A Johns Hopkins Hospital specialist says that fears of AIDS patients and doctors afraid of contracting the disease have kept more than half of Maryland AIDS patients from receiving the anti-viral drug AZT that could prolong their lives.
Dr. Richard E. Chaisson, director of the hospital's AIDS patient care, said yesterday that AIDS patients fear anemia and other much-publicized debilitating side effects and doctors who fear they will contract AIDS refuse to treat these patients "they do not feel comfortable with."
"Unfortunately, since the licensing of AZT in 1987, more than half of the Maryland AIDS patients have never received the drug and may not have received other AIDS health care as well," said Chaisson.
"This lack of access results in higher death rates," particularly for women, blacks and intravenous drug users, said Chaisson.
At a news conference yesterday, Chaisson and Dr. Richard D. Moore, the principal investigator, outlined the results of a joint Hopkins and state AIDS Administration study that appears in today's New England Journal of Medicine.
The study found that AIDS patients treated with AZT, also known as zidovudine, lived more than two years after their diagnosis.
While the study did not examine the disparity in AZT use, Chaisson said the results suggest that "major barriers exist to state-of-the-art medical care for AIDS."
Another barrier, he said, is that doctors also deny care to AIDS patients, most of whom are on Medicaid, simply because of the inadequate reimbursement they receive from Medicaid for the patient's office visit.
"Doctors who treat AIDS patients in their office only get a 30 cent reimbursement for every $1 worth of care," said Dr. Julia Hidalgo, chief of the Division of AIDS Services, Planning and Development of the Maryland AIDS Administration.
According to Chaisson, doctors will come into the Hopkins AIDS clinic and volunteer their services, but will refuse to treat AIDS patients in their offices because they cannot afford the economic losses.
The study is the first to assess health care for an entire state's AIDS patient population. The investigators used the Maryland Human Immunodeficiency Virus Information System (HIVIS), a data base that includes statewide pharmacy records, clinical trials information, health-care insurance claims, AIDS Registry, death certifiates and health care records.
The investigators studied the survival time of 1,028 AIDS patients. Of the 314 AIDS patients diagnosed between January 1983 and March 1985, 15 percent of the patients survived two years.
For all of the 714 patients diagnosed from April 1987, when AZT became available, to June 1989, 35 percent were still alive two years later, the study showed. When the 714 patients were compared by therapy, 55 percent of those on AZT survived two years later, while 25 percent of those who never had the therapy lived for that time period.
Of the patients with the deadly acquired immune deficiency syndrome who were diagnosed after AZT was approved, a two-year survival was more frequent among homosexual men, people younger than 45, non-Hispanic whites and those who had Kaposi's sarcoma or Pneumocystis carnii pneumonia when first diagnosed with AIDS.