Rising AIDS-Related Deaths in Arizona County Raise Concerns About Treatment Failure
For the first time in "years," AIDS-related deaths are rising in Pima County, Ariz., raising concern among doctors, health care workers and AIDS advocates that AIDS treatments are beginning to fail, the Arizona Daily Star reports. The advent of highly active antiretroviral therapy in late 1995 changed HIV from a "sure death sentence" to a "survivable chronic infection." Deaths from AIDS-related complications "plunged" from 50,000 in 1995 to 16,000 in 1999. But now many in the AIDS community say their "worst fears" -- that the "breakthrough therapy" would someday fail -- are coming true. Dr. Kevin Carmichael, whose three-physician practice treats most of Tucson's HIV-positive patients, said at the current rate, his office will see patient deaths "at least double." Carmichael said that at this time last year, he had lost seven of almost 1,000 patients to AIDS-related complications; so far this year he has had 18 patients die. "Earlier this year, we thought this might be a fluke -- just a temporary unexplained spike, a few bad weeks. But we have to face the fact it's much more than that," he said, adding that these are the first cases to represent the "failure of therapy." Carmichael said, "It is beginning to feel like the bad times, when we lost people every week." Danny Blake, director of client services for the Southern Arizona AIDS Foundation, said his agency is "seeing and hearing of people getting sick all the time now." He added, "It's been a long, long time since anyone has felt this kind of fear." Although the CDC cannot confirm or refute a possible national increase in AIDS deaths because figures for 2000 and 2001 are not yet available, the agency has noted a "leveling off" of AIDS deaths since 1996. CDC spokesperson Kathryn Bina said, "[N]o one here would be surprised to see them start to go up everywhere as treatment fails."
Return of Risky Behavior
The increasing death rate "destroys the notion that HIV is not really a problem anymore," Carmichael said. "We are now starting to see the limits of what we can do, around the country. We are not able to control the virus. AIDS is ultimately still a death sentence," he added. The Daily Star reports that HAART may have "[f]alsely liberated" many people from feeling they have to continue practicing safe sex. Scott Davey, coordinator of the gay men's health project at the AIDS Foundation, said, "There is a lot of unsafe behavior going on." The Daily Star reports that the "most blatant sign of risk-taking" may be seen in the return of bathhouses, "notorious for unprotected anonymous gay sex with multiple partners." Most houses were closed during the 1980s after the epidemic grew, but the houses are resurfacing; two new bathhouses have opened in Phoenix in the last few years. According to Davey, people are willing to take risks because they are hoping that new, more powerful drugs will be developed to battle the virus and "rescue them from the now-failing treatments." An "experimental four-drug regimen," known as "super-HAART," is currently being tested among 30 patients at a New York City clinic who have experienced treatment failure with other drugs. Carmichael said, "The race is on -- between the body's resistance and our ability to get new drugs tested and out there. But unless and until we win that race ... the period when everyone benefited is over" (McClain, Arizona Daily Star, 5/3).