United Press International - Tuesday, 14 August 2001
Ed Susman, UPI Science News

Failure to treat patients in a timely manner, government researchers said at the National HIV Prevention Conference, results in patients not getting treatment until they begin to suffer symptoms of the disease, and it also may mean the patient unknowingly is spreading AIDS through contact with others.

"It takes about 10 years for signs of disease to occur," said Dr. Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention.

Human immunodeficiency virus causes acquired immune deficiency syndrome. In a study presented at the conference, Leo Hurley, a researcher at Kaiser Permanente, Oakland, Calif., reported 40 percent of patients diagnosed with AIDS were first tested within a year of coming down with illnesses that characterize long-standing infection with HIV.

About one in five patients -- 18 percent -- were tested and had an AIDS-defining illness almost simultaneously, within one month, Hurley said. About 30 percent were tested within three months of developing disease symptoms and 34 percent were tested less than six months from the time of receiving an AIDS diagnosis.

"About half the patients sought an AIDS test because they were feeling ill," Hurley said. He noted when diagnosed, about half of the patients already had shown evidence of a compromised immune system, marked by depletion of CD4-positive cells. Lack of these cells means the body cannot fight off opportunistic infections, the hallmarks of AIDS. Eighty percent who were diagnosed with AIDS fell into high-risk categories: they were men who had sex with men or were injecting drug users or both.

Valdiserri said patients with many diseases, including heart disease and cancer, often are diagnosed late in the course of their illness, which makes them more difficult to treat. But patients with heart disease, cancer, diabetes and other chronic illnesses are not infectious, Valdiserri said, whereas people with HIV can pass the virus along to partners during sex or when sharing needles for illicit drug use.

"It is precisely because we are dealing with a deadly transmissible virus that early detection is needed," Valdiserri said.

"The potential benefits of early detection and treatment are clear," Hurley said. "Further transmission can be prevented, immune function can be preserved and disease-free survival can be prolonged."

Valdiserri said barriers to testing on the physician's side include taking the time to counsel a patient regarding testing, bringing up a potentially embarrassing subject -- sexual activity or drug use -- with patients and the lack of reimbursement for the time spent counseling.

He said patients may object to testing because of the stigma associated with AIDS and because of fear of the test result.

Hurley, in his study, reviewed the medical records of 434 patients diagnosed with AIDS in 1998. He tracked their treatments and tests for five years. He said Kaiser Permanente is attempting to use the results of the study to enable timelier testing of patients.

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