Strain on AIDS facilities expected

Proposal to expand testing likely to result in flood of new patients

November 30, 2006|By Jonathan Bor | Jonathan Bor,sun reporter

The federal government's proposal to routinely test Americans for HIV could produce 56,000 new patients next year, straining the nation's ability to provide treatment, according to AIDS experts who gathered in Washington yesterday.

Though they lauded the value of drawing previously unidentified HIV patients into care, the experts warned that the government will have to spend an additional $1 billion to prevent long waiting lists as patients try to seek treatment early, when it is most effective.

Much of the added federal expense - estimated at $20,000 a year per patient - would involve free or subsidized treatment and counseling for those who lack insurance.

"Most of them are unemployed, and the number of slots in existing clinics for HIV infection may be limited to the point where we can't handle the large number of new cases," said Dr. John Bartlett, a professor of infectious disease at the Johns Hopkins University School of Medicine.

The Bush administration has projected no change in funding for AIDS services.

Nearly 300 doctors, government officials and community activists gathered in Washington yesterday for a two-day meeting to assess the impact of the testing recommendations released in September by the Centers for Disease Control and Prevention.

The conference, sponsored by the CDC and a group of medical organizations, was timed to roughly coincide with World AIDS Day, which will be observed tomorrow.

The CDC recommended that everyone age 13 to 64 be tested for HIV. That reversed previous guidelines that directed most tests to people considered to be at high risk for HIV, the virus that causes acquired immune deficiency syndrome.

Under the CDC proposal, tests would be offered by primary care doctors and in emergency rooms, community health centers, substance-abuse programs, prisons and other common medical settings.

Officials said they want to reach the estimated 250,000 people in the United States who carry the AIDS virus unknowingly because they have never been tested. They account for about a quarter of Americans who are infected.

"The idea of making testing a routine part of medical care is clearly the thing to do, so long as we make sure to accompany that with care, treatment and counseling," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said yesterday.

Fauci and others lamented figures showing that the annual number of new infections - which dropped precipitously from the mid-1980s to the mid-1990s - has leveled off at about 40,000 a year.

The key to reducing that number is getting more people treated with antiviral drugs, Fauci said. That's because today's medications reduce the amount of virus circulating in the bloodstream and, therefore, the risk of transmission.

The estimate of 56,000 new patients seeking treatment came from Dr. David Holtgrave, a professor at the Johns Hopkins Bloomberg School of Public Health who directed the CDC's prevention efforts from 1997 to 2001.

An influx of patients would add to the strain on a system that treats only half of the people who know they are infected, Holtgrave said.

Some don't get treatment because clinics are underfunded, he said, and others because they fear the social stigma of being identified as AIDS patients.

Dr. William Blattner, who heads a Baltimore commission on HIV/AIDS, said he is concerned that the city would be unable to treat a new wave of patients without an increase in funding from the federal Ryan White program.

Blattner is chief of epidemiology at the University of Maryland's Institute of Human Virology.

The Ryan White CARE Act provides about $2 billion nationally, including $20 million to Baltimore. It is the chief mechanism by which clinics and municipalities provide care for HIV/AIDS patients who lack insurance but don't qualify for Medicaid.

With the Bush administration proposing to hold funding constant in the coming year, Baltimore officials are concerned that the city's share will decrease under a new funding formula.

In accordance with the CDC recommendations, doctors at the University of Maryland Medical Center's diabetes, hypertension and other clinics are beginning to offer HIV testing to their patients, Blattner said.

As patients are diagnosed with HIV infection, many will be seeking services at the medical center's Evelyn Jordan Center, which provides outpatient treatment for HIV/AIDS.

"Without additional funds to hire staff to address that, it will definitely challenge the capacity of this center and all others in the city," Blattner said.

jonathan.bor@baltsun.com

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