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Confused
May 7, 2003

I'm a bit confused about your response to the "How Many" question. If you say that there are approx. 1,000,000 HIV infected people in the U.S., and only 36 are on the AIDS Cocktails which are given all the acclaim for the decline in annual AIDS deaths, how is this possible?

If the majority of HIV positive people in the U.S. are treatment naive, we should see a rise in the amount of AIDS cases and not a steady decline.

Please explain.

Response from Dr. Young

Let me see if I understand your question.

First, it is estimated that there are about 1 million persons infected with HIV in the US. Unfortunately, many (as much as a half) don't even know that they're infected.

That leaves something around 500,000 who are actively accessing care. We know from pharmacy records that about 360,000 (not 36)persons are receiving antiretroviral medications in the US.

As for the decline in annual death rates-- this has been well established looking at the causes of death (say, from looking at death certificates or from studying cohorts of HIV infected persons- like our own HOPS/CDC study). The death rate for persons with CD4 counts less than 100 (those with advanced AIDS) has declined in the HOPS cohort from about 30 per 100 persons per year (1995)to less than 5 in 100 per year (2001). Hospitals that used to be filled with persons with HIV now find it unusual to have more than a couple of HIV infected persons as inpatients-- overall, a dramatic change in the demographics.

How is this possible, despite the minority of infected persons on medications? Simply stated, it is probable that the majority of persons with HIV infection are not in such serious condition that a death complication is likely. Another way of stating this is that most persons with HIV infection are asymptomatic, and under current treatment guidelines, do not warrant the use of antiretroviral therapy.

Hope this helps to clarify things. BY



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