AIDS Cases Drop in Baltimore, But Failure to Follow Drug Regimens Could Lead to Rise in Drug-Resistant HIV
Although the number of new AIDS cases continues to decline in Baltimore, the city is witnessing a rise in the number of cases of drug-resistant strains of HIV, the Washington Times reports. Baltimore had 585 reported AIDS cases in 2000, down from a "peak" of 1,297 cases in 1993. Baltimore Health Commissioner Dr. Peter Beilenson said that the decrease in AIDS cases can be attributed to "very intensive public health work," including more outreach from health department workers and increased screening and testing (Washington Times, 4/4). However, Beilenson said many of Baltimore's HIV-positive individuals are not properly following their antiretroviral treatment regimens, which has led to an increase in drug-resistant HIV strains. He added that 14% of new AIDS cases nationwide are resistant to two or more drugs, but the percentage is probably higher in Baltimore. Locally, the Baltimore Sun reports, the "epidemic is largely one of intravenous drug users," a group that is "notoriously" difficult to monitor. In addition, individuals who do not properly take their medications could pass on a drug-resistant strain of the virus, "making it difficult to impossible" for the newly infected person to find effective treatment, the Sun reports. "For people infected with those strains, we're going back 20 years to when the disease was universally fatal," Beilenson said. He added that while the number of AIDS deaths in Baltimore has not risen, "that could soon change" if drug-resistant HIV strains continue to develop.
Poor 'Disproportionately' Affected
Dr. Robert Redfield, director of AIDS clinical services at the University of Maryland Medical Center, said that since poorer urban residents are more likely to miss or skip medications, drug-resistant strains might "disproportionately" affect this population. He stated that this "could create a disturbing biological disparity across the city," with "untreatable strains among the urban poor" and "treatable strains elsewhere." Beilenson said that one solution could be increased outreach efforts, with health officials going into communities to personally monitor medication distribution. Such a program could be modeled after the city's "successful" TB control program, with health officials possibly delivering the drugs from vans stationed at locations throughout the day. The city could also provide "inexpensive alarm watches" to alert patients to take their medicine, he added (Bor, Baltimore Sun, 4/4).
Other STDs Also Decline
Most STD infection rates, including those for syphilis and gonorrhea, are also declining among Baltimore residents, the Associated Press reports. In 1997, Baltimore had the highest syphilis rate in the country, with 667 cases. However, the number dropped 67% to 218 in 2000 and will continue to decline over the next year, Beilenson said (Owens, Associated Press, 4/4). The city is now third in the number of syphilis cases (Baltimore Sun, 4/4). Baltimore still has the nation's highest number of gonorrhea cases, with 5,338 recorded in 2000. This figure, however, is less than half of the 10,939 cases the city recorded in 1992 (Associated Press, 4/4). However, Beilenson said he is "concerned about the spreading epidemic of hepatitis C," especially among the city's intravenous drug users. A recent study revealed that "well over" 90% of IV drug users in Baltimore have the virus, and Beilenson estimates that 36,000 of the city's 40,000 IV drug users are infected with hepatitis C (Baltimore Sun, 4/4). To lower this number, the city could implement needle-exchange programs and more blood screening and testing programs, he said (Washington Times, 4/4).