New AIDS cases
reach 10-year low

But experts say the picture
would be different if HIV,
were a reportable disease

By Helen Altonn
Star-Bulletin

Hawaii had 97 new AIDS cases last year - the lowest in 10 years - but things "aren't hunkey dorey" despite more effective drugs, says an AIDS patient and advocate.

"The truth is 50 percent of the people who try new protease inhibitors are failing on them," said Bill Healy, president and treasurer, People With AIDS Coalition Hawaii Inc.

He fears people are being lulled into thinking the AIDS problem has been beaten.

"The battle against AIDS is not over yet, much as we'd like it to be," he emphasized. "I wish it was over myself. I've been living with it for 10 years."

Healey said protease inhibitors have been helping AIDS patients live longer.

Still, people are dying of AIDS, he pointed out.

Peter M. Whiticar, head of the state Health Department's Sexually Transmitted Diseases and AIDS Prevention Branch, agreed the picture is skewed.

"People with HIV (human immunodeficiency virus) are not progressing to an AIDS diagnosis. So, although it appears to be good, it's not the whole story," Whiticar said. "A lot of people are being left in HIV without the stage of AIDS."

It's estimated that between 2,300 to 3,200 Hawaii residents have HIV. But AIDS is a reportable disease and HIV isn't - a situation Whiticar and others want to change to get a better picture of the epidemic. This is important because people infected with HIV will need services, Whiticar said.

He said he's convening a task force with representatives from Healy's group, AIDS service organizations, state government and physicians to look into an HIV reporting system by laboratories and doctors.

"The issue then is whether it's by name, or by an identifier or some code," Whiticar said. "In this state, there is very strong support for a coded system."

Such systems haven't been very successful in Maryland and Texas, he said.

However, he said Hawaii may be able to create a workable system because people aren't crossing state lines, laboratories are limited and service providers and clients have a good relationship.

Whiticar hopes to have HIV data within a year, saying it's important for planning and allocation of resources and keeping legislators up-to-date on the epidemic.

"The actual number of clients served increased last year," he said.

"New people are coming in, although people are not dying at the same rate."

The ideal scenario is to catch people early in the infection and take care of them when they have a stable lifestyle, Whiticar said, pointing out, "It's not easy to take medications."

He said 20 to 40 drugs a day may be involved with different requirements: "Before and after meals, on a full stomach, an an empty stomach. Many people have to design their day around the regimen."

Healy said he's taking a triple combination of medications, including a protease inhibitor. All are highly toxic and have side effects, he said.

Dr. Cyril Goshima, Honolulu internal medicine specialist who treats HIV/AIDS patients, also stressed that the AIDS fight is far from over, although lives are being prolonged.

"Now that we have ways of measuring actual viral activity, we know the medications are working," Goshima said. "We also know the medicines need to be taken on a regular basis in order to suppress the virus."

However, treatment is complicated, with 9 to 12 or more pills required daily just to control the HIV virus, he said, "let alone a lot of other things they may have to take for prevention of pneumonia or other things."

Patients may not remember to take all of the medications or tire of taking them or not take them properly, Goshima said.

"That's when resistance occurs. And when that occurs, you quickly limit the options of medications you can take. Often, resistance to one medication will cause resistance to another. . . . You really limit options for the future."

The drug combinations also are extremely expensive, Goshima said.

"And we're not talking about something they're just going to take for a week. We're talking about indefinite usage."

Healy cited another problem: Women aren't included in studies done before products go on the market, he said. "As a result, women react entirely different to them."

Goshima acknowledged "very limited information on females" for a lot of medications. He said it's a major complaint that studies don't include many women, who "can possibly respond differently."

He stressed that, while the situation is better, much more research is needed "because we don't know how long these sorts of things will last."

The larger numbers of people with HIV are "more reflective of what the epidemic is doing," Goshima said.