AIDS Survival: First Drop in Total Deaths in U.S.; Larger Drop in France

On February 28 the U.S. Centers for Disease Control and Prevention reported that, for the first time, the total deaths from AIDS had dropped in the U.S. The decline was 12% from the first six months of 1995 to the first six months of 1996.

A CDC synopsis attributed the decline in deaths to "improvements in recent years in treatments which delay the progression of HIV and prevent opportunistic infections, coupled with the success of prevention efforts in slowing the growth of the epidemic overall. While it is too soon to determine the impact that protease inhibitors, as part of combination therapies, will have on these trends, these therapies promise to further lengthen the lifespan of persons living with HIV."

However, the total number of new AIDS cases diagnosed may still be increasing. In 1995 (the latest year for which an estimate can be made) the number of new cases increased 2% over the previous year -- a smaller increase than in earlier years.

Other major findings:

* "In 1996, non-Hispanic blacks accounted for 41% of adults reported with AIDS, exceeding for the first time the proportion who were non-Hispanic white."

* "Women accounted for an all-time high of 20% of adults reported with AIDS."

* The decline in deaths from the first six months of 1995 to the first six months of 1996 varied by region of the country.The decline was 16% in the West, 15% in the Northeast, 11% inthe Midwest, and 8% in the South.

* By ethnic group, the decline in total deaths was 21% amongnon-Hispanic whites, 2% among non-Hispanic blacks, 10% among Hispanics, 6% among Asians/Pacific Islanders, and 32% among American Indians/Alaskan Natives.

* Total deaths decreased 15% among men, but increased 3% among women.

* Deaths decreased 18% among men who have sex with men, and 6% among injection drug users -- but increased 3% among persons infected through heterosexual contact.

The full report is available through the CDC home page, http://www.cdc.gov.

Comment: While the total number of deaths obviously reflects access to care, it also depends on the total number of cases.
>From 1995 to 1996 there was a large increase in the total number of persons diagnosed with AIDS who were infected heterosexually -- usually women infected by partners who used injection drugs. This would account for part of the disproportionate increase in the number of deaths among women.

France Reports 25% Drop in Deaths

On March 1, France reported a 25% reduction of AIDS deaths,from 1995 to 1996. (Unlike the U.S. figures, the French statistics included all of 1996, not only the first half.) France also reported a 21% reduction in diagnosed AIDS cases from the first half to the second half of 1996.

The Health Ministry attributed the reduction in deaths to"the wide distribution of new treatments."

Comment

In comparing the French vs. the U.S. death statistics, it is important to remember that -- for better or for worse -- the U.S. is a much less centralized society than France, much less controlled by the central government. This could affect the comparison in many ways:

* The U.S. could not report statistics for all of 1996 at this time, because the reporting would be too incomplete.France could report for the whole year. Therefore its survival statistics could reflect the impact of protease inhibitors much more than the U.S. statistics, which so far only looked at the first six months of 1996.

* The U.S. has much greater variations in medical care than many other industrialized countries. In many parts of theU.S., the quality of AIDS care is likely to be very poor. New treatments could therefore take longer to impact the death rate.

* The 21% decrease in France in the number of new cases diagnosed -- compared to increasing new cases in the U.S. --might reflect inadequate U.S. AIDS prevention programs, due to political interference. These figures need attention,because they might help to document the cost of Federal mismanagement, and the extent of possible improvement if Congress would let health professionals do their job.