The Chicago Tribune; Sunday, January 13, 1985, Page: 15
Jon Van, Science writer

The test, which government officials say may be approved for use by blood banks within a month or two, detects antibodies to a virus, called HTLV-III, that is associated with acquired immune deficiency syndrome. Though the virus is linked to AIDS in some way, researchers don't yet know exactly how.

Among groups at high risk for AIDS, such as male homosexuals, antibodies to the virus are common even in people with no symptoms of disease. Thus, researchers stress that the antibody test isn't a test for AIDS.

Researchers agree that the test should be useful in locating blood of donors who carry the antibody and then purging it from the blood bank system to avoid whatever threat such blood may carry.

THOUGH SUCH testing may add more than $100 million a year to the cost of blood processing, the nation's blood bank operators will begin the testing as soon as it becomes available.

Their fear is that some people at high risk for AIDS who have refrained from donating blood to avoid spreading it through transfusions will begin donating again to learn if their blood passes or fails the antibody test.

Because the test will not detect some blood infected with the virus, any large influx of high-risk donors could make the blood supply less safe.

"There is a concern that we may make the blood supply less safe if we don't make the antibody test available in the community to people who are curious about their own blood," said Dan Connor, president of the Blood Center of Northern Illinois.

YET DON McLEARN, a spokesman for the federal Food and Drug Administration in Washington, said his agency is likely to approve the antibody test kits only for marketing to blood banks.

Five pharmaceutical groups are working to produce the tests, and spokesmen for some of the firms point out that once the FDA approves sale of a test kit for any reason, laboratory personnel are free to use the tests however they wish.

Dr. David Ostrow, on the faculty of Northwestern University and a consultant to the AIDS task force of the Chicago Public Health Department, said the test will have no value beyond screening blood products, and he opposes even informing a donor if his blood tests positive and is discarded.

At present, if a person's blood is rejected because of other infections, such as hepatitis, the donor or his doctor is informed. But in the case of hepatitis, Ostrow said, it is possible to tell if the donor is a carrier, is immune or has the disease. With the AIDS-virus antibody test, none of this is known.

THOUGH KEEPING test results secret from donors might solve the problem of attracting curious high-risk people to blood banks, it probably wouldn't be ethical or legally sound, those who operate blood banks say.

Connor said that if a person with no reason to fear AIDS infection was to have the antibody but was not told about it, he or others he infected might later sue the blood bank for failure to inform him.

The American Association of Blood Banks has already advised its members to inform any donors whose blood shows positive signs of the HTLV-III antibody.

Dr. Neil Schram, chairman of the Los Angeles AIDS task force, said a homosexual man has nothing to gain and much to lose by having his blood tested for the antibody. Because the test will fail to detect infection in at least some cases, "a negative test is meaningless for a gay male," Schram said.

AND POSITIVE results from such a test could become a surrogate test for homosexuality, Schram warned, and they could haunt a person once placed in his medical files.

"People think medical files are private," he said, "but you must waive that privacy when applying for insurance or, possibly, for a job."

While the antibody test information is useless to someone in a group known to be at high risk of AIDS, it could be useful to someone in a low-risk group, Schram said. Such people might alter their activities to avoid spreading the infection to sexual partners or choose not to have children because of the chance they would be infected, he said.

Though public health officials and gay advocacy groups advise male homosexuals to avoid the blood antibody test, Schram said, it would be foolish not to expect that some curious male homosexuals will seek to have the test.

THE TESTS should be available free or at low cost in community health clinics and at blood-donation centers for people who wish to have the test without donating blood, Schram said. People whose blood shows signs of the antibody in blood center testing should be listed on a donor-deferral list, he said.

Such lists now give the reason for deferral, such as hepatitis infection, but the reasons could be dropped, lumping all deferrals together to provide anonymity for AIDS-related cases.

Studies now show that the number of homosexual men donating blood in southern California has dropped to nearly zero, Schram said.

"If large numbers of high-risk donors flock to centers to donate blood in order to learn test results," Schram said, "it is very likely the safety of the blood supply will be decreased rather than increased by introduction of the test."

SINCE ABOUT five years ago, when physicians first started seeing cases in which a person's natural immunity to infection breaks down, there have been 7,788 documented cases of AIDS, resulting in 3,687 deaths. Most victims have been male homosexuals and users of intravenous drugs. Only 106 of these cases have been traced to infection from blood transfusions.

Gilbert Clark, executive director of the American Association of Blood Banks, estimated that it may cost as much as $10 for each blood donation when all the expenses of testing for the HTLV-III antibody are included. With 12 million donations a year, the cost would be $120 million.

In Illinois, Connor said his group plans to raise the price it charges a hospital for a pint of blood to $41, up from $38. This increase is based on little solid information on costs and could be followed by other increases as more is known.

Dr. S. Gerald Sandler, associate vice president of American Red Cross blood services, said the costs of counseling donors who have positive antibody tests may prove quite high, especially once those donors seek testing from their physicians.

SOME PHYSICIANS and researchers complain privately that the rush to provide a test to screen the blood supply is based more on political concerns than on sound science. When Margaret Heckler, secretary of health and human services, announced last year that the HTLV-III virus had been isolated, she promised such a test within six months.

More research on the test--for instance, using it only in selected areas before releasing it to the entire nation--might have made more sense scientifically, researchers say, but the political decision was to provide immediate action in the one area in which the general public is at risk of getting AIDS.

Even if the antibody test were totally effective at screening infection from the blood supply, there would be many more transfusion-related AIDS cases because the disease can incubate for years after original infection. THE HUGE COSTS associated with testing all donated blood for the antibody may be just a hint of the financial burden AIDS will impose upon the nation's health-care resources in the future.

In an editorial in the current edition of the Journal of the American Medical Association, Dr. Thomas Quinn of the National Institute of Allergy and Infectious Diseases estimated that there may be 40,000 new cases of AIDS in this country in the next two years.

It is also estimated that each AIDS patient requires about $50,000 in medical care.

CAPTION: Photo: Dr. David Ostrow, a consultant to the AIDS task force of the Chicago public health department, contends the AIDS-virus antibody test has no value beyond screening blood products.

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