PAGE ONE AIDS Death Rates Fall Among Adults 25 to 44

Sabin Russell, Chronicle Staff Writer

SAN FRANCISCO

AIDS has been displaced as the leading cause of death
among Americans in the prime of life, a tribute to the
power of new drug therapies and years of prevention
efforts.

Federal researchers yesterday reported that the AIDS
death rate among adults ages 25 to 44 had fallen 26
percent in 1996, an astonishing drop among the core
population where AIDS has struck the hardest.

Health and Human Services Secretary Donna Shalala hailed
the findings as ``a truly remarkable achievement,'' the
highlight of an administration report that also showed
significant lowerings in the rates of infant mortality,
homicide and teen pregnancy.

Since the epidemic began in 1981, deaths from AIDS
climbed relentlessly, and in 1994 the disease became the
nation's leading killer of younger adults in America,
outpacing deaths from all accidents, such as car wrecks,
plane crashes, falls and drowning. The decrease in AIDS
deaths means that accidents are again the No. 1 cause of
death among younger adults.

The latest figures put the AIDS death rate in the adult
group at 27.2 per 100,000, compared with 36.9 in 1995.
``This is one of the largest drops we've ever seen in
the death rate from a single cause in a single year,''
said Kimberly Peters, a federal statistician with the
Centers for Disease Control and Prevention.

AIDS experts say there is no single cause that can
explain the decrease, but the use of new anti viral
drugs approved in late 1995 and early 1996 clearly are
playing a role.

``This is a payoff from a combination of research,
clinical trials, drug development and behavior
modification,'' said Dr. Anthony Fauci, director of the
National Institute of Allergy and Infectious Diseases,
the federal government's leading agency for AIDS
research.

Fauci also attributed the declining death rate to the
dramatic shift toward safer sex that occurred in the
mid1980s, which sharply reduced the infection rate
among gay men. Because it can take more than 10 years
for an HIV infection to develop into AIDS, the decreased
death rate was, in effect, predicted more than a decade
ago by successful prevention efforts.

Fauci said strides made in the treatment of the
opportunistic infections that ultimately kill AIDS
patients also have saved lives, as has the growing
understanding among doctors about how best to manage the
disease. ``The longer you do something, the better you
get at it,'' he said.

Yesterday's report by the National Center for Health
Statistics is just the latest in a string of encouraging
stories of progress in the battle against AIDS, but the
good news is tempered by the still horrific death rate
for the disease, and concerns that the favorable trend
may not continue.

Fauci cautioned that the heartening statistics could
take a nasty turn upwards in the future, if the
beneficial effects of the latest AIDS drugs wear out.
The latest drug regimes, centered on combinations of new
protease inhibitors and older antiviral drugs, could
simply be postponing deaths that will occur in great
numbers later on.

He also noted that the favorable results in the United
States are not occurring in Africa and Asia. ``Not only
are deaths not tapering off, but they are accelerating
with no end in sight,'' he said. ``From a global
standpoint, this epidemic is still out of control.''

Timothy Rodrigues, a spokesman for the San Francisco
AIDS Foundation, said there are many reasons to be
cautious about the latest statistics. ``The challenge is
that we are starting to see some people fail with the
protease inhibitors,'' he said.

The increased longevity of AIDS patients also is
straining the fragile infrastructure of services such as
housing and medical care. With more people not dying of
AIDS, there are more people living in need of help.
Patients who once were resigned to what seemed like
certain death are now struggling with issues such as
whether and how to return to the workforce.

Tom Coates, director of the University of California at
San Francisco AIDS Research Institute, notes that the
benefits of new medical care are not being shared
equally by all segments of society.

The federal study found decreasing death rates among
many segments of the AIDS community, but the rate of
decrease was not identical. In the same age group, the
rate for men fell 27 percent, and the rate for women 17
percent. Among white males in the group, the death rate
fell 32 percent, while the death rate among black males
of the same age fell only 19 percent.

``These figures point to the discrepancy between what's
available for much of the population and what's
available to poor people,'' he said.

In addition to the decline in AIDS deaths, federal
statisticians found that:

Homicide rates per 100,000 population fell 11
percent, to 8.4 in 1996 from 9.4 the prior year.

Infant mortality fell to 7.2 deaths per 1,000 live
births. One third of the decline is attributed to a 15
percent decline in deaths due to sudden infant death
syndrome. Deaths decreased after researchers urged
parents to have their babies sleep on their backs or
sides, rather than their tummies.

Teen birth rates among 15 19yearolds fell 4
percent. The figure has declined by 12 percent since
1991.
_ The Chronicle Publishing Company