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AIDS deathtoll drops 19% decline recorded in 1st 9 months of '96; new drug mix noted; 'Entering a new era'; But concern voiced over disparity in race, gender percentages

WASHINGTON — WASHINGTON -- The number of AIDS deaths fell during the first nine months of 1996, a sign that new drug combinations may indeed be extending lives as doctors and patients had hoped.

"We really are entering a new era," Dr. Helene Gayle, acquired immune deficiency syndrome director at the U.S. Centers for Disease Control and Prevention, said in releasing the figures yesterday.

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During those nine months, about 30,700 people in the United States died from the disease -- a 19 percent drop from the 37,900 deaths reported during the same period a year earlier.

A similar decline was reported in Maryland, where 20 percent fewer people died in all of 1996 than in the previous year.

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Gayle attributed the national decline not only to advances in therapies, but also to an overall slowing of the rate at which the disease is spread. However, alongside the good news was the sobering caveat that these effects were not being felt evenly across America.

The decline was much greater among men than women -- and greater among whites than African-Americans and Hispanics.

"Certainly, it's enormously positive that we're seeing a decline in the number of deaths," said Liza Solomon, director of the Maryland AIDS Administration. "The disparity in the amount of decline by race and gender is a real concern and certainly gives us a target to work for."

Although Maryland has one of the nation's most generous programs of drug assistance to people suffering from AIDS, she said many women and minorities are slow to get the drugs because they are diagnosed late in their disease and have poor access to care.

"People may not know they are infected -- people whose lives are so chaotic and troubled they can't make good use of the system," Solomon said.

"There is still a lot of stigma. People may be afraid to come forward."

In Maryland, the gender disparities were even starker than they were nationally.

Statewide, 1,168 people died of AIDS in 1996, a 20 percent decline.

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That same year, 863 men died of the disease, a 25 percent drop.

Yet the decline among women was practically zero -- 305 deaths, compared with 306 the previous year.

Differences based on race in Maryland were not immediately available.

The disparities could not overshadow the fact that last year, for the first time since the epidemic surfaced in 1981, the number of AIDS deaths not only stopped climbing but actually fell.

The national figures released yesterday continued a trend started in the first six months of 1996, when 13 percent fewer people with AIDS died than in the first half of 1995. It was the first time a significant drop was recorded, but officials awaited yesterday's update to see if the trend was sustained.

In all, 45,765 people died of AIDS in 1995.

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Experts at yesterday's briefing noted that 600,000 to 900,000 people in the United States remain infected with the human immunodeficiency virus. And as long as there is no cure, patients will need care.

"AIDS is not over," Daniel Zingale, executive director of AIDS Action, an advocacy group. "If we treat it like it is over, it never will be."

Gayle said she felt confident that the decline will continue.

For one thing, much of the 1996 decline may be due to the use of drug combinations that included traditional drugs such as AZT and DDI -- but not the powerful "protease inhibitors" that were added to the drug arsenal early that year.

"Some of this [decline] actually predates broader use of protease inhibitors and is likely due to other combination therapies," said Gayle, who released the figures at a briefing organized by AIDS Action. "Thus far, we don't think the full effect of protease inhibitors has kicked in."

Protease inhibitors might intensify the trend, but their full impact will probably not be seen until the figures emerge for 1997 and the years beyond, she said.

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Doctors at the Johns Hopkins Moore Clinic, which has the largest AIDS caseload in the state, said patients on the new therapies have made startling improvements. Some who were close to death are now living independently; others have gone back to work.

"My feeling is that we have seen a decline certainly in deaths in our group of patients," said Dr. Pamela Tucker, who works at the clinic. "We can actually offer patients something that keeps them well for long period of time. From the provider's point of view, it's very encouraging and makes our job more worthwhile.

"From the patient's point of view, there's a lot of hope."

Pub Date: 7/15/97



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