San Francisco Chronicle (SF) - WEDNESDAY, December 21, 1994 Edition: FINAL Section: News Page: A2 Word Count: 663
David Perlman, Chronicle Science Editor

As a result, health officials are debating controversial proposals to offer the test routinely to all new hospital patients in the United States on a voluntary basis.

In theory, it could be the key to early detection of the disease for many people who might never know until too late that they are infected. And it might also protect health care workers by making them extra mindful of "needle sticks" and other infection routes if they know when a patient tests positive for HIV, the virus that causes AIDS.

But the problem is a sticky one: It poses serious ethical concerns about privacy and consent; it involves technical uncertainties about the test's reliability, and it poses monumental issues of costs for testing and counseling that could rise to the billions.

In the first effort to resolve those questions on a national scale, a team of San Francisco AIDS prevention specialists has just completed a study of the problem. Their conclusions:

-- Any program of voluntary HIV testing and counseling for hospital patients would make sense, both medically and economically, because the rate of HIV infection is at least 1 percent of all patients who are admitted.

-- But as for protecting health care workers, the specialists argue that there is "no justification" for routinely testing all patients, in any institution. At best, they calculate, such a program could avert fewer than four HIV infections a year among all the nation's hospital workers, although the program's total cost would reach $753 million for each case of infection that the testing effort prevented.

RISKS FOR HEALTH WORKERS

On-the-job HIV infections among health care workers are extremely rare, and the federal Centers for Disease Control in Atlanta has recorded only 42 cases since the epidemic began.

The analysts, headed by epidemiologist Dr. Peter Lurie, are members of the Center for AIDS Prevention Studies at the University of California in San Francisco, and they report their conclusions today in the Journal of the American Medical Association.

Some 40,000 to 60,000 HIV infections occur in the United States each year, and AIDS specialists know that there is a huge backlog of infected people who have never been tested. As a result, Lurie's team estimates, the first year of a nationwide hospital testing program could detect nearly 170,000 unrevealed infections among patients.

But the national program still would miss nearly half the people who carry the virus, the researchers said. And because testing is far from perfect, the effort would create an emotionally wrenching problem by yielding more than 30,000 "false positives" -- results that show a person is infected when the person is not. Basing their analysis on sophisticated statistical techniques, the prevention specialists maintain that the benefits of a widespread HIV testing program in hospitals would prove cost-effective in hospitals only where the virus is widely prevalent.

CALCULATING THE COSTS

If it is known to be infecting 1 percent of the patients in an institution, the cost of detecting each additional case of infection would be more than $16,000, the analysts calculated. But if the program were confined to hospitals where the prevalence rate has been 10 percent, then the cost of detecting an infected person would drop to $8,000, they said.

According to Lurie, the HIV prevalence rate reaches 1 percent or more in every hospital in every major city in America, and in some hospitals in cities such as New York, San Francisco and Los Angeles, the rate is as high as 10 percent.

Although the CDC has no record of HIV infection rates in hospitals, it does track HIV prevalence rates in specialized clinics that treat sexually transmitted diseases; rates there run as high as 11.5 percent in New York, 10 percent in San Francisco and 9 percent in Los Angeles. Copyright 1994 The San Francisco Chronicle

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