New mortality data from the US Centers for Disease Control and Prevention (CDC) suggest the numbers of Americans dying from AIDS continued to fall in 1998. However, the rate of decline was considerably slower than that observed in 1997.
Though the absolute number of deaths was lower in ‘98 than for the previous year (down to 17,047 from 21,222), this represents a 20% decline in the mortality rate between 1997 and 1998, compared with a 47% reduction between 1996 and 1997. The tumbling death rates seen during this period have been linked with the introduction of more effective anti-HIV treatments, in particular protease inhibitors.
While close monitoring will be required to fully determine the reasons for this slowing decline, public health researchers believe a combination of factors are likely to be contributing. It’s possible that those people with a diagnosed HIV infection who might benefit from treatment have already been reached by the US healthcare system, and that treatments themselves are beginning to fail, whether through the emergence of resistance, toxicities, or other causes.
The search for effective second and third-line ‘salvage’ therapies has dominated the AIDS research agenda throughout 1999. HIV’s rapid and error-prone reproduction means drugs used to treat HIV infection are highly vulnerable to drug resistance. Though the use of multi-drug combinations able to suppress HIV to minimal levels are now known to fend off resistance, the many people who began treatment in earlier years carry strains of HIV resistant to several, or even to all currently available treatments. In these circumstances, assembling a new drug regimen, which has a reasonable chance of suppressing the virus and in turn supporting the immune system, may be extremely difficult. See Changing treatment here on aidsmap.com for more on these issues.
Of further concern for US health officials is the disproportionate impact of the epidemic on Black Americans, who represent 13% of the US population but make up 49% of all AIDS deaths. AIDS death rates in 1998 remained almost ten times higher amongst blacks than whites, and the decline was slower too, falling just 17% in 1998 and 35% in the previous year.