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Number of reported AIDS cases increases sharply in S. Florida
  By Bob LaMendola
Health Writer
South Florida Sun-Sentinel
February 17, 2005
New AIDS cases in Florida leaped by a surprising 24 percent last year, fueled by a growing failure of drug cocktails and an increase in patients who didn't know they were infected until they got sick, health officials said.
The state's first real jump in AIDS in more than a decade -- since before today's drug cocktails -- may signal a resurgence in the disease. Infection rates have climbed for several years as young adults have grown cavalier about practicing safe sex.
But officials said they hope the AIDS spike is only a temporary blip caused by a major campaign of HIV testing that found many new cases. Also, 2004 figures released Wednesday carried good news: New HIV cases dipped 3 percent. HIV causes AIDS, but patients can live for years without getting sick.
"We are seeing some patterns we don't like," said Thomas Liberti, AIDS director for the Florida Department of Health. "I would not feel so secure if we saw a big jump in HIV, too, but we didn't. I'm encouraged by that. We are going to be watching the trend closely in the next few months."
Among big metropolitan areas, Broward County had the biggest jump in AIDS cases, 49 percent higher than 2003. Cases in Miami-Dade County were up 33 percent last year.
"Am I concerned? A couple years ago I might have said yes," said Lisa Agate, AIDS coordinator for the Broward County Health Department. "We have done a lot of testing. I think that's all catching up."
The exception was Palm Beach County, where AIDS cases were flat and HIV cases fell by 17 percent last year.
"The numbers went down, but it wasn't a good year," said Larry Leed, deputy director of the Comprehensive AIDS Program of Palm Beach County. HIV is still spreading among young adults, and patients moving from out of state soak up federal program grants, which have been flat, he said.
A big portion of the increase in new AIDS cases are patients like Sam, of Fort Lauderdale, who unknowingly carried HIV for perhaps 15 years until the virus crippled his immune system enough that he got sick. The accountant, 60, who asked to remain anonymous, said he never got tested until he was diagnosed in June with an eye infection that signals AIDS.
"It's called the ostrich effect," he said. "I think I always knew. I was in a state of denial. `I don't have anything because I feel fine.' I never wanted to know, and my doctor never insisted."
Doctors have put him on antiretroviral drugs that he says reduced the virus and helped his immune system. But he and others like him missed the chance to catch the disease early, when it's easiest and cheapest to control with drugs.
Illnesses since his diagnosis have put Sam in the hospital six times and left him unable to work, to walk or to stand for long. The pills caused diarrhea and dehydration. Tell that, he says, to the young gay men and heterosexual adults who are ignoring or missing the message of safe sex.
"I'm on a cane. I feel like an old fart," Sam said. "I always thought AIDS was a death sentence. It's manageable. But it's still a chronic disease, and you have to deal with a lot of different things all the time."
South Florida has been a center of HIV/AIDS for years. While AIDS cases steadily dropped since the early 1990s, new HIV cases began climbing again in 2001.
In 2003, the latest year for which data are available, Miami-Dade County had the second-highest rate of AIDS cases per capita in the nation, behind New York City. Broward County was fourth and Palm Beach County sixth. Florida had the fourth-highest rate among states.
"In the black neighborhoods, they wait until the last minute before they get tested," said Carl Roberson, an HIV patient who chairs the Broward County HIV Planning Council. "That's for economic reasons. If it comes to paying the doctor or paying their rent, they're going to pay the rent."
Liberti said the state's campaign that has tested almost a million people since 2001 has found thousands of people who didn't know they were positive, some with AIDS.
Liberti said he was heartened that HIV infections had dropped in Broward and Palm Beach counties, and in every major metropolitan area.
Other AIDS experts said they were worried by a growing number of patients who progressed to AIDS because the virus had grown resistant to most or all of the drugs available. No figures on drug failure were available.
Studies show the virus can become resistant if the patient does not take drugs properly and on schedule 95 percent of the time. Patients who fail with one drug switch to another.
"Some people go on and off the drugs," said Dr. Michael Sension, a Fort Lauderdale AIDS specialist. "Maybe they have drug troubles; maybe they are in and out of jail; maybe the drugs are too hard on them."
But "it's not doom and gloom" on drugs, Sension said. Patients are failing on the early cocktail drugs from the mid- and late 1990s. Back then, patients had to take as many as 18 pills a day on complex schedules and experienced debilitating side-effects that made it hard to comply.
Newer drug combinations require only three pills a day, and a one-a-day drug might not be far off, Sension said.
Another factor could have affected the jump in new AIDS cases. A 2003 state policy requires doctors to log HIV patients' test results, which prompted them to retest many patients, said Dr. Luis Garcia, director of HIV surveillance at the Miami-Dade County Health Department. As a result, some of those were found to have progressed undetected to AIDS.
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