AIDS: You Haven't Heard Anything Yet

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-- AIDS is posing an economic threat in the U.S. The cost of caring for victims of the disease, many of whom are denied health insurance, is already estimated to exceed a billion dollars a year. By 1991 AIDS medical bills could total as much as $14 billion annually, according to Health Economist Anne Scitovsky of the Palo Alto (Calif.) Medical Research Foundation, "and that does not begin to address the loss in productivity from the death of people in the prime of life."

-- The prognosis for carriers of the virus seems bleaker than previously imagined. While public health officials first believed that perhaps 10% of those infected would go on to develop AIDS, evidence now suggests that at least 50% of them will progress to the full-blown disease. As more cases are reported, researchers have come to realize that the chances of developing AIDS are greater in the second five years after infection than in the first. "As time goes on," says Dr. James Curran, a top AIDS epidemiologist at the CDC, "only a minority of infected people will remain healthy. I feel less optimistic about a normal life span for any infected person."

But for all the staggering statistics, frightening findings and apocalyptic statements, uncertainties abound. Few experts expect the situation in the U.S. ever to reach the catastrophic proportions evident in Central Africa. While the African epidemic is spreading throughout the general population, in the U.S., it is concentrated among high-risk groups: homosexual and bisexual men and intravenous drug abusers. The proportion of heterosexual cases, however, is increasing at a worrisome rate. For the present the heterosexuals facing the greatest threat are those most likely to consort with infected drug addicts: mainly the inner-city poor, who tend to be black or Hispanic. "Two- thirds of the heterosexual cases now are black and Hispanic, concentrated on the East Coast," says Curran. "I would predict that AIDS would spread fastest in those communities."

The most encouraging difference between AIDS and epidemics of the past is the pace at which medicine is coming to grips with the crisis. "We're talking about a disease that was recognized from a practical point of view only in 1981," says Dr. Samuel Broder, who oversees the development of anti-AIDS drugs at the National Cancer Institute in Bethesda, Md. Since that time, he notes, the cause of AIDS has been discovered, the virus cloned, a blood- screening program implemented and development of a vaccine begun. Possibly most remarkable, the FDA is soon expected to approve the first therapeutic drug: azidothymidine (AZT), manufactured by Burroughs Wellcome.

AZT, which has already been given to more than 3,000 AIDS patients, is a source of optimism to AIDS researchers. "The drug has taught us that it is possible to make significant inroads against the virus," says Broder, "even in patients who are quite advanced." AZT not only prolongs survival, he explains, but produces "clinical improvements: weight gains, increased energy, neurological improvements." It can reverse one of the most disturbing symptoms of advanced AIDS: dementia and loss of mental function.