Five years from now, AIDS could be one of America's top 10 killers, according to a gloomy report yesterday by the federal Public Health Service that called for a national commission to help deal with the growing dimensions of the disease.

The new government report projected that, during 1991 alone, deaths from acquired immune deficiency syndrome could total 54,000, putting it ahead of current annual deaths from pneumonia and influenza, car accidents, diabetes, suicide, chronic liver disease or hardening of the arteries.

As of June 9, the cumulative total of AIDS cases in the United States was 21,517, including 11,713 deaths since the disease was first recognized in June 1981.

The estimated number of Americans sick with AIDS and seeking treatment five years from now could be 145,000 annually, with medical costs between $8 billion and $16 billion in 1991, the government said. This would be about 2.5 percent of total personal health care expenditures in this country.

The report acknowledged that AIDS case and death projections may be underestimated by at least 20 percent because of underreporting, and cost figures may be conservative by 10 percent to 50 percent because of the medical burden of other illnesses associated with the AIDS virus infection as well as nonmedical management costs.

These are "very staggering numbers for 1991," said Dr. Donald Ian MacDonald, acting assistant secretary for health in the Department of Health and Human Services. "This is a major problem, probably bigger than the Public Health Service," he told a news conference yesterday.

"Clearly, a national, coordinated response is necessary," MacDonald said. He urged establishment of a national commission representing public, private and voluntary sectors, as well as government at all levels, "to make recommendations on how all sectors of our society can handle this major crisis."

In the meantime, he released a new Public Health Service plan for the prevention and control of AIDS that was drafted during a three-day session last week in West Virginia by 85 experts from inside and outside the government.

The federal Centers for Disease Control (CDC), based on experience to date, projected that more than 270,000 cumulative cases of AIDS will have been diagnosed by the end of 1991, including 74,000 that year alone. In comparison, about 16,000 new cases are expected in 1986.

The cumulative number of AIDS deaths at the end of 1991 may grow to 179,000, including 54,000 that year alone, the government said. About 9,000 AIDS deaths are expected this year. Currently, there are about 2 million deaths in the U.S. annually, including 750,000 deaths from heart disease, 400,000 from cancer, 158,000 from stroke, 95,000 from accidents of all kinds and 60,000 from chronic obstructive lung disease, according to Dr. Joel Kleinman of the National Center for Health Statistics.

"If the projections are true, AIDS could become one of the 10 leading causes of death," Kleinman said in an interview.

More than 70 percent of cases will continue to be diagnosed among homosexual or bisexual men and 25 percent among intravenous drug abusers. A rise in heterosexual transmission is projected, up from 7 percent of the total for 1986 to more than 9 percent by 1991.

By 1991, a cumulative total of more than 3,000 cases is predicted in infants and children exposed to the virus during pregnancy or shortly after birth, compared to about 300 to date, the CDC said.

The report estimated that 20 percent to 30 percent of the estimated 1 million to 1.5 million Americans who are now thought to be infected with the AIDS virus but who are not ill will go on to develop AIDS by the end of 1991. The health officials declined to estimate how many Americans might be infected in years to come, but sources said that if current patterns persist, the numbers could well double two years from now and perhaps reach 5 million by 1991.

The report said no drug to treat AIDS safely and effectively is now known and none is expected to be available for general use "for the next several years." Similarly, a vaccine to prevent infection is not expected for widespread use "before the next decade."

The report urged education and voluntary blood testing of those at high risk. It stressed that the virus is spread largely through "sexual contact or sharing of drug-injection equipment with an infected person. Studies now clearly demonstrate that AIDS is not spread by casual contact, such as sneezing, coughing or sharing meals.