As many as 40,000 Americans who are HIV-positive will start 1993 with a diagnosis of AIDS, the consequence of a new and more inclusive official definition that is likely to place a strain on already strapped social-service agencies and add to the emotional trauma of many who are infected.
The broader definition, drafted by the federal Centers for Disease Control and Prevention after a year of debate, is intended to give public health officials a truer picture of the scope of the disease by adding symptoms often found in women and intravenous drug users, who have been undercounted in the past.
"The current definition was falling out of step with the times," said Dr. John Ward, acting chief of the AIDS Surveillance Branch of the CDC. "This will help us more completely represent the HIV epidemic."
The CDC predicts that the new policy will increase the nation's roster of new acquired immune deficiency syndrome patients by about 80 percent in 1993, to 90,000 people newly diagnosed from an average of 50,000 in previous years.
In some cities, authorities are estimating that the AIDS population will more than double; San Francisco officials say their AIDS caseload will jump from 3,600 to 8,800.
The updated definition is a victory for AIDS activists, who have long argued that women and intravenous drug users -- many of whom are members of minority groups -- have been ignored by official government statistics.
But many say the expansion does not go far enough. At a news conference in Los Angeles Wednesday, representatives of the AIDS Healthcare Foundation and other local groups decried the new definition as inadequate and said it must be broadened further.
Under the current definition, in use for five years, a person infected with the human immunodeficiency virus is diagnosed with AIDS when he develops any one of 23 indicator
illnesses. Among the most common are cytomegalovirus, pneumocystis pneumonia and the skin cancer Kaposi's sarcoma.
The new standards add three diseases -- cervical cancer, pulmonary tuberculosis and recurrent pneumonia -- that studies
have shown are common in HIV-infected women and drug users.
But the government declined to include other ailments, such as recurrent yeast infections and pelvic inflammations, that are also common in these groups.
Including the three diseases is expected to push caseloads higher, but the real boost in numbers will come from the addition of a fourth indicator, a dip in the level of the immune cells that are the main target of HIV.
Under the expanded definition, an HIV-positive patient will be diagnosed with AIDS if those cells -- known as CD4 cells or T-cells -- have slipped to 200 per cubic milliliter of blood, about one-fifth the level of a healthy person.
Use of the T-cell count as a marker of AIDS means that thousands of patients will be diagnosed much earlier in the course of the disease and that some patients will be classified as having AIDS even though they do not exhibit any symptoms.
"This is a step in the right direction," said David Eng, spokesman for the Gay Men's Health Crisis, a New York-based advocacy group. "If you go by the official numbers, they haven't been counting women all this time."
As the AIDS count soars, there will be a host of ripple effects:
* More cities will be competing for the same dollars under the federal Ryan White Care Act, which distributes money according to the number of AIDS cases in each jurisdiction.
* Activists will use the bigger numbers to clamor for additional funding, arguing that the crisis is more acute than previously believed.
* Community agencies expect to be swamped with requests for help from those whose medical status changes.
* Legal advisers say that as more people are diagnosed with AIDS, more will face discrimination by their employers and health insurance providers.
* Counselors warn that the sudden switch in diagnostic standards might cause psychological trauma for patients. "This will overwhelmingly increase our workload, particularly in the emotional support area," said Eric Rofes, executive director of the San Francisco-based Shanti Project, which plans to cope with the crush by adding several hundred people to its 1,000-member corps of volunteer counselors.