AIDS Costs Will Nearly Double by 1994 : Medicine: HIV bills also soar as the use of expensive drugs widens, U.S. official tells conference in Italy.

The costs of treating all people infected with the AIDS virus in the United States will nearly double between 1991 and 1994--from $5.8 billion to $10.4 billion, according to the first such estimates prepared by the federal government.

As a federal official reported the estimates Wednesday, activists here at the Seventh International Conference on AIDS staged a noisy demonstration calling for the cancellation of next year’s international AIDS meeting scheduled for Boston.

The health care expenses of people with human immunodeficiency virus who have yet to develop AIDS have “increased substantially” as the use of expensive drugs such as AZT and aerosol pentamidine has widened and patients live longer, said Fred J. Hellinger, an economist with the U.S. Department of Health and Human Services.

Previous estimates have focused almost exclusively on patients with acquired immune deficiency syndrome and have substantially understated the true costs of the epidemic, according to the federal study.

Hellinger said “it is likely” that costs and survival will rise even further as more drugs become available to prevent AIDS-related infections, and if new antiviral drugs, such as DDI and DDC, are approved for prescription sales.

As Hellinger spoke at a plenary session, a dozen AIDS activists lay on the floor in front of the podium. Many held placards shaped like tombstones that criticized “U.S. AIDS imperialism.”

Later, activists from the organization ACT-UP disrupted a press conference called by Boston organizers of the 1992 international AIDS meeting.

The activists are seeking an unequivocal commitment that the meeting, sponsored by Harvard University, will be canceled if the U.S. government does not reverse its current restrictions on the entry of HIV-infected foreigners into the country. Otherwise, the activists vowed to boycott the meeting.

Officials of the meeting and leading AIDS experts are trying to persuade the Bush Administration to drop the controversial restrictions. But the meeting chairman, Max Essex, said that while the conference “may be canceled,” a final decision is unlikely before August.

In other developments at the meeting:

* William A. Haseltine of the Dana-Farber Cancer Institute in Boston will report today on new information about how HIV may be sexually transmitted.

Researchers in Haseltine’s laboratory have found that cells on the interior surfaces of the rectum, vagina and other organs can be directly infected with HIV. These cells, related to the body’s immune system, have unfamiliar names such as dendritic cells, Langerhans cells , and M cells.

Haseltine believes that the ability of HIV to infect these cells may “pose a serious problem” for the development of AIDS vaccines. Previous research has suggested that germs that enter the body through these so-called “mucus membrane” cells may be able to escape elimination by the immune system.

* San Francisco researchers reported that the proportion of men developing AIDS continues to rise with increasing duration of infection, reaching 62% at 12 years. They are continuing to study a group of 507 men who are known to have become HIV-infected between 1978 and 1980.

* Leon McKusick of UC San Francisco Medical School reported on the psychological distress, including severe depression, that the AIDS epidemic has inflicted on members of the city’s gay male community. Of an estimated 56,000 gay males in San Francisco at the time the epidemic began, MuKusick said that 12% have now died of AIDS and 6% are living with AIDS. In total, 35% to 40% of gay males in San Francisco are now estimated to be HIV-infected.

The new federal study of the cost of the AIDS epidemic indicates that total expenses for treating people with HIV will increase about 20% a year between 1991 and 1994. The analysis does not take into account general health care inflation, which has been running about 15% a year, so the actual increase may be significantly higher.

These statistics reflect a greater number of patients who are likely to develop AIDS over the next few years. They also reflect longer survival of patients and increased costs of drugs.

The 1991 cost estimate of $5.8 billion accounts for less than 1% of total U.S. health care expenditures, expected to amount to $671 billion, Hellinger said.

But such an overall comparison can be misleading. This is because the costs of AIDS care fall disproportionately on government health programs, which are often overburdened and short of funds.

The average expense of treating an AIDS patient is now $32,000 a year, according to Hellinger. This includes $24,000 for hospital care and $8,000 for other services, such as drugs and physician visits.

The average expense of treating an HIV-infected person without AIDS was calculated to be $5,150 a year.

After AIDS develops, Hellinger estimated the lifetime cost of medical care for one person at about $85,000. This is higher than previous estimates, which have ranged between $40,000 and $75,000.

Hellinger developed the estimates by using a variety of data from ongoing AIDS studies throughout the country. He said his analysis was performed using conservative assumptions and that the true costs of the HIV epidemic will probably be higher.

Projected Costs of Treating HIV Infection

All numbers in billions of 1990 dollars, numbers and percentages are rounded.

1991 1992 1993 1994 For all people with HIV $5.8 $7.2 $8.7 $10.4 For people with AIDS 4.4 5.4 6.6 7.9 For people with HIV but without AIDS 1.4 1.8 2.1 2.5

Source: Agency for Health Care Policy and Research, U.S. Dept. of Health and Human Services