The AIDS virus is so prevalent among Maryland's prison inmates that it would be exceptionally difficult and costly to find out if any caught the virus while an ailing dentist worked on their teeth, medical authorities said yesterday.
Studies have shown that many inmates have injected drugs or engaged in unprotected sex -- behaviors that put them at a higher risk for contracting the AIDS virus than did their treatment by a dentist who had the disease.
Yesterday, Sgt. Gregory M. Shipley, a spokesman for the Division of Correction, said prison officials hoped to issue letters today to past and current inmates who were treated by Dr. Victor Luckritz, who died of acquired immune deficiency syndrome May 7. The letters will offer counseling and testing.
Dr. Luckritz was the chief dentist at the Maryland Penitentiary between June 1988 and April 1990 -- a time when he also treated prisoners throughout the state prison system. Prison authorities said they did not know Dr. Luckritz had AIDS until they read his death notice, adding that the news sparked concern because of reports he did not always wear protective gloves.
But officials associated with the prison investigation said yesterday they had no idea if they would ever be able to answer the question that lies at the heart of the Luckritz case: Did the dentist infect any of his patients?
"It's a pretty laborious job, and it has not been looked into," said Dr. Lawrence Levy, national medical director for Correctional Medical Systems, the private company that provides medical and dental care throughout the prison system and that hired Dr. Luckritz.
Studies of inmate health and lifestyles conducted by the Johns Hopkins School of Hygiene and Public Health offer clues to how difficult the task could be:
* A 1988 study of prison inmates entering the Maryland Penitentiary found that 8.1 percent were infected with the human immunodeficiency virus, which causes AIDS. This rate is about 50 times the rate believed to exist in the general population.
* Studies in selected prisons across the nation found that about one-third had histories of intravenous drug abuse between 1985 and 1988. "Maryland is consistent with the national trend," said Dr. David Vlahov, a Hopkins epidemiologist who has been involved in the prison studies.
The figures suggest that, potentially, hundreds of Dr. Luckritz's patients could test positive for HIV. Health investigators would have to take histories to sort out inmates who had put themselves at risk through drug use or unprotected sex from those who had no known risk factors.
A sophisticated test known as DNA (deoxyribonucleic acid) sequencing could determine with a high degree of accuracy if an inmate who had no other known risk factors was indeed infected by the dentist. That test compares one person's virus to another's to see if they are genetically similar.
The cost to test each inmate could run well over $1,000, according to scientists in New Jersey and Maryland.
The DNA test also requires a preserved sample of Dr. Luckritz's blood. Dr. Levy said he did not know if such a sample exists.
In Florida, state health authorities and the federal Centers for Disease Control spent "several hundred thousand dollars" investigating whether a dentist infected any of an estimated 2,000 patients. In that case, health authorities concluded that three people had viruses that closely matched the virus that killed Dr. David Acer -- and they concluded the dentist must have infected the three.
But in that case, authorities were dealing with a relatively low-risk population. They found fewer than 10 patients who tested positive for HIV, according to Dr. Paul Arons, medical director for the state AIDS program in Florida. For that reason, they performed the costly DNA test on only a handful of patients.
Testing Maryland's prison inmates would be a different matter.
"It would be extraordinarily difficult," Dr. Vlahov said. "At thipoint, how do you go back and piece that whole puzzle together?"
A spokesman for Gov. William Donald Schaefer said yesterday that the governor would ask the attorney general's office and the state health department to look into the possibility of testing all medical personnel under state contracts for the AIDS virus.
"Whether it goes past the talking stage, it's too early to say," said Ray Feldmann, the spokesman.
Meanwhile, the Division of Correction moved to prevent any inmates from talking about the Luckritz case.
"We cannot and will not set up inmate interviews, for the express purpose of maintaining the security of our institutions at this point," said Sergeant Shipley, the corrections spokesman.
"The inmates have taken [the news] very well -- and we desperately want to keep it that way," he said. He said that no additional security measures have been put in place.