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Risk of AIDS and death still falling for people with HIV

BOSTON (AP) _ Seven years into the modern era of AIDS treatment, the outlook for people with HIV infections continues to improve.

Encouraging new European data released Friday show that the risk of developing full-blown AIDS or dying of the disease is still falling.

In 1996, treatments became widely available that abruptly changed the prospects for people with HIV. These people once faced almost certain death, but the combinations of drugs have made HIV a treatable and largely survivable infection.

Still, many have wondered how long these benefits would last. Currently, 16 AIDS drugs are on the market, and many more are in development. Yet some patients have resistant forms of the virus that flourish despite shifting combinations of pills. Others have worrisome side effects, such as rising cholesterol levels.

However, figures presented Friday at the 10th Conference on Retroviruses show that despite all the drawbacks, the drugs continue to work well, and their benefits have not been exhausted.

Dr. Amanda Mocroft of Royal Free and University College Medical School in London outlined the outcomes of 9,803 people diagnosed with HIV in Europe between 1994 and 2002. Between 1994 and 1998, their risk of AIDS or death fell by 80 percent.

Since then, improvements have continued. Between September 1998 and 2002, the risk of AIDS or death has fallen 8 percent each six months.

``Even though therapy is not perfect, it's working,'' Mocroft said.

The continuing decline in death and AIDS is a surprise, she said. ``An awful lot of people expected the curve to bottom out or even rise again, but it's still going down,'' she said, ``which is very encouraging.''

The outlook is worst when people have high levels of virus and few of the blood cells that HIV attacks. Mocroft's team found that survival has significantly improved in recent years among people who start treatment with low blood counts but not among those with higher levels.

``It's quite remarkable. You have to wonder what the end of the story will be,'' said Dr. Kevin DeCock, head of the U.S. Centers for Disease Control and Prevention's program in Kenya.

In the United States, the CDC has followed 1,769 Americans diagnosed with HIV since 1994, and ``we have data that corroborates what the Europeans are saying,'' said Dr. Scott Holmberg, a senior epidemiologist.

The first goal of treatment is to drive down the virus so it falls below the ability of detection on standard tests, which can find 25 copies of HIV in a milliliter of blood. In the mid-1990s, many worried that virus levels would begin to rise again as resistant forms of HIV evolved, but Holmberg said the opposite has happened.

``We are seeing more people who are able to suppress to undetectable viral loads,'' he said. ``HAART continues to do better and better.''

HAART _ highly active anti-retroviral therapy _ is what doctors call the combinations of pills that have revolutionized the treatment of AIDS.

Holmberg said that while deaths from all causes among people with HIV have stabilized in the United States in recent times, deaths from AIDS itself have continued to fall. Instead, they are dying from heart disease, liver problems, cancer and other ills unrelated to their HIV infections.

Another analysis from Dr. Jonathan Sterne of the University of Bristol in England found that how people do in their first six months of treatment is more important in the long run than their initial blood counts and virus levels.

``It matters where you are, not where you came from,'' he said.

Those who have respond the best after six months have only a 2 percent risk of death over the next three years, compared with an 83 percent risk among those doing the worst after six months.
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