Plague of The Innocents

By Christine Gorman

Just a few years ago, no one believed that AIDS, which seemed to strike mainly male homosexuals and intravenous drug users, could also attack children. Since 1981, however, doctors have reported more than 750 such cases. Now the news is even grimmer. Health officials last week announced the results of a study that showed an astonishing one out of every 61 infants born in New York City harbors antibodies to human immunodeficiency virus (HIV), the cause of AIDS. Says State Health Commissioner David Axelrod: "What is alarming is that this is a higher level of infection than we had considered to be likely within the overall community."

Last November, Axelrod ordered medical technicians throughout the state to begin collecting samples of blood from every newborn baby for one month. Of 19,157 infants delivered, 164 proved antibody-positive, meaning that their mothers almost certainly were infected. About 90% of the affected children were born in New York City. Previous surveys have indicated that many such mothers are poor, black or Hispanic women from neighborhoods where intravenous drug abuse is rampant, confirming a demographic pattern established by a similar study in Massachusetts published last year. Not all of these newborns, however, are doomed. Doctors estimate that more than half received only antibodies -- not the virus itself -- from their mothers during gestation. These lucky ones will not develop AIDS. The others, however, will eventually sicken, most before the age of two.

In an attempt to combat further spread of AIDS, Axelrod has written to New York State's 50,000 physicians, including obstetricians and gynecologists, recommending that they routinely counsel all women of childbearing age about the risk of AIDS. The letter urges that all women in the early stages of pregnancy, or even considering pregnancy, be tested. Radio and television campaigns, brochures and posters are also in the works. "The studies are telling us the extent to which AIDS has spread within the community, particularly the intravenous drug-abusing community," Axelrod argues. "We have to look at every preventive action we can, including the distribution of condoms."

The New York report comes at a time when researchers are trying to broaden the definition of the deadly syndrome to include all of the damage that can be caused by HIV infection, not just terminal AIDS. A textbook case of AIDS, involving Kaposi's sarcoma or Pneumocystis carinii pneumonia, represents only the tip of the iceberg. Epidemiologists estimate that for every person with AIDS, there may be as many as ten more suffering from other illnesses caused by the virus. "The real disease starts when you become infected with HIV," says William Haseltine, chief of biochemical pharmacology at the Dana-Farber Cancer Institute in Boston. "AIDS is just the most severe manifestation of that disease, but there are many more, and they can kill you too."

As a result, doctors at the Walter Reed Army Institute of Research in Washington have divided the infection into six progressive stages based on the level of destruction inflicted by the virus on the immune system. In Stage 1, a person is infected but does not have chronically swollen lymph nodes; the immune system still seems normal. By Stage 6, however, the body's defenses have collapsed; normally harmless bacterial and viral infections become life threatening. According to Dr. Robert Redfield of Walter Reed, a person can have Kaposi's sarcoma at any stage. Whether or not the victim survives depends on the stage of the infection.

Unfortunately, at least 90% of individuals suffer damage to their immune systems in the first three to five years of HIV infection, although AIDS may not show up for as long as a decade. "This forces us to change our focus from certain high-risk groups and AIDS to the grim reality that the full extent of the virus infection today will not be recognized until the end of the century," Redfield concludes. "The AIDS epidemic of the late 1990s has already happened." Even more sobering, health officials know exactly where it will strike: the drug-infested Roxburys, Bedford-Stuyvesants and South Bronxes of the nation's inner cities.

With reporting by Jeanne McDowell/New York