TIME: Almanac 1993/TIME Almanac 1993.iso/time/061989/06198900.009

Text File | 1992-09-23 | 5.4 KB | 105 lines

                ╛σ4                                                          MEDICINE, Page  52

Longer Life for AIDS Patients


New drugs are giving hope but also raising difficult questions

By DICK THOMPSON/MONTREAL


    A new generation of AIDS patients may be on its way. It is
a generation of hope -- not for a cure anytime soon but for a
longer and more productive life despite the disease. One of its
heralds is a 30-year-old housewife named Belinda Mason, who was
infected with the virus when she received a transfusion of
untested blood during delivery of her second child. She lives
in Tobinsport, Ind., a heartland town where AIDS services are
scarce and discrimination against patients is all too common.
Yet Mason, who is chairwoman of the National Association of
People with AIDS, is convinced she is witnessing the
transformation of the epidemic. Says she: "I think I'm going to
be in the first generation to see AIDS become a chronic,
manageable illness."

    Last week, as 11,000 physicians, scientists and health
officials gathered in Montreal for the fifth International
Conference on AIDS, evidence was building that Mason could be
right. While AIDS is still cutting lives short, early
intervention with new drugs is lengthening the time between
diagnosis and death and offering the hope that a full life for
the disease's victims may some day be possible. Said New York
City Health Commissioner Stephen Joseph in Montreal: "We are
very close to turning the corner on this epidemic." But there
is a price tag to this success. Medical b-ills for the growing
pool of infected people will be staggering. And a surprising
number of AIDS-virus carriers are returning to high-risk
behavior that could spread the infection to others.

    The gloom of AIDS is being eased somewhat by two drugs, AZT
and pentamidine. In 1982 less than 30% of gay men diagnosed with
AIDS in New York City lived more than 18 months. By 1987, after
the introduction of AZT, survival at 18 months jumped to 62.9%.
Says Michael Callen, a singer and songwriter who has had the
disease for seven years: "We need to change our conception of
AIDS. Not everyone dies of AIDS." Today about 70% of all AIDS
deaths result from Pneumocystis carinii pneumonia. But studies
reported in Montreal confirm that pentamidine inhaled directly
into the lungs is dramatically effective in preventing the
pneumonia from developing. Federal health officials are so
impressed by the drug that they will recommend that those
infected with the virus start monthly aerosol treatments as soon
as their immune systems begin to weaken.

    Like all AIDS care, other drugs showing promise in the lab
will be expensive. At typical dosages, AZT costs each patient
about $7,000 a year, and pentamidine up to $1,200. Since more
than 1 million people in the U.S. are believed to be infected
with the virus, the national AIDS medical bill is expected to
soar to between $4.5 billion and $8.5 billion a year by 1991.
Moreover, the demand for outpatient services, nursing homes and
housing for AIDS patients is expected to overwhelm health care
systems in the hardest-hit cities.

    For researchers the most urgent need may be to regain
control of studies being conducted to test the efficacy of
various AIDS drugs. Now that doctors have medications that work,
they need to find what works best. But for the past several
years, experimental drugs have first been available on the AIDS
black market, through which patients who felt they had little
to lose began their own treatment programs. The FDA, responding
to intense public pressure to demonstrate both compassion and
efficiency, has established a "fast track" for the approval of
AIDS drugs. However, that streamlining may have permanently
distorted the traditional protections afforded by careful drug
studies. Some scientists are demanding a stop to
self-experimentation.

    Despite all the progress, the AIDS virus still takes a
terrible physical and emotional toll. Each day at New York
City's Montefiore Medical Center, women infected with the AIDS
virus ask if they can still have children. Patients are told
that chances are greater than 1 in 4 that their child would be
born with the virus. The prognosis for these children is bleak,
especially since they may be orphaned.

    As people infected with the AIDS virus live longer, some
are drawn back to high-risk behaviors such as unprotected sex
or needle sharing, which exposed them to the virus in the first
place. Investigators in New York City have found that nearly a
third of the intravenous drug users who stopped sharing needles
because of the AIDS scare later started again. A study of gay
men in Chicago has shown that a quarter of those who had begun
to practice safe sex occasionally reverted to unprotected sex.
Officials in San Francisco are concerned that these behavioral
relapses may soon trigger another increase in new infections.

    The new drugs are extending lives, but it is uncertain
whether they are adding decades of productive life or merely
postponing by a few years the eventual calamity of early death.
And many of the lives being lengthened are either dangerous to
others or sexually isolated and childless. Says a 27-year-old
military officer infected with the virus three years ago:
"Meeting someone to marry is going to be very difficult. And
being celibate is not easy for anyone." Still, says Belinda
Mason, "every day is a gift."