^bc-magic-treatment<

^(wap) (ATTN: National editors)<

^Experts Won't Speculate on Potential Treatment for Johnson<

^By David Brown=

^(c) 1991, The Washington Post=

WASHINGTON _ A healthy man in his thirties recently infected with the human

immunodeficiency virus (HIV) has about a 1-in-2 chance of living 10 years

before developing AIDS. The average life expectancy after the first symptoms

appear is about two years.

Improved drugs aimed at staving off the symptomatic period of HIV infection,

and better treatments for the late-stage infections that usually kill AIDS

patients, may extend both the early and late stages of the disease.

Those were the conclusions of several experts in the natural history and

treatment of HIV infection interviewed Friday in the aftermath of basketball

superstar Magic Johnson's announcement that he is infected with HIV.

None of the experts would speculate specifically on the possible course or

treatment of Johnson's illness. Virtually nothing has been disclosed of the

medical details of his case beyond the positive finding of HIV. A spokesman for

Michael Mellman, one of the Los Angeles Lakers' team physicians, said the

doctor would not comment on Johnson's case.

There is no scientific research on whether physical activity such as that in

playing professional basketball could accelerate progression of HIV infection,

though several experts said they were not surprised that Johnson was advised to

stop playing.

``There is some medicine that is practiced at the level of common sense,''

said Lewis K. Schrager, a researcher at the National Institutes of Health on

the relationship between behavior and the biology of AIDS. ``We are not talking

about pickup basketball games here. We are talking about an incredibly grueling

schedule that involves travel, lack of sleep, long days and extraordinary

physical stress. There is nothing proven, but it just makes sense that you'd

want to limit that.''

Aside from basketball, Johnson's case may be best compared to that of the

516 men who acquired HIV infection through sexual contact early in the epidemic

and whose course is being followed by the San Francisco city health department.

The average age of that ``cohort'' of patients _ many of whom are now dead _ is

about 40. Johnson is 32.

Approximately 50 percent of those men lived 10 years before they developed

an infection or cancer that met the official definition of AIDS. About 40

percent lived 11{ years before the onset of AIDS, said Nancy Hessol, an

epidemiologist at the health department.

There is less clear data on how long an otherwise healthy man can expect to

live before developing symptoms such as weight loss, tiredness, night sweats,

and diarrhea that typically mark the progression of HIV infection but not the

onset of clinical AIDS. In the group of San Francisco men who contracted the

disease before 1981, 22 percent were still without symptoms at the end of 1989,

Hessol said.

(Some of the men in the study had blood specimens drawn and stored in the

late 1970s as part of hepatitis research studies. Consequently their HIV status

is known from a time before the AIDS virus was first described.)

Pneumocystis carinii pneumonia (PCP), a parasitic lung infection, is the

first ``AIDS-defining'' illness in about 48 percent of HIV-infected patients.

Other less common illnesses heralding AIDS include fungal infections of the

esophagus, dementia, Kaposi's sarcoma, and lymphoma, a cancer of the type of

blood cells known as lymphocytes.

The average survival after the onset of AIDS in the San Francisco cohort is

24 months, Hessol said.

HIV-infected persons are not immediately prescribed drugs. Current

recommendations are that patients get zidovudine (AZT) when there is laboratory

evidence of damage to the immune system-specifically when cells called CD4

lymphocytes (also called T-4 cells) number fewer than 500 per cubic millimeter

of blood. This is usually before symptoms of AIDS begin. Not long ago, however,

it was common not to begin AZT therapy until the disease was more advanced. The

10-year figure for the hiatus before these symptoms begin is based on patients

treated under the older, less aggressive regimen. Survival time nowadays may be

longer.

AZT often causes anemia, or other side effects, severe enough that it has to

be stopped. A second drug, didanosine (DDI), was recently approved as a

substitute for patients who cannot tolerate AZT, or whose infection is

resistant to the older drug.

When the CD4 cell count drops below 200, most patients receive monthly

treatments with pentamadine, a drug that helps prevent pneumocystis pneumonia

when inhaled as an aerosol.

Most infectious disease specialists give newly diagnosed HIV patients

vaccinations against pneumococcal pneumonia-a common bacterial lung

infection-and often against hepatitis B virus as well.

Most patients also get a skin test to see if they have been exposed to

tuberculosis, a bacterium that can lie dormant for decades but then suddenly

cause disease when a person's immune system weakens. Those testing positive for

TB exposure are generally given a year's treatment with the pill isoniazid even

if they have no evidence of active tuberculosis. Similarly, persons with

evidence of exposure to the syphilis bacterium on blood testing are also

treated, the experts said.

LAT-WP 11-08 1957EST<