San Francisco Chronicle; Thursday, June 4, 1998
David Perlman, Chronicle Science Editor

And it is women and minorities who are faring the worst -- a fact that may well contribute to their notably higher death rates, doctors warned yesterday.

Less than a year ago, the nation's leading AIDS physicians, working with the Department of Health and Human Services, published guidelines urgently recommending that all doctors prescribe a three-way combination of new and old drugs when they begin treating AIDS patients.

But those guidelines are not being followed everywhere, the survey disclosed. And doctors with the least experience in battling the epidemic are the most likely to wait too long to begin therapy, and then to use only one or two of the older drugs while ignoring the new triple combinations, according to the first national survey of AIDS treatment practices.

Results of the study were reported in Washington yesterday by Dr. Paul Volberding, director of the University of California at San Francisco's AIDS program at San Francisco General Hospital, and Dr. John G. Bartlett, chief of infectious diseases at Johns Hopkins University in Baltimore. The survey was conducted by Louis Harris & Associates, the nationwide polling firm.

Volberding and Bartlett are pioneers in assessing the effects of innovative AIDS therapies. They were members of the team that originally called for AIDS treatment to begin with a combination of one of the new compounds called protease inhibitors plus two of several older drugs like the familiar AZT. Both classes of compounds prevent HIV, the AIDS virus, from replicating after it has invaded crucial cells of the immune system.

Using only a single drug to attack the virus, Bartlett warned, makes patients more likely to develop dangerous AIDS-related symptoms and also exposes them to resistance against the effects of the medicines.

"It's clear that physicians who receive new information and education on an ongoing basis are more likely to adopt and apply the treatment guidelines," said Volberding in a statement. "Likewise, patients who are familiar with the health benefits of new treatments will more likely seek and receive the most aggressive care."

After the new protease inhibitor drugs became available in 1996 and their combination with older drugs became standard treatment in the hands of knowledgeable doctors, death rates from AIDS began to drop dramatically. Among white patients the death rate dropped by 33 percent in 1996, but among women with AIDS the decline was only 13 percent and among people of color AIDS deaths decreased by 19 percent.

To Volberding, the national survey's results provided "troubling information about the obstacles to treatment that women and minorities face." For example, he said, "many of the more experienced physicians are not always easily accessible to this growing segment of the population most affected by HIV."

The findings are "worse than we thought," said Dr. Scott Hitt, chairman of the President's Advisory Committee on AIDS. "We've got to do better at educating physicians and also educating patients about seeing specialists."

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