San Francisco Chronicle - Saturday August 19, 1989
Steve Massey, Elaine Herscher, Chronicle Staff Writers

A significant portion of the estimated 1 million to 1.5 million Americans who are infected with the AIDS virus could benefit from taking the medication, according to the study released Thursday.

The study showed that the drug slowed the onset of the disease in people infected by the virus who have no AIDS symptoms but whose count of T4 cells in the blood has fallen below 500 per cubic millimeter.

For public health officials, the findings are a source of hope and concern. Although hundreds of thousands of Americans who carry the virus could become eligible to take AZT, paying for it will require a huge increase in financing from a government that has been reluctant to pay for early AIDS treatment.

"When you do the multiplication, the amount of money that will be needed is pretty staggering," said Dr. Thomas Peters, associate director of the San Francisco Department of Health.

"On the other hand, I don't know why we should have any more hesitancy to acknowledge that this is an issue we must take care of just like Congress and the administration acknowledged the problem and committed the funds for the savings and loan bailout," he said.

Currently, AZT is licensed for use by the Food and Drug Administration in 50,000 cases of AIDS patients showing symptoms in the United States. The drug treatment costs about $8,000 a year per patient, putting the total annual bill for its use at $400 million.

INSURANCE PROGRAMS

That bill has been paid by private medical insurance and the federal government, through Medicaid (Medi-Cal in California) and a $30 million annual supplement for AZT users not covered by private or public health insurance.

Now the number of people taking the drug could grow greatly, depending on how many people test positive for the AIDS virus. Experts estimate that as many as 650,000 people who carry the virus but have no symptoms might benefit from taking the drug.

Demand for the medication will put the annual price tag for AZT treatment in the billions, even though the cost per patient is expected to decrease by half. The study found that 500 milligrams of the drug taken daily is sufficient to combat the early stages of the disease, compared with the current standard dosage of 1,200 milligrams.

Because of the potential demand, the stock of AZT's manufacturer, the British company Wellcome Plc, soared on the London Stock Exchange yesterday. Shares in the firm rose by more than one-third, to 6.95 pounds ($10.84), before backing off by the closing bell to end at 6.71 pounds ($10.50).

SALES TO SOAR

One analyst said worldwide sales of AZT would soar to $880 million by 1992. Another said sales would reach $1 billion, from $230 million this year. Worldwide, the World Health Organization estimates the number of HIV-infected people to be 5 million to 10 million.

Despite the potentially huge costs associated with widespread use of the drug, Dr. Paul A. Volberding, the University of California-San Francisco researcher and San Francisco General Hospital AIDS division director who coordinated the ground-breaking AZT study, is hopeful that Congress and the Bush administration will come up with new funds.

He noted that at the Thursday press conference announcing the results of the study, Secretary of Health and Human Services Louis Sullivan called for widely expanded use of the medication and of HIV testing to catch the disease in the early stages.

Also encouraging, Volberding said, was Sullivan's suggestion that the Medicaid program could be expanded to include payments for the drug for people who test positive for the AIDS virus, as opposed to the current practice of providing payments for AZT only to patients in the disabling stages of the disease.

Federal subsidies to pay for the drug for uninsured users also will have to be expanded substantially, said Steve Morin, legislative assistant on health policies to Representative Nancy Pelosi, D-San Francisco.

CONGRESSIONAL ACTION

That should be easier to do given the study's findings, even though Congress has not been forthcoming on some key AIDS proposals so far, Morin said. Earlier this year, it authorized but did not finance the creation of early intervention programs sponsored by Pelosi.

Whatever the outcome of the financing debate, Volberding said it is imperative that anyone who suspects they may have come in contact with the AIDS virus be tested immediately. "The time to bury your head in the sand is over," he said.

At San Francisco General, doctors and nurses are changing their treatment of AIDS and HIV-infected patients as a result of the study, said J. B. Molaghan, head nurse of the hospital's AIDS clinic.

A third of his 40 HIV-infected patients will now receive AZT, Molaghan said. He added that, despite the widely publicized report, the clinic yesterday received only a half dozen inquiries about taking the HIV test.

The reaction was stronger in other parts of the city.

District Health Center No. 1 in the Castro district was inundated by callers asking how they take the AIDS antibody test, said Dr. Ken Dunnigan, the center's health officer. "The person answering the phone has been swamped," he said.

Dunnigan cautioned, however, that asymptomatic people who test positive for antibodies to the virus will not be helped by AZT if they can't afford to buy it. "The only point of doing screening is if there's something one can do with the result. There now has to be pressure brought to bear primarily on insurance companies and Medi-Cal" to pay for the drug, he said.

Terry Beswick, of the patient advocacy group, ACT-UP, said that because preliminary studies showed the usefulness of AZT, many San Franciscans who test positive but are healthy are already taking the drug, and some are having great difficulty paying for it.

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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