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AIDS Detective's Grim Conclusion: Worst of Epidemic Is Yet to Come

March 10, 1988|DENNIS BREO | Dennis Breo is special assignments editor of American Medical News.

During the 1970s, as the nation lived through its drug and sexual revolutions, Dr. James Curran of the Centers for Disease Control in Atlanta was tracking mini-epidemics of genital herpes, resistant strains of gonorrhea, hepatitis B, genital warts, chlamydia and other forms of pelvic inflammatory disease. In May, 1981, when the first five puzzling cases of what would turn out to be acquired immune deficiency syndrome were reported to CDC from three Los Angeles hospitals, Curran was assigned to the mystery. Subsequent cases among young homosexual men predominantly from New York involved Kaposi's sarcoma, a rare cancer previously confined to elderly men of Mediterranean heritage. The task force Curran was by then heading became known as the "Kaposi's Task Force."

In this interview, Curran, one of the world's leading experts on AIDS, talks about the future of the disease as a threat to us all.

"Kaposi himself is a strange case," Curran said. "He was a Hungarian Jew named Morris Cohn who was very ambitious and who became a dermatologist and married the daughter of the chairman of dermatology at the University of Vienna Medical School. The chairman suggested to him he might do better with a different name, so he became Morris Kaposi. In 1867, he discovered 'Kaposi's sarcoma.' "

That rare cancer and many others are among those afflicting AIDS patients.

"The epidemic will get much worse before it gets better, both here and throughout the world," Curran said.

Question: What is the future of AIDS?

Curran: The question comes in two parts: Where is the epidemic headed in this country and where is it headed throughout the world? Currently, we have much more information about what is going on here than we do elsewhere in the world.

For the U.S., the outlook is very sobering, and we must conclude that AIDS is endemic to the United States. During the last 12 months, there have been 20,000 new cases of AIDS reported to CDC, for an overall total of almost 50,000 (48,574 as of Dec. 14, 1987), and statistics show that 60% of all patients will die within 1 1/2 years of diagnosis and upwards of 90% within three years. We can expect that the number of American AIDS cases will increase for the rest of this decade and that the problem will be with us for the rest of this century.

Our best estimate is that 1 million to 1.5 million Americans have been infected with the human immunodeficiency virus (HIV), and I am confident that this figure is neither too high nor too low. Our data show that within 7.5 years, 35% of all those now infected with the virus will progress to full-blown AIDS and that another 40-45% will progress to AIDS-related complex (ARC) or have lymphadenopathy or other signs of immunological abnormality. Just 20% will remain asymptomatic, and these patients, too, will probably in time become ill.

Our surveillance provides little hope that this is a benign infection. So we are looking at hundreds of thousands of AIDS patients who in the near future will require lifetime care and counseling.

It is an enormous problem, and AIDS continues to spread through sex, through needles and through childbirth.

The good news is that middle-aged gay men appear to have listened to our message, and we are seeing a dramatic drop of new cases among gay men.

The bad news is that the intravenous drug abusers appear not to have listened to our message, and they are our biggest concern. The epidemic of intravenous drug abuse is absolutely central to the spread of AIDS among heterosexuals and children.

The risk to heterosexuals remains unknown, but clearly it is more of a problem in areas like the inner city, where the drug abusers cluster.

Worldwide, there is less data available, but it appears that AIDS is less of a problem in Asia and Europe than in America. It is a growing problem in the Caribbean, and it is a much greater problem in Africa than anywhere else in the world. The World Health Organization estimates that there are 5 million to 10 million AIDS cases worldwide, and I am inclined to accept this estimate, with the caveat that less is known about the world picture than the American picture.

Q: There seems to be a backlash in the news media and a smugness in the general population, suggesting that there is little, if any, risk to heterosexuals who do not abuse intravenous drugs. What is the real risk to heterosexuals who have no acknowledged risk factors?

Curran: There has always been a waxing and a waning of concern about the risk of AIDS to heterosexuals. People want simple answers--like AIDS is going to kill everybody or heterosexuals do not have to worry. The truth, of course, is in the middle, and we can't give many people what they want--to be told, "It won't happen to me!"

On the other hand, some people want to think that if everyone's behavior does not fit their norm of what is acceptable, then everybody should die, and this is not the case, either.

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