TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/061989/06198900.009

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MEDICINE, Page  52Longer Life for AIDS PatientsNew 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."