AIDS Group in L.A. Joins Call for HIV Testing

Southern California’s largest local AIDS services organization said Friday that it will recommend voluntary anonymous testing for the AIDS virus based on scientific evidence that the drug AZT delays progress of the disease in people who are infected with the human immunodeficiency virus who have not developed symptoms.

The decision by AIDS Project Los Angeles came after a similar announcement earlier this week by the Gay Mens Health Crisis in New York, and it represents a major shift in perceptions of the epidemic.

At the same time, the Health Insurance Assn. of America in Washington said the new findings make it more likely that insurers will reimburse policyholders for prescriptions of the expensive drug in cases of early infection. Until now, some insurers had limited their coverage to patients with either full-blown acquired immune deficiency syndrome or severe AIDS-related complex.

Smaller Dose Possible

Although medical economists and others have been worried about the high costs of a large-scale AZT treatment program, a key element of the new findings shows that less than half the current recommended dosage for full-blown AIDS may be effective, potentially saving a patient thousands of dollars a year in treatment costs.

Until recently, some gay men have resisted taking the test because of fears of discrimination and the belief--mistaken, it now appears--that there was little they could do if they learned they were infected. The San Francisco AIDS Foundation endorsed testing earlier this year.

With HIV infection viewed increasingly as a chronic but manageable illness, there will probably be a surge in demand for new AIDS testing nationwide and added pressure on policy makers to create financing mechanisms to cover treatments with AZT and other anti-AIDS drugs for uninsured Americans or those without prescription benefits.

“Whoever is going to deliver these services--testing, counseling, monitoring and treatment--has got some fast (work) to do,” said Peter Arno, a medical economist at Montefiore Medical Center in New York. “Right now, we are not in a position to deliver any of this stuff.”

Arno has estimated that a national early-intervention program could cost from $2.5 billion to $10 billion a year, depending on how many infected individuals come forward and the level of care that they need.

“The U.S. now has to face foursquare the issue of health care for people who have HIV and other long-term, catastrophic illnesses,” added Tom Sheridan, director of public policy of the AIDS Action Council in Washington. “Everybody has known this study was in progress and had been anticipating these results, yet the level of planning has been negligible.”

In Orange County, Dr. Thomas J. Prendergast, manager of the county Health Care Agency’s program of AIDS testing, treatment and surveillance, said that he had expected that the reports on AZT would increase the number of people seeking prescriptions for it.

“But at the moment there’s no change in what will be done in Orange County because the system is already in place,” Prendergast said. “We will proceed.”

Steve Peskind, executive director of Laguna Shanti in Laguna Beach, which offers volunteer services to people with AIDS, said that reports of the effectiveness of AZT would “stimulate many people to consider getting tested who have thus far been resistant to that.”

But, he said, there is some fear among homosexuals that there might be a legislative move to make test results public.

“People who are considering getting tested are worried about the threat of a change in the political climate as they consider taking a big step--getting tested and getting medication,” Peskind said.

Stephen Bennett, executive director of APLA, said the call for voluntary testing will be coupled with “a very strong push for counseling, education and making early intervention available to those who test positive.” He said APLA’s board will likely enact the new policy at its regular meeting Tuesday evening.

Los Angeles County health officials have estimated that there are 70,000 to 100,000 HIV-infected individuals in the county, about half of whom would benefit from AZT. Bennett said AIDS Project Los Angeles wants these people to take an AIDS test and get treated “before they show up at our doorstep (with full-blown AIDS) needing our services.”

Public health officials recommend testing for homosexual men, intravenous drug users, people who have received blood transfusions before widespread screening for the virus and also for the sexual partners of these people.

The trend toward broader testing will likely gain ground if, as expected, Congress enacts a Bush Administration-supported bill barring discrimination against disabled people, including those with HIV.

Arno said the push should be for better access to health care rather than testing.

“What is the use of telling people to get tested if they don’t have a doctor?” Arno added. “Poor people need what we don’t give them in our society: decent primary health care.”

National Institutes of Health AIDS researcher Dr. Daniel Hoth said Thursday’s announcement, along with a similar finding two weeks ago that AZT is useful in people with early AIDS symptoms, “means that there has been a more than tenfold increase in the number of people who need treatment.”

Doctors estimate that up to 600,000 HIV-infected Americans have “helper T-cell” counts of below 500 and would thus benefit from treatment, compared to the roughly 40,000 people who are living with full-blown AIDS. Helper T-cells are white blood cells that act as key sentinels of the body’s immune system, and they are destroyed by the AIDS virus.

Hoth said half to two-thirds of the estimated 1 million to 1.5 million people infected with HIV have not yet had their conditions diagnosed.

As for the dosage of AZT required, the study revealed Thursday shows that a regimen of 500 milligrams per day of AZT is as effective in staving off AIDS as one of 1,500 milligrams. The standard dose for full-blown AIDS is 1,200 milligrams a day; treatment in that amount costs $8,000 to $10,000 a year.

“If you cut the costs, you are at least putting it in the ballpark for more people,” said Dr. Philip Lee, director of the Institute for Health Policy Studies at the UC San Francisco School of Medicine.

Lee said paying for AZT for asymptomatic people testing positive is both humane and cost-effective “because it will reduce the cost for hospitalization, at least in the short term.”

In announcing the findings of the AZT trial, which involved more than 3,200 volunteers, Health and Human Services Secretary Louis W. Sullivan said the federal Medicare program will reimburse for AZT used for early intervention. He also called for state Medicaid programs, which are paid for jointly by states and the federal government, to do the same.”

“His intent was to use that as moral suasion to have other payers pick up their share,” said James Allen, director of the the department’s national AIDS program office.

Jude Payne, a senior policy analyst at the Health Insurance Assn. of America, said, “All indications are that insurers will chose to pay since this was a scientifically sound, carefully controlled clinical trial.” Insurers, on the other hand, are likely to balk at paying for experimental treatments in the absence of proof of their efficacy.

There has been speculation that Burroughs-Wellcome, the manufacturer of AZT (its stock price jumped 30% Friday in London), may take advantage of economies of scale to cut the drug’s price. But David Barry, the firm’s vice president for research, said Thursday that the company has no present plans to cut its price.

Burroughs, which obtained an exclusive worldwide license to manufacture the drug from the U.S. government, has been sharply criticized by AIDS activists for the high price of the drug.

After the experience with Burroughs-Wellcome, the federal government changed its licensing policy. For example, Bristol-Myers, which obtained the license for another promising antiviral drug, DDI, is required to charge a “reasonable” price.

DDI is scheduled to enter widespread efficacy trials next month, at which time it will also be distributed to AIDS patients in critical need under a new program that provides wide access to experimental drugs.