculosis, heart-valve infection or pneumonia, which are common in addicts but not usually fatal. The research shows the pneumonia deaths probably were not from P. Carinii, a common AIDS infection.

The team found that many of those deaths appear to be the result of AIDS. A review of their medical records showed that many of the deceased drug users suffered symptoms of an early stage of AIDS, such as oral thrush, chronic diarrhea and weight loss. Stoneburner and his colleagues suspect the addicts had AIDS-damaged immune systems that left them vulnerable to infections. The deaths weren't classified as AIDS because they didn't meet the Centers for Disease Control's strict definition of the disease, which specifies opportunistic infections such a P. carinii.

Unreported AIDS-associated deaths seem most prevalent in one risk group: minority intravenous drug abusers, Stoneburner says. White drug users and homosexuals are dying of AIDS, but they don't usually die of the particular infections seen in the study. Stoneburner suspects impoverished minority drug users are more likely to be exposed to pathogens and less likely to receive prompt treatment.
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Author:Fackelmann, Kathy
Publication:Science News
Date:Nov 12, 1988
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