San Francisco Chronicle - Thursday, August 13, 1992

If the confidential system were already operating in hospitals, the researchers said, at least 110,000 unwitting AIDS victims could be detected, counseled and given a chance to begin early therapy that could delay, if not prevent, the onset of the disease.

And with counseling, the study's authors said, the risk that those patients would inadvertently spread the infection to thousands of others could be sharply reduced.

The study, conducted by a research team headed by Dr. Robert S. Janssen at the federal Centers for Disease Control in Atlanta, is being published today in the New England Journal of Medicine.

Experts familiar with the concept, however, warned that formidable obstacles, such as the huge costs involved and the increased need for trained personnel, would make the proposal difficult to implement.

After examining nearly 200,000 anonymous HIV-positive blood samples, taken between 1989 and 1991 from patients in 20 acute-care hospitals around the country, the CDC researchers found that about two-thirds of all the patients had been admitted for illnesses or accidents wholly unrelated to AIDS or infections with HIV, the AIDS virus. Most of them, therefore, presumably did not know they were infected.

LIMITED PROGRAM

Although there are more than 5,500 acute-care hospitals in the nation, Janssen's team considered the impact of launching "routine" voluntary HIV testing and counseling on a smaller scale. Their study focused on offering it only to patients between the sexually active ages of 15 and 54 who were admitted to the fewer than 600 hospitals located in communities where more than one new AIDS case per thousand patients are treated each year.

The result, said the researchers, would be to provide testing and counseling to about 3 million patients in those hospitals a year -- something they admitted would be an overwhelming job.

Although the findings by the CDC epidemiologists do not represent official federal policy, the agency's researchers urged hospitals to seriously consider implementing the concept.

And in a commentary published in the same medical journal, Dr. Thomas C. Quinn of the National Institute of Allergy and Infectious Diseases said the plan would make excellent sense, even though it would impose heavy new costs for laboratory tests, for trained counselors and for expanded treatment services. It would also require strong legal safeguards at the federal level to protect the confidentiality of test results, he said.

"With all the improvements in survival and quality of life for HIV-infected persons, it is imperative that patients be given the opportunity to be routinely counseled and tested for HIV," Quinn maintained.

DEBATE ON MASS TESTING

Routine counseling and testing for HIV infection has long generated controversy in hospitals and local health departments, and some specialists have maintained that mass testing programs, even if voluntary, would do little to slow the epidemic. A few medical groups have even argued against keeping test results confidential.

California, however, has been a leader in providing confidential HIV testing, as well as skilled professional counseling, to everyone who seeks it. But the state's larger hospitals in the Bay Area and other urban centers are already overburdened with the problem of caring for existing AIDS patients.

Dr. Merle A. Sande, the chief of medical services at San Francisco General Hospital, who has headed the state's AIDS task force, said he is "100 percent in favor" of the CDC proposal.

"It's time for the medical profession and all these hospitals to start offering testing and sound, professional counseling to every patient," he said, adding: "It's in their best interest, now that we can do something to help them remain symptom-free with anti-viral therapy.

"I think counseling and testing should be offered to everyone, in clinics and everywhere else," he said.

ENORMITY OF TASK

Dr. Constance Wofsy, a specialist in infectious diseases who sees AIDS patients crowding San Francisco General Hospital, had reservations.

"Intuitively, it's logical," she said, "but practically, I would have grave concerns about the ability of so many acute-care hospitals to provide top-notch counseling. It makes sense to offer counseling and testing and to follow that up with adequate medical services, but I'd be very reluctant to institute new programs in hospitals that even now can't possibly cope with the burdens of care they already face."

Always watch for outdated information. This article first appeared in 1992. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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